That means, among other things, communicating with extreme frequency and urgency, he says, "because people are afraid to switch to something new. You have to delineate who's going to do what in excruciating detail. If you don't, you'll stagnate. Traditional medical staff departments are not designed to integrate clinical and financial outcomes—they're just not."
While Cors says the transition to a service lines–oriented approach that uses care protocols and reinforces good business practices of eliminating waste and harm is fairly easy to articulate, the "little stinky details are going to sink you.
"This is a tough thing, because I have been a huge advocate in investing in physician leadership and the organizations that have done that are at a strategic advantage," he says. "But as things get more complex, that's precisely the time you need strong physician leaders, and that's when hospitals say, 'Oh my goodness, we don't have any.' "
That can be a problem as leaders look to inculcate evidence-based medicine protocols into practice, he says.
"Even though there's a much greater acceptance of evidence-based medicine, you still have significant points of resistance," he says.
More important to physicians, he says, is who decides what is in these protocols. In most instances, he says, even though vendors promise to deliver real-time evidence-based protocols, he thinks each institution should not determine the rules on its own, but as a group. "There's a critical role for physician input into that whole process," he says.
Having invested so much in the electronic medical record, Cors says Pocono is setting up a CPOE governance committee that scrutinizes such things.
"We will be measuring conformance with those protocols and using peer-review expertise to look at actual practice patterns,' he says. "If I'm Doctor A and Doctor B only follows protocol 75% of the time vs. my 95%, that's how we'll drive conversations for quality of care."
What's your delivery system?
Call Paul Kronenberg, MD, envious of integrated delivery systems. He does not lead one; however, if Crouse Hospital in Syracuse, N.Y., was integrated, he feels the job of leading his physicians into new models of care would be much easier.
As it is, the president and CEO of the 400-staffed-bed hospital has to work a transition that's very dependent upon the private practice market and the maturity of the healthcare system.