The framework for this kind of improvement is being built by many healthcare systems, done best through teambuilding and a multidisciplinary approach for improved patient care.
That certainly was evident at a HealthLeaders Media Rounds panel discussion this week, focusing on cardiac care leadership for improved alignment and outcomes, and held at the Baylor Health Systems in Dallas, TX. Three top officials of Baylor discussed the shared vision for physicians and administration as partners, and the vital need for transparency and data collection as the process evolved.
Specifically, their talk focused on the Baylor Heart and Vascular Hospital (BHVH), which is part of the Baylor Health Care System. The BHVH opened in 2002 as the first joint venture hospital within Baylor Health Care System with, its officials say, the purpose of aligning physicians and hospital administration for heart and vascular patients. The hospital is 49 % owned by physician partnership and 51% by Baylor University Medical Center.
While it’s important to “facilitate the economic model,” says Kevin Wheelan, MD, chief of staff at BHVH and co-medical director of cardiology, a desire of physicians and administration is to “solve a common goal of providing excellent patient care.”
“It’s about achieving excellence in providing a commitment to the community and environment where we can practice the art of medicine,” he added. “Baylor has been a physician friendly institution, but the dynamics of that relationship has changed dramatically” following the creation of the BHVH, with the “medical staff and working at an equal partnership.”
As Wheelan and other top Baylor officials, Nancy Vish, RN, FACHE, president of BHVH, and Paul Convery, MD, MMM, chief medical officer for the Baylor Health Care System, see it, improving coordination between physicians and administration is a constantly evolving process. Variables within the system run through it, such as medical leadership meetings; the hospital system’s physician leadership councils – responsible for medical staff governance and alignment roles – and other work products, such as a special focus committees, where physicians and administrative staff focus on common goals. In addition, hospital leadership established a physician leadership development program, which includes training for physician “champions” –physicians who are considered high-level doctors in quality and safety specialty core areas.
Indeed, the HealthLeaders Media industry survey shows that physicians nationwide are heralding quality improvement initiatives, with 76% saying they believe such programs will have a positive or strongly positive impact on their organizations. The survey shows that quality and patient safety experience, and developing an accountable care organization are among the top priorities they see over the next year, according to the survey data.
Physicians consider the impact of patient experience and patient-centered care as extremely positive. The survey shows that 60% and 20% respectively, believe such initiatives will have a positive or strongly positive impact on their organizations.
When the Baylor Heart and Vascular Hospital began, physician and administrative team started with common goals and a similar vision for improved patient care, but Vish acknowledged there were challenges “getting the entire team on board.”
But that has changed. The hospital’s twice-monthly medical leadership meeting involving physician and administration leadership is a key element toward “problem solving, goal creating and strategizing,” says Wheelan. The meetings “get longer with the complexities of certain issues and the government always continues to throw us curve balls of new processes and paperwork to deal with,” he says.
“The meeting is the environment in which we do a lot of problem solving. It’s a very open environment to address issues of quality, service, finance,” Wheelan says. “Data is a very critical element to our process and we believe the data needs to be transparent. Without metrics, comparisons and benchmarks, it is very difficult to achieve a higher level of excellence.”
“A lot of physicians will bring ideas problems from a clinical perspective and then hand off to an administrative team,” says Convery. While there have been tendencies to “compartmentalize,” meetings between administration and physicians on a “regularly structured basis helps keep all of that moving.”
The Accelerating Best Care at Baylor is an innovative educational program that focuses on healthcare quality and improvement, teaches healthcare leaders theory and techniques of rapid cycle quality improvement, outcomes management and staff. It facilitates the enhancement of skills by physicians, nurses, administration and others to lead quality improvement efforts.
Referring to physician and hospital alignment in co-management plans, panelist Tim Attebery, CEO of Wellmont Cardiology Services in Kingsport, TN, expressed some caution for those embarking on the process. He says many physicians are taking the wrong, initial steps. “A of cardiology groups are in discussion with hospitals about an integration arrangement and they have not put together a service line management arrangement,” he says. For physicians to be “truly at the table to be accountable for the overall performance of the enterprise, they have to have management responsibility and those responsibilities need to have quality metrics, cost metrics, patient satisfaction metrics and growth metrics. The physicians need to maintain a level of intensity and engagement.”
Suzette Jaskie, MBA, executive director of Frederik Meijer Heart & Vascular Institute for Spectrum Health in Grand Rapids, MI, says physicians are weighing autonomy or working within a system after determining “their ability to impact the system of care.” They may find that “autonomy is a small price to pay for impact,” she says.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
