Jonathan Bush: Health systems should focus more on access, less on the Triple Aim

Declaring a keystone habit is the name of the game for providers who seek revealing metrics that may not seem wholly relevant right off the bat but, upon closer examination, serve as invaluable indicators of the health and performance of their companies and endeavors, writes Jonathan Bush, CEO and president of athenahealth, in a blog post for the Harvard Business Review this week.

For athenahealth, Mr. Bush's own brood, he singles out workforce stability as a keystone metric, one that will lead to improvements across the board when properly measured and nurtured.

"Over 17 years, we've found that our success depends on focusing first on managing voluntary turnover, ahead of all other traditional performance measures (including the ones our investors care about). Any spike in voluntary turnover is a canary in our coalmine and raises an alert that we take very seriously," he writes.

Managing these habits for a single company is one thing, but is this philosophy scalable to a machine like the healthcare industry overall? Yes, Mr. Bush argues, if providers can keep their fingers on the right pulse.

The Institute for Healthcare Improvement's 2008 Triple Aim strategy, which focuses on improving individual patient experience, improving the health of overall populations and reducing the per capita cost of care, has become has become a healthcare trope of sorts, he notes. And those three points might be more pulses than the industry can — or should — aim to keep tabs on.

Though the Triple Aim serves as a stirring call to action, according to Mr. Bush, dividing the attention and resources necessary to conquer the three-heads of that beast may be a kind of multitasking that results in spinning wheels rather than incremental steps forward.

"It's not that I don’t believe those three outcomes are vitally important … I just don't believe it's possible to aim at three things at once. As a manifesto or creed, it's inspiring. As a roadmap, it's a bit hard to follow," writes Mr. Bush.

More than the Triple Aim, patient access should be the focus for providers, he says, even if it comes before quality of care.

"When providers make it a habit of opening their schedules and committing to same-week-or-sooner appointments other good things can happen. Appointment types can be simplified and streamlined, driving other opportunities for process improvement and efficiency. Care is more likely to be directed as appropriate to lower-cost providers and nurse practitioners or even to virtual consults, cutting costs and eliminating unnecessary care. And, most important, physicians can be freed up to see the sickest patients when they need to be seen," he writes.

Review studies, meta analyses of big data and anecdotal patient and clinician experience show this to be true, according to Mr. Bush. If providers feel around for a different, more focused pulse, it could help tighten screws in the larger machine.

"Being best in the world at getting your patients in for care quickly when they need it can lead to being best in the world at other good things. Some don't buy it, or have other priorities that seem right for their practices, which is fine by me. As long as they pick one thing (not three) to focus on relentlessly, and then test and learn their way forward from there."

More articles on leadership:

Executive roundtable: Strategies from making the shift from fee-for-service
5 powerful habits that keep Scripps CEO Chris Van Gorder connected to his team
20 pieces of advice from hospital CFOs

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