Aligning strategic and clinical initiatives: 23 hospital leaders weigh in

The healthcare industry is undergoing unprecedented change, and leaders at all levels are looking for new strategies to improve outcomes, enhance the patient experience and lower costs.

"The shift from fee-based, volume-driven care to value-based, patient-centered care propels us all into uncharted territory, no matter what role you play in healthcare," said Michelle Zaluzney, vice president of business development for Dublin, Ohio-based Cardinal Health. "These changes will require clinical initiatives to more directly align with the hospital’s strategic initiatives."

The most successful and high-performing healthcare organizations are already embedding business principles into patient strategy across all care settings to remain financially viable and competitive in today's complicated healthcare environment, according to Ms. Zaluzney.

She joined nearly two dozen hospital and health system leaders to discuss the challenges and benefits of incorporating business acumen into critical clinical initiatives. The discussion occurred during an executive roundtable at the Nov. 14 Becker's Hospital Review 6th Annual CEO + CFO Roundtable in Chicago.

Prioritizing clinical initiatives
While most hospitals can easily identify areas of clinical and operational improvement, attempting to tackle too many strategic initiative projects at once is costly and yields few benefits. Therefore, leaders must carefully decide where to focus their limited financial and human resources to make the greatest impact on their organization's strategic goals.

Clinical and administrative leaders identified numerous methods for choosing which clinical initiatives to prioritize. The CEO of a 52-bed nonprofit hospital on the West Coast said her hospital relies on data dashboards to choose strategic initiatives. "The dashboards are usually based on CMS core measures like safety and value-based purchasing metrics that will affect both the hospital's bottom line and patient experience," she said.

A 117-bed nonprofit hospital in the Southwest also uses dashboards to prioritize initiatives, but incorporates clinician input via clinical consensus groups, according to the organization's CEO. These groups, comprised of clinicians from different specialties, are responsible for identifying top clinical issues based on volume or risk and presenting them to hospital leadership, who can then add the initiatives to an executive dashboard.

Clinician involvement in this decision-making process is crucial, according to the executive director and CNO of a small acute care heart hospital in the Midwest. Clinical initiatives will not be successful unless clinicians have a stake in the strategic initiative and understand the organization's overall vision. At her hospital, clinicians and executives meet annually to assign strategic goals. "We sit down at the table and co-manage together to make decisions and drive the solution," she said.

Removing the roadblocks to success
Deciding which clinical initiatives to tackle is just the first of many barriers leaders may face.

Most executives at the roundtable discussion agreed their hospitals have too many dashboards and too many initiatives listed in each dashboard, which makes it difficult to prioritize initiatives and focus on overall strategy. If leaders are too caught up in one dashboard or task, they may ignore other initiatives that, when missed, can threaten the health of the organization, according to the CEO of a 25-bed critical access hospital in the South.

"If you're in a car and focus too much on the speedometer, you don't worry about tire pressure, oil level or the engine unless you see smoke coming out of the hood," he said. "The same thing is true with dashboards."

Leaders also identified integration with pre- and post-acute care partners as another barrier to success. These providers may not be aware of the hospital's specific clinical priorities, which can hinder progress toward strategic goals. To sidestep this issue, the CEO of a 52-bed hospital on the West Coast said her hospital employs clinical pharmacists and care coordinators to work with physician groups on important clinical initiatives, such as medication reconciliation. This strategy supports the hospital's clinical priorities, but represents a direct cost for the organization, which can add up, she said.

Pre- and post-acute care is key for future success, according to the CMO of a 520-bed hospital in the Northeast. "As healthcare organizations struggle to prevent hospital readmissions, we need to shift our thinking to the prevention of admissions," he said. "We must think about patient care that can occur in the ambulatory environment.  Without an admission, there can be no readmission."

Strategies for optimal alignment
While executives and clinicians shared different pain points surrounding clinical and strategic alignment, both groups agreed transparency and trust between staff and leadership are critical.

Before implementing a clinical initiative, leaders must clearly articulate what they're trying to accomplish and why. Employees are more likely to buy into the vision when they realize the initiative is crucial for the organization's future success, according to the president and CEO of a community hospital in the South.

"You need to convey this message to the entire organization," he said. "While physicians and housekeepers may have different motivators, everyone understands the need to be financially viable."

After leaders achieve organization-wide buy-in, they must also ensure employees understand their role in the initiative and feel a sense of ownership over the tasks at hand. Providing staff members with data on pricing, utilization and quality measures can help them better understand the hospital's strategic agenda and motivate them to positively change behavior.

Once leaders and clinicians are aligned and working toward a common goal, the remainder of the process is all about gradual, ongoing improvements, according to the CEO of a 25-bed critical access hospital in the South.

"If you implement an initiative on a Monday, you can't walk into your hospital on Tuesday and expect something to magically happen," he said. "It has to mature and develop. But when the opportunities present themselves, you'll see amazing things come out of your team."

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