Baker's Decalogue for high-performance healthcare organizations

Jordi Varela
Editor

 

Americans trust that competitiveness is the essence of human activity, which has made them the world's leading power, with China's permission. This principle, however, has not worked for them when they have applied it, without palliative, to their health care system, which is showing clear signs of poor performance: it’s very costly, it’s inequitable and it’s showing poor results. For this reason, some public health care organizations such as Veterans Affairs and Medicare, or private, such as Mayo Clinic, Cleveland Clinic or Kaiser Permanente, are trying to put sanity, analyzing what are the keys to improve the performance of the system.

On the other hand, national health systems, which are cheaper, more equitable and with better results, are faced with the need to introduce elements of competitiveness to fight the stagnation typical of monopolies. Along these lines, ten years ago, the King’s Fund invited Canadian professor Ross Baker to London to advise a commission that had been created to strengthen leadership in the English NHS. Baker explained that seven experts from the University of Toronto had selected some seemingly high-performing healthcare organizations from various countries to analyze their leadership strategies, their organizational processes and the investments they made to achieve a climate favourable to continuous improvement. From Baker's report (don't miss the video of his conference at King's Fund attached below) I would like to extract the Decalogue that he used to advise the English experts:

1. Consistent leadership that align objectives and activities across the entire organization.

2. Quality and improvement systems are considered strategic and therefore prioritized in budgets.

3. The skills of management professionals are fostered.

4. Primary care is robust and at the centre of service delivery.

5. They try to get patients involved in the design of circuits and procedures.

6. A professional culture favourable to multidisciplinary teamwork, continuous improvement and patient involvement is promoted.

7. An effective integration of services is applied.

8. Clinical information is a platform that guides improvements.

9. Strategies are used to test innovations, validate them, and scale them across the organization.

10. Negative circumstances that hold back innovations are fought.

After Baker's work, there have been several reviews: Taylor (2015), Ahluwalia (2017), Vaughn (2018), on what is the best definition of a high-performance healthcare organization and what are the factors that characterize it, but Baker's Decalogue, despite being ten years old, is still so comprehensive that there is no need to revise it.

From this post, I support Baker's Decalogue (2011) as the basis for building a new evaluation model, updated to the Porterian criteria, that stimulates benchmarking and continuous improvement of health care systems on the value that contributes to the health of citizens.