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Nudging Physicians Toward Team-Based Care
The ED group tackled wait times in the ED, for example, and variation among ED physicians on testing, service scores, and length of stay.
Now he’s trying his collaborative philosophy on a grand scale.
Hanley likes to look at the work he’s doing to cut costs and improve quality in terms of an analogy: the farmer vs. the architect.
“An architect represents a top-down philosophy,” he says, while the farmer nurtures and isn’t really sure what’s going to come from that nurturing.
“My job is to move the rocks out, pick the weeds, and make the ground fertile so when these experts come in, I have given them enough tools and enthusiasm to allow them to grow their own ideas.”
The experts of whom he speaks aren’t consultants or high-powered physicians; they’re people on the front lines of care.
“People who work on the front line are the experts. If you want fundamental knowledge of the process, you need to talk to them,” he says. “I’m not an expert in cardiology or pediatrics, but I can help get them to figure out where they have opportunities for change because they’re already hooked in.”
Historically, Centra has featured high quality, high patient satisfaction, and low costs, says Hanley, so it’s a challenge to see where improvement can be made. The reason Centra has accomplished its lower costs is aggressively managing the supply chain, revenue cycle, length-of-stay case management, and productivity and, to continue Hanley’s analogy, it feels like it has harvested much of the low-hanging fruit in cutting healthcare costs.
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Comments are moderated. Please be patient.
Stefani D (12/8/2011 at 11:26 AM)
Atul Gwande wrote that physicians are trained to behave like cowboys - independent, autonomous, even arogant. But today, he goes on to say, we need pit crews. The image is relevant - unless there is consequence for behavior that is not in the patient's best interest, the transition to pit crews will be delayed.