In an article in Harvard Business Review, Fixing Health Care on the Front Lines, Richard Bohmer presented the three pillars of modern clinical management (see post: Clinical management as a mechanism of change). I like Bohmer’s contributions because he always looks at what can be done to bring the concepts to the real world, so it has seemed appropriate to comment on another one of his articles published in NEJM, The Four Habits of High-Value Health Care Organizations, which raises the logical point: if you want to encourage high value clinical practices, high value health organizations are paramount and for this reason, the author has studied the ways of working of the US healthcare institutions that are showing the best results in clinical and cost effectiveness (referencing the outcomes of Michael Porter) and he extracted 4 habits that, according to him, should be exportable:
Habit 1: Planning processes is as much detail as possible
High-value health organizations provide activities on a tight schedule, and this affects both patients’ circuits (admissions, schedules, discharges, checklists, etc.) and clinical processes (diagnosis, selection of treatment, severity scales, risk, etc.). Planning also includes the patients’ cataloguing in groups with clinical sense in order to standardize at maximum the care routes and adjust the incorporation of a shared clinical decision.
Habit 2: Adapt structures to the needs of the processes
The profile of professionals responsible for a plan and the resources allocated to it are appropriate in each clinical process. Infrastructures are modular and flexible as to adapt easily and thus facilitate their efficiency. As a process, management models are capable of generating micro-systems that harmonize budgets, professional teams, training, goals, etc. so that all the vectors are mutually reinforcing. The generation of micro-systems with clinical judgment stresses the use of complex platforms such as operating theatres or intensive care units, or even the workloads of doctors, but high value health organizations planned and managed to harmonize it all.
Habit 3: Measure and monitor processes
Health institutions generate a lot of data and statistics, some of a general type (for the government), others for invoicing, some for external auditors, some aimed for the analysis of the complexity casuistry, resource management, quality care, clinical safety, internal costs, etc. But Bohmer remarks that to promote value, managers of high value clinical organizations, despite the ocean of available figures, are able to generate indicators that make sense for the specified processes, and measure effectively both compliance with what is planned as well as the specific desired results.
Habit 4: Continuous Improvement
To promote modern clinical management, paying attention to knowing how to rigorously apply the best practices and address the complex processes with mechanisms of trial and error and learning from daily activity is important. So in the analyzed institutions there are professional teams involved in each clinical process that go beyond the traditional individual practice of medicine.
High value health organizations, according to Bohmer, are different in two aspects: a) for them these 4 habits are real, already established in their structures, cultures routines and attitudes; and b) they have overcome the organizational model based on resource management and are able to put the focus on process development and clinical outcomes on an everyday basis.