Very few in healthcare would deny the industry today is plagued by variability, error and high costs. In fact, most would argue that the organizations that figure out how to remove this variability and error, while better coordinating care, will be the organizations able to succeed in what can best be described as an extremely complex and challenging environment.
But how do healthcare organizations achieve standardized care? For many leaders, the answer has been to take on risk. However, those who pursue this method should be warned: Taking on risk is the end-game, and not where to start to bring about meaningful behavior change.
According to Tom Burton, co-founder and senior vice president of product development at Health Catalyst, and former engineering manager for Murray, Utah-based Intermountain Healthcare, the question healthcare organizations need to answer in order to succeed at risk, and improve healthcare overall, is: "How do we change clinical behavior in a systematic way?"
While technology is needed to analyze care decisions and guide physician decision making, healthcare will not succeed at improving care unless providers and processes become the focus. "This isn't just a technology problem," he told me during an interview at the HIMSS Annual Conference and Exhibition in Orlando last week. "There's no technology silver bullet."
So how do we change providers' decisions and processes? Three key steps are needed, each of which serves as an answer to three questions that currently perplex the industry, said Mr. Burton. While the "how" to each step is yet to be figured out, the questions can serve as a starting point for innovation that hopes to improve care delivery.
1. Faster diffusion of best practices — How do we get new medical knowledge into everyday practice? On average, it take more than a decade for a new medical discovery to be incorporated to a physician's daily practices. The need for a speedier method of diffusion is obvious.
2. Reliable, near real-time measurement systems — How do providers know how they're doing? Mr. Burton mentioned pilots as an example of a profession that has reliable, real-time feedback at their fingertips. As a result, errors rarely occur. "We need that same kind of measurement system, feedback loop, in healthcare."
3. Deploy measurement across networks — How do we change clinical behavior systematically? Improved adherence to evidence-based best practices and better performance data for physicians at one organization isn't enough. How does a change taking place at one hospital move into all 20 hospitals in a network? Across a region? Across the nation?
Our industry's lack of an answer to these three questions can be illustrated by efforts to reduce early elective deliveries.
Providers have long been aware that early elective deliveries (before 39 weeks) are associated with higher costs and complication rates; the American College of Obstetricians and Gynecologists has advised against these deliveries for over 30 years. Yet as recently as 2010, 17 percent of deliveries did not comply with this guideline. Since then, however, there has been significant improvement in compliance, through education and payer incentives, among other "carrots" and "sticks." According to new data from The Leapfrog Group released today, the national rate of early elective deliveries has fallen below 5 percent (the rate for the 2013 calendar year).
Yet, the improvement isn't equally distributed. "Some hospitals are still reporting early elective delivery rates higher than 20 and 30 percent, which means there is still work to be done," said Leapfrog President and CEO Leah Binder is a statement on the findings.
So, while it appears that the healthcare industry has finally answered questions one and two (albeit after 30 years), the third question remains; and it's the very one Mr. Burton started our conversation with: "How do we change clinical behavior in a systematic way?"