The top issues confronting hospital leadership teams can often be traced to organizational silos, lack of integration and lack of alignment. This was the consensus reached by participants at a recent executive roundtable hosted by TeamHealth at Becker's Hospital Review's 10 Annual Meeting in Chicago, an event that included C-suite executives from leading hospitals and health systems.
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TeamHealth's chief growth officer, Dan Collard, led the conversation, which focused on the risks of a lack of alignment and integration across important clinical service lines. Dan Wilbanks, senior vice president of business development, shared success stories and lessons learned from TeamHealth's experience driving alignment and integration.
Top issues for hospital leaders
The American College of Healthcare Executives polls hospital leaders each year to identify the top 10 issues confronting hospital executive teams. Mr. Collard summarized the most recent results, telling attendees that financial pressures (as in previous years) top the list, followed this year by government mandates. Tied for third were personnel shortages and patient safety and quality.
Over the past two years, personnel shortages largely refer to physician shortages. This is a problem experienced by many types of hospitals, including those in competitive urban communities, in rural areas, big brands and community hospitals that compete with those big brands.
The first silo
The operational challenges facing hospital leaders are often born from organizational silos. Patients also experience silos and the impact that can result from poor alignment and collaboration across service lines of silos. Mr. Collard termed "the first silo" experienced by patients is a disconnect between physicians in the emergency room and hospitalist physicians who take the lead in caring for patients after they are admitted.
When emergency department physicians and hospitalists don't work together in an integrated way, the entire care process is not smooth. Results include longer stays in the ED and more sentinel events due to dropped balls and lack of communication. Mr. Collard observed, "Lack of integration means it's not the best of care. It's confusing for patients…most importantly, in many cases it's more expensive care. It's not as efficient as care should be."
Achieving alignment and integration
Reflecting on what it would take to improve the integration between various hospital-based services, Mr. Wilbanks commented, "It's not really rocket science. Successful integration comes from alignment and coordination of care." In TeamHealth's experience, successful integration is a result of focusing on very basic elements of:
- Having aligned goals and incentives between all clinical services lines, particularly emergency medicine and hospital medicine.
- Ensuring frequent communication. A simple example is a daily huddle between hospitalists and emergency medicine physicians.
- Establishing a unified platform with consistent metrics.
Also, when TeamHealth works with a healthcare organization to provide hospital-based services, the company improves integration by creating a single point of contact between TeamHealth and the hospital or system.
Here are two examples of integration success:
- Nevada hospital. TeamHealth was brought in to assist a hospital in Las Vegas that lacked collaboration between the emergency room and hospital medicine. One step TeamHealth took was to focus on having discharge orders written on a timely basis each day. This resulted in a 400 percent increase in discharges before 11:00 am, an improvement that helped the hospital decrease the average length of stay by 2.7 days. Mr. Wilbanks pointed out that when you have integrated services, you have improved patient experiences and greater clinical and economic efficiencies.
- Alabama health system. At several hospitals in the Birmingham, Ala. market, TeamHealth implemented what Mr. Wilbanks termed, "some common sense coordination." This involves working with each hospital to determine departmental goals and common goals, and then working to establish aligned incentives for physicians and service providers. Mr. Wilbanks recapped, "There would be an emergency medicine goal, a hospital medicine goal and then there would be combined goals . . . and we would drive toward making sure we hit both the individual goals and the common goals as well."
These examples convey the benefits of alignment and coordination, which Mr. Wilbanks described as improved quality of care, enhanced patient safety, a better patient experience and improved clinician satisfaction and engagement.
The importance of leadership and goal alignment
During the roundtable, the president and CNO of a not-for-profit hospital in the Southwest said she believes having disparate goals for individual departments undermines alignment. When each department is solely focused on achieving its own goals, this results in an emphasis on speed as opposed to thoroughness. It causes missed handoffs and leads to readmission penalties.
The hospital president said aligning and coordinating goals requires setting up consistent protocols and metrics for all service lines. She suggests "aligning contracts and using those incentives to help drive the organization's efficiencies, finances, quality and safety." At her organization, goal alignment improves handoffs because everyone is incentivized to support the organization's overall goals. In assessing the ability of organizations to support successful integration and alignment, the CNO said, "I think it's going to take real leadership to pull it all together."
Mr. Wilbanks agreed, terming leadership as "the super glue." TeamHealth's model involves investing in leadership development and leadership succession planning.
Mr. Wilbanks summarized a leadership lesson from TeamHealth's experience. He said, "When you have a facility medical director leading the [emergency medicine/hospital medicine] integration, that in and of itself has shown to have a huge impact. . . . [A hospital in Alabama] would say it is that leadership existed over both of these services that helped achieve positive results."