The Exec: How to Succeed in Integrating Clinical Care

The first step in integrating clinical care is figuring out how to provide value for patients, this chief physician executive says.

One of the top priorities of University of Iowa Health Care's inaugural chief physician executive is integrating clinical care across the health system.

Bevan Yueh, MD, MPH, began his new role as chief physician executive of University of Iowa Health Care on July 31. He previously worked as CEO of University of Minnesota Physicians and vice dean of clinical affairs at University of Minnesota Medical School.

"What I must figure out first is how to provide value to patients in the state," Yueh says. "This is a state institution. We have got to be able to show everyone in the state that we are valuable to them. When I integrate clinical care, I want to make sure it is what people in the state want."

The number of patients that want to seek care at University of Iowa Health Care is growing, and integrating clinical care is imperative, according to Yueh.

"We know that we do not have enough resources here to take care of every patient who wants to see us," Yueh says. "In the past, we knew that we were comfortable only being in Iowa City and that patients had been willing to travel a long distance to see us. But healthcare is changing, and we must evolve."

A key to success in integrating clinical care is for leaders of the health system and clinical staff to view patients as if they were family members, Yueh explains.

"I would not want my mom driving four hours to Iowa City if care could be provided closer to home," Yueh says. "We need to figure out how we can work with partners throughout the state, so that we can give care to patients conveniently. We can't buy hospitals and other facilities to provide care."

Bevan Yueh, MD, MPH, is the inaugural chief physician executive of University of Iowa Health Care. Photo courtesy of University of Iowa Health Care.

Driving quality improvement

Culture and measuring results are essential in quality improvement efforts, according to Yueh. Clinical staff must understand that the organization is committed to doing things better.

"Then you must be able to measure what you are doing wrong and where you are not doing a great job," Yueh says. "Measurement must be accurate—you need to have one source of truth, so people agree on how you are doing in terms of quality."

A chief physician executive, CMO, and other clinical leaders can play a pivotal role in establishing a culture that supports quality improvement, Yueh explains.

"Most doctors, advanced practice providers, and nurses want to do things better," Yueh says. "A clinical leader has to unleash that spirit and to make doing things better easy. A clinical leader must identify barriers to make it easier for their staff to do things better. A clinical leader must listen to their staff members to understand their frustrations."

In addition to culture and measurement, a health system or hospital must be able to prioritize to improve quality, according to Yueh.

"You cannot improve every quality measure at the same time," Yueh says. "In Minnesota, we decided to prioritize sepsis care response time. Our care teams were just not getting to sepsis patients quickly enough. We decided this was a priority because if we could get to sepsis patients within the first hour of symptoms, their mortality rate decreased significantly."

Achieving a coordinated care experience

Clinical leaders and staff members must appreciate the patient perspective to achieve a coordinated care experience, Yueh explains.

"Leaders and staff members need to think about a coordinated care experience as if they were caring for their mom, their kid, or their spouse," Yueh says. "Staff members need to focus on how they would want those family members to have a care experience."

Listening to patients and recognizing any struggles they have in receiving care is essential in providing a coordinated care experience, according to Yueh.

"For example, you need to acknowledge if you required a patient to travel 200 miles three times to see a surgical oncologist, medical oncologist, and radiation oncologist," Yueh says.