leadership

Service Business Model Innovation, the fourth case study from our recently published book chapter

By M2|2017-10-09T01:56:26+00:00April 13th, 2017|Uncategorized|

Service Business Model Innovation, the fourth case study from our recently published book chapter

As we a few weeks ago, M2HCC authored a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach” in Service Business Model Innovation in Healthcare and Hospital Management published by Springer. Today we share highlights from the fourth case study we feature in the chapter.

Sutter Health and the Sutter Medical Network
Sutter Health is a community-owned, not-for-profit health care system operating in northern California. The system has over 50,000 employees and 5000 affiliated physicians. Facilities include 24 hospitals, 34 outpatient surgery centers, 9 cancer centers, 9 neonatal intensive care units, 6 behavioral health centers, 5 acute rehabilitation centers, 5 trauma centers, and more than 4,000 licensed acute care beds. Sutter was recently named as one of the Healthgrades Top Hospitals in the U.S. for 2017.

We talked with Sarah Krevans, President and CEO of Sutter Health, and Don Wreden, M.D., Senior Vice President for Patient Experience, about how Sutter has been able to build the trust necessary to move from a diverse health care delivery system with inconsistent patient experience to a more integrated approach over the past several years. Their advice to build trust, cooperation and leadership? 1) Find a way to collaborate; 2) Embrace strong leadership; 3) Change takes time; 4) Acknowledge innovative ideas can come from anywhere.

Find a way to collaborate
Sutter was able to build trust that lead to service innovation, first, by finding ways to collaborate. Sutter’s collaboration efforts initially focused on selecting common clinical performance standards, goals and measurement mechanisms seeking to develop new and more efficient ways of delivering coordinated, consistent, high quality health care. It was essential to unite around common clinical goals so the medical group partners were motivated to work together in attaining clinical goals focused on patients. The common clinical goals were driven in part by looking at the varying practice styles of health care practitioners across the organization in a non-threatening way. For example, by aiming to reduce clinical variation, Sutter helped clinicians focus on the goal, instead of demanding practice style change.

As our Sutter case study interviewees described it, “we got our training wheels” by doing small, focused clinical initiatives where providers could agree on the goal and “could all understand how to work together.”

Embrace strong leadership
“We remember the health care market of the 1990s,” said Dr. Wreden, “where hospitals were buying medical groups without a clear strategy for clinical integration. We know now that didn’t work out in California.”

What Sutter did instead was nurture engagement of physicians in leadership roles and commit to educate and train physician leaders—which was part of a cultural evolution in the industry. Developing leaders, perhaps not surprisingly, requires a vision that embraces the importance of physician leaders.

One way to encourage leadership, Krevans explained, is not to be afraid of bringing in strong leaders through growth or mergers. If a strong leader exists outside the organization, it is okay to keep that leader engaged and interested in serving the Sutter mission when they come into the organization. As part of its commitment to developing leaders, one particularly innovative approach Sutter uses is to evaluate for leadership potential as part of the recruitment process. “We invest in team development,” Krevans said. Sutter seeks to ensure that it is growing and recruiting the right leaders; for Sutter, a leader needs to be thinking about how to better integrate the health care services the organization provides in service to the needs of the patient.

Trust takes time
Dr. Wreden further explained saying, “We facilitated this evolution by giving true responsibility to physician leaders. We ensured they were focused on partnership, collaboration, shared accountability” and they were serving patients the culture that supports a trusting, cooperative organization. However, both leaders acknowledged such an approach “is fragile, and takes time—it can’t be done in a year.”

These Sutter executives recognized that in today’s turbulent health care market, organizations needing to innovate will probably have to move faster than Sutter had to when they embarked upon this journey several years ago.

Acknowledge innovative ideas can come from anywhere
Finally, and uniquely in the case studies M2 wrote, the Sutter leaders advised health care organizations seeking to innovate their service model would do well to recognize innovation can come from people from a variety of backgrounds, including those with non-clinical training or experience.

For example, in 2015, Sutter hired Chris Waugh to be its first Chief Innovation Officer. Waugh had previously held leadership roles at IDEO, a global design firm that creates human-centered design. Sutter also relies on ethnographers, technologists, and other types of experts, to name a few, to ensure the organization is always improving at serving patients.

One of the key lessons from Sutter Health’s innovation experience is: “Don’t just value a particular kind of leader. Respect every member of the team,” according to Krevans. It is important to appreciate the skills and background of all different kinds of staff within the organization.

“Innovation in the service model and true breakthroughs will come from this range of expertise,” said Krevans.

The third case study from our recently published book chapter in Service Business Model Innovation

By M2|2017-10-09T01:58:36+00:00April 4th, 2017|Uncategorized|

The third case study from our recently published book chapter in Service Business Model Innovation

As we a couple weeks ago, M2HCC authored a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach” in Service Business Model Innovation in Healthcare and Hospital Management published by Springer. Today we share highlights from the third case study we feature in the chapter.

The Massachusetts General Physicians Organization

The Massachusetts General Physicians Organization (MGPO) is a multi-specialty medical group that provides patient care, teaching, and research in partnership with the Massachusetts General Hospital and in cooperation with Partners HealthCare. Several of the hospitals in the Partners HealthCare system, including the Massachusetts General Hospital, are teaching affiliates of Harvard Medical School.

We talked with Dr. Daniel M. Horn, Assistant Medical Director for Ambulatory Quality at the MGPO whose work is focused on the next steps in quality in his role leading efforts to improve the quality of care for 160,000 patients across 21 primary care practices.

Quality measures and the binary fail

Measuring quality is a building block for payment and delivery system reforms, such as accountable care, integrated delivery, shared-savings or value-based approaches. However, there is a difference between true quality of care and quality measures. Improving patient outcomes is likely to represent high quality of care, but how would that be measured?

At MGPO, the organization is using the current “binary fail” method of measuring quality as an opportunity to build trust. For example, most healthcare providers are in some way subject to quality measures designed for health plans called the Healthcare Effectiveness Data and Information Set (HEDIS). Dr. Horn used the example of the HEDIS measure for controlling blood pressure to explain the problem of the “binary fail.” Heart disease and stroke is the leading cause of death in the U.S., and because high blood pressure (hypertension) increases the risk for heart disease and stroke, there is no question that controlling high blood pressure is important. What is at issue is the way providers are measured on the concept of “controlling.”

Controlling high blood pressure, according to HEDIS, is the measurement of the percentage of patients 18–85 years of age who had a diagnosis of hypertension and whose blood pressure (BP) was adequately controlled during the measurement year, for example, by showing the patient’s blood pressure was less than 140/90 mm Hg. In a clinical practice, this means the denominator is the number of patients who come into the practice in the first 6 months of the year where the clinician submitted a bill with the appropriate ICD-10 code related to an abnormal blood pressure reading without a hypertension diagnosis, and the numerator is the number of patients who come into the practice in the second 6 months of the year and have a blood pressure reading below 140/90 mm Hg.

Even a non-clinical reader can quickly see various patient scenarios that would fall outside of this narrow consideration of the quality measure called controlling high blood pressure; hence, Dr. Horn’s pronouncement that the HEDIS measure creates a binary fail for measuring the control of a patient’s blood pressure.

Building trust, then, is accomplished by rewriting the measures with an algorithm for all of your patients. MGPO developed a measure that is clinically valid and acknowledges what the clinician knows, which is that it might have taken 18 months to control a patient’s blood pressure, for example.

Dr. Horn explained that building trust and cooperation in order to achieve service business model innovation requires: 1) Building better quality measures; 2) Changing the mentality; and 3) Providing usable data.

Build better quality measures

Dr. Horn explained that in response to the changing healthcare environment, and in an effort to build trust with clinicians to show that their work and interest in patient care is paramount to the organization’s success, MGPO addressed the gap between payer-defined measures, such as HEDIS, and clinically valid and meaningful quality measures. His team, in close cooperation with other clinicians, has helped the organization rewrite measures used internally so they would be clinically valid in the healthcare provider’s point-of-view. “We have electronic health record (EHR)-based data sets to manage clinical care, so let’s build better measures, then maybe build that into contracts,” said Dr. Horn.

Change the mentality

Thinking first about how clinicians work and why they choose to serve patients, meant changing the rhetoric and mentality around payer-driven measures. Dr. Horn explained, “We want to empower you to do this work and we want to define it in clinically meaningful terms.” By doing this over the past 3 years, the system is, in a way, divorcing itself from the market-driven quality measures when it comes to thinking about true quality and patient outcomes

Provide usable data

Trust is also bolstered when data being used to measure quality and performance is actually usable. Clinicians are more likely to trust data with three characteristics, according to Dr. Horn. First, it must be reliable. Second, the measurement criteria being used “must represent something they believe in as a physician.” Third, the data must be timely. To incentivize behavior change, showing a clinician or clinical practice information from 6 to 12 months ago is simply too old. The data should be real-time, valid and represent clinician values. In Dr. Horn’s experience, showing data that has even a single mistake or two is enough to create some distrust with clinicians.

As we grapple with ways to improve health care quality and lower costs, the MGPO approach to quality measures is certainly an innovation. To create truly accountable care, quality measures that are valid, valued and usable by clinicians are needed to improve the provision of primary care.

*Daniel M. Horn, M.D., is the Assistant Medical Director for Ambulatory Quality at the Massachusetts General Physicians Organization (MGPO). Dr. Horn is also a primary care physician and Unit Chief at Internal Medicine Associates, where he provides comprehensive primary care and helps with day-to-day leadership of the largest primary care practices at Massachusetts General Hospital (MGH).

Service Business Model Innovation, the second case study from our recently published book chapter

By M2|2017-10-09T02:00:19+00:00March 28th, 2017|Uncategorized|

Service Business Model Innovation, the second case study from our recently published book chapter

The BJC Collaborative
BJC HealthCare is based in St. Louis, Missouri and includes Barnes-Jewish Hospital and St. Louis Children’s Hospital. It is one of the largest nonprofit healthcare organizations in the U.S. and it is the largest provider of charity care in the state of Missouri. In 2012, Saint Luke’s Health System in Kansas City, Missouri, and CoxHealth in Springfield, Missouri, and Memorial Health System in Springfield, Illinois, joined BJC to form The BJC Collaborative. Over the past few years, four more organizations joined the Collaborative and members have combined annual revenues of over $9.3 billion but remain independent, serving residents of Illinois, Kansas, and Missouri.

The BJC Collaborative has three primary focus areas: 1) Implementing clinical programs and services to improve access to and quality of health care for patients; 2) Lowering health care costs and creating additional efficiencies that will be beneficial to patients and the communities served by the member organizations; and 3) Achieving cost savings. (BJC Collaborative 2016)

We talked with Sandra Van Trease*, group president of BJC HealthCare about how trust, cooperation and leadership have helped the Collaborative increase innovation year after year.

Common values and previous relationships
The importance of trust and relationships is on point, especially in this kind of organization, where entities are coming together as a collaborative, explained Van Trease. For example, the senior leadership of these organizations knew each other before the Collaborative was formed. “We already knew each other, we knew each entity was high performing, we held similar values, we all recognized a need for evolution and change in the healthcare system,” said Van Trease. Common values were a key component to building the Collaborative.

Service priorities should matter to staff and leadership
While it is clear that leadership and strong relationships drove the creation of the Collaborative, the process the Collaborative uses to determine priorities is also driven by a structure built on trust and leadership. It is essential to set service priorities that matter to both staff and leadership, not just one or the other.

Get results to improve results
Notably, Van Trease explained that getting results also helped to build trust, which in turn, drove improved results. High-performing systems are like competitive athletes, always wanting to improve and set higher goals. Getting results makes people more likely to trust each other, and the process, creating momentum that generates further progress, explained Van Trease.

Communicate what works
Finally, and one of the unique components of the four case studies M2 wrote, Van Trease explained that it is essential to celebrate and share successes and best practices that can be replicated is essential. At the BJC Collaborative, there is a dedicated communications roundtable that captures this information, writes it up, and then disseminates it to each local health system.

Talk to your team, then have them talk to each other. Have leaders work in close connection with team members. On paper, it doesn’t seem that difficult, but in practice, the BJC Collaborative worked hard to build trust, increase cooperation and show leadership to create a truly innovative service approach for their area of the United States.

*Blessing Health System in Quincy, Illinois (2013), Southern Illinois Healthcare in Carbondale, Illinois (2013), Sarah Bush Lincoln Health System of Mattoon, Illinois (2015), and Decatur Memorial Hospital in Decatur, Illinois (2016).

*Sandra Van Trease serves as a group president for BJC HealthCare, and provides strategic leadership and direction to the BJC Collaborative. In 2012, Van Trease was appointed president of BJC HealthCare’s Accountable Care Organization and leads BJC’s overall efforts in Population Health.