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The Meaning of Alignment

Edward Prewitt, for HealthLeaders Media, April 27, 2012

This article appears in the April 2012 issue of HealthLeaders magazine.

Hospital-physician alignment is a sought-after state of being. It ranks as the fifth-highest priority for healthcare leaders responding to our annual Industry Survey, and 12% of executives say it is their single highest priority. But what does alignment actually mean? The answer may depend on where you stand within your organization's structure.

For healthcare CEOs and CFOs, alignment can refer to doctors who keep readmissions low and don't order too many tests. For physician leaders, alignment can mean hospital executives who stay out of the way and let physicians practice medicine as they know how—never mind initiatives for quality, efficiency, and the like. Meanwhile, patients are unlikely to talk about alignment, but they hope that everyone is pulling together for their benefit.

In the larger picture, alignment really means that everyone is working to navigate the changing structure of today's healthcare business. This issue's cover story shows how economic incentives now encourage—even demand—alignment between hospitals and physicians. The upshot of closer collaboration can be better care for patients.

Yet it would be Pollyannaish to predict that everyone will get along, get rich, and get better at delivering healthcare. Big hurdles exist to the solutions cited in our article. Not all physicians will want to become employed by hospitals. Not all healthcare executives will want to cede control to physician leaders. Not all hospitals can afford and manage the information systems required for coordinated care.

Most physicians still feel the need to practice unnecessary and expensive defensive medicine, as discussed in this issue's Council Connection section. In our monthly Intelligence Report, which draws on a survey of HealthLeaders Media Council members, less than half of executives tell us that they are ready to align with other organizations and commit to an accountable care structure.

Recently I had the pleasure of moderating a Roundtable discussion of healthcare leaders regarding the strategic importance of operations. Operational excellence and efficiency affects the patient experience, clinical quality and safety, and organizations' bottom lines.

In a wide-ranging, three-hour conversation, our panelists detailed the necessary conditions and the barriers to operational excellence (see the edited transcript in this issue). Although information technology is a great enabler of hospital operations, in the end our speakers agreed that IT is only a tool for healthcare leaders. The driver of excellence is healthcare leaders' ability to work together. In a word, alignment.


This article appears in the April 2012 issue of HealthLeaders magazine.


Edward Prewitt is the Editorial Director of HealthLeaders Media.
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