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Utilizing Clinical Integration to Foster Successful Hospital Operations Improvement

Frank G. Flosman, MBA, Bonnie Barndt-Maglio, RN, PhD, and Patricia A. Hines, RN, PhD, for HealthLeaders Media, October 29, 2009

2. Development of staffing and other resource utilization models across functional areas to facilitate CI (e.g., alignment of ancillary, clinical, case management, support area staffing, skill-mix adjustments, flexing models, etc.)

3. Enhancement of care and disease management functions across care components (e.g., redesign case management functions in line with clinical integration requirements, enhance roles of internal and external providers such as intensivists, mid-levels, referring physicians, etc.)

4. Integration and utilization of clinical information systems into care and management processes across service components, including standardized coding, information dissemination, hard-wiring data entry, and sharing care and decision processes.

5. Development and dissemination of key financial indicators across service components that facilitate in incentive and risk management alignment.

6. Initiation of performance measurement, monitoring, and accountability systems and structures that include CI elements and requirements that are based on standardized metrics and considered best practice standards

7. Development of CI oversight structures and integration of these functions into operations management configurations

  • Physician leadership
  • Performance management
  • Financial monitoring

8. Staging of all improvement initiatives to realize operational efficiencies in the context of increased service coordination and integration.

As a key component of hospital operations improvement initiatives, clinical integration should include the assessment and redesign of all key functional areas within a hospital on both an inter- and intra-departmental basis. An operations improvement initiative should focus on achieving sustainable improvements by applying leading practice methodologies to specific organizational situations and requirements, including a rigorous approach to both assessment and redesign within the context of the current economic climate, not to mention impending healthcare reform.

Optimally, content area experts with extensive best practice experience across a range of functional areas should be utilized to assess factors affecting performance as well as develop improvement opportunities specific to an organization's needs and operating environment. Most importantly, such initiatives should focus on implementing improvements that extensively incorporate clinical integration, accountability structures, and performance measurement so that improvements can be acculturated and expanded upon on a continuous basis.

Changes in the healthcare landscape going forward will challenge hospitals and healthcare organizations at every level. With an increased number of patients entering the healthcare system and an even more complex payment structure to deal with, operational efficiency will be essential to succeeding in this new environment. Well-designed and executed processes and efficient use of resources aligned with clinical integration requirements will continue to be the foundation for success. Organizations that proactively conduct a thorough assessment of their current operating performance, understand their deficits and opportunities, and engage every member of the organization in a detailed planning and implementation effort will be best positioned to navigate through the current environment and prepare for whatever systemic changes may come.

Although healthcare reform will certainly challenge every hospital's ability to deliver services efficiently, it will also reward those who have developed and realized capabilities to coordinate services, measure and manage performance, use resources wisely by matching them with demand across the care continuum, and aligning the activities of key provider stakeholders.


Frank Flosman is vice president at the Camden Group where he leads the performance improvement group. He may be reached at 312.775.1714 or fflosman@thecamdengroup.com.
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