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Nudging Physicians Toward Team-Based Care

Philip Betbeze, for HealthLeaders Media, December 8, 2011

But with a patient mix that skews 55% Medicare, Hanley says Centra “is living closer to the edge than some of the other systems, and that’s forced us to look at a lot of stuff that others are only looking at now. The benchmark going forward is surviving under Medicare.”

Centra has some variables in its favor. It has a well-developed EMR that has used computerized physician order entry for five years, has standardized order sets, and culturally, “we are a single-specialty town, so we don’t have another big hospital to compete with,” he says.

Still, future success will center on innovations in clinical care delivery, Hanley says, and that’s something where process engineers have an important contribution to make.

“If I wanted a breakdown on a financial report I could get that in a couple of hours,” he says. “But if I want some detailed report on a clinical process, that could take days.”

That’s not unusual, but Hanley wants to make it so that possible changes in clinical care delivery can be modeled. His reliance on process engineers started after his emergency medicine physician group was absorbed into Centra in 2006.

“When we became employees, we wanted a process engineer for our department who didn’t have history in healthcare so they could be objective. We made a commitment to the science of quality improvement. That was a huge decision for us.”

Many of the gains made by the ED group were data driven and facilitated by the process engineer.

“So when I moved into this role, that idea has always been there,” he says. “Sometimes it’s better to be lucky than good.”

Lucky or not, he knew a good thing when he saw it. Now, process engineering is a vital part of the performance improvement regime and has become its own department. The pharmacy and therapeutics committee tackled the medication delivery process, and in doing so saved about $1 million in drug purchasing costs. The performance improvement department also concentrated resources on DRG profitability studies and implemented the clinical council, which, Hanley admits, is “part infrastructure and part culture.”

The clinical council—which includes professionals from physicians to nurses to administrators—is a broad forum to discuss and implement quality and process improvement ideas along service lines.

“It extends beyond the borders of the organization’s quality. It’s really about community quality and, going forward, will take a greater level of collaboration to create the solutions we need,” says Hanley.

“The clinical council is a budding plant right now,” he says. “We’re trying to build a platform of constant process improvement, where it becomes an intrinsic part of the work we do. We have a system in place with tools and resources and space to continually improve. We have a very good start, but we may need a couple more growing seasons.”


This article appears in the November 2011 issue of HealthLeaders magazine.


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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1 comments on "Nudging Physicians Toward Team-Based Care"


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.