By Stuart R. Levine
Published In, The Credit Union Times

In the successful implementation and sustainability of any project, whether it be a patient’s recovery from a chronic illness or a complex project with significant funding, roll-outs often fall short and create either massive losses in investments, financial and human resources or human life for the following reasons:

• the foundation for success is not set at the outset;
• accountabilities are not identified;
• strategic communication is lacking throughout the implementation process;
• transformation and change management support is often overlooked.

Our firm’s knowledge and experience in transforming cultures and leading change within the healthcare industry has shown us that through a strong project management foundation, a strategic communication focus and change management initiatives, we bring together clinical and administrative components to increase organizational leadership capacity to drive the changes needed to assure long term sustainability and better patient outcomes.

There are conflicting incentives in the healthcare industry that lead to difficulty in achieving the right outcomes.  Within the care management process itself, the hospital is incentivized for shorter patient stays; while physician’s incentives increase as the patient stays under their care longer. A lack of team communication results in poor results but in healthcare clinical errors can be deadly. Strategic communication, from the top, is essential. But how can this be incentivized?

In healthcare, the directive for high quality has led CEOs to mandate debriefing when something goes clinically wrong. Unfortunately, the reasons usually boil down to a breakdown in communication and teamwork. For example a clinician could have picked up a sign from the patient or another staff member that something was not right and shared that information before it became a costly, or even deadly, error.

What can organizations do to create a culture where trust allows proper debriefing and the ability to move the culture towards learning and openness to achieve better outcomes?

The board needs to mandate the understanding of poor outcomes, like in any organizational initiative it starts at the top.  Leaders need to look underneath the hood, to dive deeper into the organization to see how teams are working together which is where mistakes happen.  Having open, non-judgmental discussions, creating an environment that encourages people to be truthful, admit mistakes, and to use these experiences as lessons and ways to learn and develop – that’s a learning culture.  We have seen this at both the North Shore-LIJ Health System in New York where there is 100% compliance on admitting mistakes, and anyone can call a “time-out” in the OR, as well as at Emory University Hospital in Atlanta, where they focus on a “fair and just culture” with an algorithm in place to change the system and learn from their mistakes.

One client, a large health system that anchors an Accountable Care Organization, by coordinating the delivery of care through efficiencies and teamwork combined with transformational leadership, was able to combine multiple call centers to a single location, coordinating the jump in contacts from approximately 800,000 per year to over 1.9 million. A strategic communication plan was also developed that drove culture change and acceptance of the new care delivery model. Teamwork was redefined across the ACO, and along with solid leadership, resulted in strong financial and clinical outcomes for people with chronic illnesses in an underserved population.

The cost of medical care is projected to continue growing as a percent of both salaries and national GDP.  Currently, healthcare costs represent 18% of GDP, up from 12% just 10 years ago, and is projected to reach 25% of GDP by 2025.  The healthcare system’s “healthcare triad” doesn’t help. Insurers (Payers) pay, the healthcare professionals (Purchasers) make decisions on your tests, treatments, medications, hospitalizations, and the patients (Users) for the most part, don’t decide and often seek out expensive care believing it correlates with high-quality. These three unique roles do not encourage cost containment or efficient care.  New paradigms are happening where Payers and Purchasers are merging into one system as a new way to control costs and deliver cost conscious best practices.

For the primary care provider to become accountable for the patient and their success as the “team leader”, they must acquire significant communication skills as “key communicator” and “key driver of quality patient outcomes”.  Ongoing strategic communication is the glue that brings together all components to increase the capacity to drive project results in an organization or create quality patient outcomes.   As with any change, the right incentives need to be in place, leadership is required and the values of any organization are paramount.