With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come. The delivery of health care is unique, complex, and currently fragmented. Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century. The evolutionary pace of health care culture is about to be shocked into a mandated reality. One that will inevitably require health care leadership to adopt a new, innovative perspective into the delivery of their services in order to meet the emerging requirements.
First, a bit on the details of the
coming changes. The concept of Value-Based Purchasing is that the buyers of
health care services (i.e. Medicare, Medicaid, and inevitably following the
government's lead, private insurers) hold the providers of health care services
accountable for both cost and quality of care. While this may sound practical,
pragmatic, and sensible, it effectively shifts the entire reimbursement
landscape from diagnosis/procedure driven compensation to one that includes
quality measures in five key areas of patient care. To support and drive this
unprecedented change, the Department of Health and Human Services (HHS), is
also incentivizing the voluntary formation of Accountable Care Organizations to
reward providers that, through coordination, collaboration, and communication,
cost-effectively deliver optimum patient outcomes throughout the continuum of
the health care delivery system.
The proposed reimbursement system
would hold providers accountable for both cost and quality of care from three
days prior to hospital admittance to ninety days post hospital discharge. To
get an idea of the complexity of variables, in terms of patient handoffs to the
next responsible party in the continuum of care, I process mapped a patient
entering a hospital for a surgical procedure. It is not atypical for a patient
to be tested, diagnosed, nursed, supported, and cared for by as many as thirty
individual, functional units both within and outside of the hospital. Units
that function and communicate both internally and externally with teams of
professionals focused on optimizing care. With each handoff and with each
individual in each team or unit, variables of care and communication are
introduced to the system.
Historically, quality systems from
other industries (i.e. Six Sigma, Total Quality Management) have focused on
wringing out the potential for variability within their value creation process.
The fewer variables that can affect consistency, the greater the quality of
outcomes. While this approach has proven effective in manufacturing industries,
health care presents a collection of challenges that go well beyond such
controlled environments. Health care also introduces the single most
unpredictable variable of them all; each individual patient.
Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered. The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out. Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.
Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect? How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS? The fact of the matter is, health care is the most human of our national industries and reforming it to meet the shifting demographic needs and economic constraints of our society may prompt leadership to revisit how they choose to engage and integrate the human element within the system.
In contemplating this approach, a
canvasing of the peer-reviewed research into both quality of care and cost
containment issues points to a possible solution; the cultivation of emotional
intelligence in health care workers. After reviewing more than three dozen
published studies, all of which confirmed the positive impact cultivating
emotional intelligence has in clinical settings, I believe contemplating this
approach warrants further exploration.
Emotional intelligence is a skill as
much as an attribute. It is comprised by a set of competencies in
Self-Awareness, Self Management, Social Awareness, and Relationship Management,
all leading to Self Mastery. Fortunately, these are skills that can be
developed and enhanced over the course of one's lifetime. Keeping the number of
handoffs and individuals involved in delivering the continuum of care, let's
examine how emotional intelligence factors into the proposed quality measures
the Department of Health and Human Services will be using come October, 2012:
1.) Patient/Caregiver Experience of
Care - This factor really comes down to a patient's perception of care.
Perceptions of care are heavily shaded by emotions. Patients consistently rate
less skilled surgeons that have a greater bedside manner as better than maestro
surgeons that lack, or choose not to display, these softer skills. Additional
research into why people sue over malpractice also indicates how perceptions of
care are formed. People don't sue over a medical mistake in and of itself.
People sue because of how they felt they were treated after the error occurred.
From the patient's perspective (and often their family's) there's a difference
between being cured and being healed. The difference often can be found in the
expression of authentic empathy through healthy, professional boundaries.
This is a key driver in patient
decision-making as well. Patients tend to choose a hospital based upon one or
two criteria; the recommendation of their primary care physician (with whom
they have an established relationship) and/or upon the recommendations from
family members or friends that have experienced care in a particular hospital
or an individual surgeon. A quick look into the field of Applied Behavioral
Economics supports this finding. Economic decision making is 70% emotionally
driven with the remaining 30% based in rational thought. In many instances, it
would appear that a lot of hospital marketing initiatives don't seem to reflect
an understanding of this phenomena. Waiting room times in Emergency Rooms have
little to do with why patients choose a hospital, yet we see billboards
everywhere that have the actual E.R. wait times electronically flashing along
the roadside. A patient's experience (and perception) of care can be highly
impacted at the handoff points within the continuum of care. Any new model of
care will require exceptional cross-organizational communications to emerge.
This requires a high level of engagement and commitment to the new vision at
every patient touch-point.
This metric also addresses the
caregivers' experience of care. This speaks largely to the experience of nurses
that are delivering that care. The research related to the impact of
cultivating emotional intelligence in nurses clearly demonstrates a reduction
in stress, improved communication skills, improved leadership and retention,
the ability to quickly connect and engage patients, as well as a reduction in
nurse burnout (which leads to turnover and additional stress amongst the
remaining staff).
2.) Care Co-ordination - Again, this
will require optimal engagement and pro-active communication
intra-organizationally and cross-organizationally. Each handoff introduces
opportunities for variable care to emerge that must be seamlessly co-ordinated.
Poor co-ordination also introduces the risk of eroding the quality of the
patient's experience.
3.) Patient Safety - Research shows
that the cultivation of emotional intelligence competencies in nursing
contributes to positive patient outcomes, lowers the risk of adverse events,
lowers costs at discharge, and reduces medication errors, all while lowering
nurse stress, burnout, and turnover. Each time a nurse resigns it adds to the
nursing shortage on the floor, requires additional hours from other nurses, and
costs the hospital approximately $64,000, on average, to backfill the open
position. Improving how an institution cares for its nurses improves the level
of patient care and safety as well. In many institutions, this will require a
shift in leadership's perspective in order to support a culture that embraces
and values the critical role nurses play in maintaining patient safety.
4.) Preventive Health - Elevating
Self-Awareness and Social Awareness in clinicians helps them quickly connect
and effectively communicate with patients. Subtle, non-verbal cues become more
readily apparent, helping clinicians understand the fears and emotions of their
patients. Self Management and Relationship Management helps clinicians
communicate appropriately and supports the expression of authentic empathy
through healthy, professional boundaries. All of these factors come into play
when speaking with patients about lifestyle choices, course of treatment, and
preventive health care. From our own personal lives we've all learned we cannot
"fix" other peoples' behaviors. We can, however, be in relationship
and help support healthy changes they're ready to embrace. Pro-actively moving
to improve preventive health will require deeper, more authentic relationships
to emerge between front-line health care providers and patients.
5.) At-Risk Population/Frail Elderly
Health - Like preventive health, being measured on the care of the community's
at-risk population and elderly will require an innovative approach to community
outreach and pro-active communication. These are not populations that can be easily
reached via Facebook or Twitter. Building effective relationships with these
demographics will require trustful, human contact and deep engagement with each
population, both of which are supported through the development of a mindful
approach (i.e. emotionally intelligent) to the challenges at hand.
It will be interesting to see how
reform unfolds and how leadership within the health care delivery system
chooses to respond to the challenges that lie ahead. Systems and hospitals that
choose to take an honest, evidence-based look at how they choose to lead, how
they create and execute strategy, and the organizational culture they're
cultivating will be well served in preparing to successfully navigate this
unprecedented change.
© 2011, Terry Murray.
Terry Murray is a professional coach
and business executive with twenty-five years of progressive experience in
strategic development, executive leadership, and the deployment of highly
profitable business teams. His executive leadership with Fortune 1000 and
start-up companies has directly contributed more than $1 billion in market
capitalization growth throughout his career.
Terry is the founder and president
of Performance Transformation, LLC a Professional Coaching and Strategic
Development firm focused on igniting breakthrough performance through the
authentic engagement and development of human talent. The company's
evidence-based programs and philosophical approach employs their proprietary
Adaptive Coaching Process. The organization's engagements align the clients'
human capital with their strategic imperatives driving tangible results,
delivering a sustainable competitive advantage and an exceptional Return on
Investment. Terry is a graduate of The Whittemore School of Business,
University of New Hampshire and a veteran of U.S. Naval Intelligence. He has
just completed his first book, "The Transformational Entrepreneur ~
Engaging the Mind, Heart, & Spirit for Breakthrough Business Success".
Nice concept..
BalasHapusPreventive healthcare