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How The Executive Committee Can Support Physician-Hospital Alignment

News  |  By Credentialing Resource Center  
   October 30, 2017

As healthcare reform becomes the new reality, the ability of institutions to survive depends upon the ability of the medical staff and hospital to align and integrate. 

This is an excerpt from an article that originally appeared on Credentialing Resource Center on October 2, 2017.

From the Encarta Dictionary, the definition of alignment is “the correct position or positioning of different components with respect to each other or something else, so that they perform properly.”

If the hospital and physicians are not aligned, reaching the desired destination will be a significant challenge. The above definition works because the medical staff and healthcare system must become aligned to reach the Triple Aim of the Institute for Healthcare Improvement, which is:

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of populations
  • Reducing the per capita cost of healthcare

It certainly sounds like a noble task that should be relatively easy to accomplish, especially since making people better is what healthcare is all about. But ask any physician, hospital executive, or hospital board member if this is easy and you will be greeted with a resounding “no.” The medical executive committee must have a basic understanding of alignment, but what should its role be in fostering alignment?

Clinical alignment/integration

According to an article in Trend Watch, “To achieve clinical integration, we need to promote changes in provider culture, redesign payment methods and incentives, and modernize federal laws.”

This involves the concepts of set, communicate, and achieve buy-in to expectations. An example of this is standardized order sets and pathways. The MEC needs to have oversight of the development process such that the most scientifically up-to-date evidence is used and that there is a method to decrease variation that does not add value.

Whether the MEC mandates the use or just creates a process that makes following the protocol the easy thing to do is a cultural choice. The self-proclaimed “expert” may not really be the expert, so a solid medical staff process to review the evidence and ask the question, “Why are you different?” needs to be monitored by the MEC to enable a culture of continuous performance improvement to thrive. Clinical alignment may also be negatively impacted by economic alignment/integration.

Economic alignment/integration

Hospitals and physicians are not aligned financially. This provides an easily understood example of why hospitals and physicians may not be economically aligned. A subtler example can occur when quality is not aligned with quantity. Medicare helped physicians learn that when you get paid per widget, you make more widgets. The ugly example of this is the “Medicaid mill,” where the less advantaged population with limited access to care is pushed through the healthcare system so fast that even the most astute provider would be unable to provide a high-quality service.

We all know that some physicians are faster and more efficient than others when it comes to evaluating patients or performing procedures. The MEC should develop a method of oversight, which is most often accomplished through the peer review process. For example, a routine competency metric may be colonoscope withdraw time. If the metric is “Scope withdraw takes at least six minutes,” and you have an endoscopist that schedules patients every 10 minutes and can stay on schedule, you may have an issue. The idea is not to punish the efficient but to make sure that you don’t allow financial gain to eclipse quality.

Cultural alignment/integration

Whether you perceive cultural alignment as the hardest or easiest alignment-related issue depends upon your current culture. Culture, previously defined as “the way we do things here,” is a major factor in the alignment process. The MEC, hopefully composed of the best and brightest of the institution’s clinical leaders, must set, monitor, and demonstrate the behaviors of the culture your facility wishes to maintain or attain. Collaboration and teamwork must replace the silo mentality that not only exists between nursing, administration, and the medical staff but also exists within the medical staff (i.e., between departments).

“Us and them” must become “we.” “Either/or” must become “and.” This is often more difficult for physicians who were trained to be the captain of the ship with complete autonomy and absolute power (somehow we missed that the captain needs a crew to run the ship) than it is for the more recently trained that have been more exposed to team building and collaborative practice. Culture will eat strategy for lunch every day. The MEC must constantly strive to create and maintain a culture of patient safety, quality, and continuous performance improvement.

As healthcare reform becomes the new reality, the ability of institutions to survive depends upon the ability of the medical staff and hospital to align and integrate. Those that can achieve this first will have a competitive advantage. Alignment is not a one-time fix, but an ongoing process that needs vigilance and nurturing. Just as in continuous performance improvement, the MEC must keep what works and discard what doesn’t to strengthen the alignment. 

The Credentialing Resource Center (CRC) is the premier destination for credentialing, privileging, and peer review expertise. Membership provides MSPs, quality professionals, and medical staff leaders with a collection of continuously updated tools, best practice strategies, and compliance tips developed by industry experts. With three membership tiers, you can customize your access level depending on your education and training needs. Learn more

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