Writing in NEJM, Harvard physician Thomas Lee outlines a three-step strategy to redesign hospital care that rallies physicians to cut costs and improve quality without implementing a new payment model.
Although Lee notes that costs represent a constant struggle for health care organizations, he writes that for health providers, “cost reduction alone is not an effective rallying cry: health care is intended to help people, not just provide a commodity as inexpensively as possible.”
Nonetheless, Lee writes that health costs must be addressed as they “threaten social and economic progress.”
He describes an approach used to redesign care at Partners HealthCare System—a Boston-based Harvard affiliate—that “seems to be both consistent with clinicians’ values and responsive to the needs of patients and the marketplace.”
The approach “does not require, and need not await, the implementation of new payment models,” Lee writes, noting that “these themes are potentially useful wherever clinicians seek to improve care in the context of constrained resources.” Rather, the approach requires that hospitals follow three steps to redesign care:
Strategy: Hospitals must establish consensus on the organization’s overarching goal and a performance framework for that goal. Lee recommends focusing performance benchmarks on patient needs rather than compliance with evidence-based guidelines. For example, the hospital might assess organizational performance using readmission rates rather than the use of beta blockers after a myocardial infarction (MI).
Tactics: Care-design teams must determine how the hospital can best meet its overarching goal and performance benchmarks. This step requires observation of the hospital’s current strengths and weaknesses. For example, Partners care-design teams developed new guidelines for MI patients undergoing coronary stenting after it noticed postoperative care inconsistencies.
Operations: Care-design teams that were involved in the strategy and tactics steps must be responsible for overall improvement in value-added outcomes. “These teams should not be committees with a time-limited deliverable but rather permanent parts of an organization’s structure,” Lee writes.
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