In a post-COVID world, healthcare systems are even more challenged to figure out how to do more with less. "Systemness" is an operational approach to these challenges that brings uniformity and greater transparency to health systems.
During a session sponsored by North American Partners in Anesthesia (NAPA) at the Becker's 10th Annual CEO + CFO Roundtable, Peter H. Doerner, NAPA's Executive Vice President & Chief Development Officer, led a discussion on Systemness.
Three key takeaways were:
1. Clinical staffing shortages are forcing systematic changes. At a time when healthcare is in high demand, the strain on resources can lead to the contracting of health systems through closure or consolidation of service lines. Enabling clinician-physician teams to drive the decision-making process can be an effective way to ensure providing safe coverage and retaining patients during this challenging time.
For example, a group in Chattanooga, Tenn., made the difficult decision to close a STEMI program at their smaller hospital to consolidate staff at its main hospital, Baroness, due to shortage of needed competencies. However, the stakeholders in the GI program—composed of nurses, physicians, and anesthesiologists—made the decision together to set up two separate teams for two different hospitals to cover the system, despite the intensified travel and scheduling demands.
2. Systemness improves organizational consistency and quality. Multiple models within a single health system often result in different sets of metrics for outcomes, multiple points of contact, and a variety of delivery systems. In such a landscape, subspecialists may be duplicated versus cross utilized.
At a highly integrated, multi-institutional health system in the Midwest comprising 15 hospitals and more than 250 physician practice sites, serving midsized and rural communities throughout both states, its CEO and health system team have been working with NAPA to create a unified model of perioperative services.
By bringing the original five different models (hospital-employed, system-employed, plus three separate small anesthesia groups) at the system under one umbrella, it sought to achieve consistency of quality and outcomes across all sites and services. Eliminating silos is allowing the health system to gather actionable and robust quality metrics, streamline service provider contracts and billing, and strengthen the system by allocating resources and sharing knowledge. The hospital leadership is actively working with NAPA to implement Systemness in anesthesia, with goals to extend the approach to other clinical and non-clinical areas moving forward.
3. Successful change management requires trust building. Like that Midwest system, an east coast health system previously used different methodologies for delivering anesthesia and perioperative care. Working with NAPA to implement Systemness, this system gained operational and cost efficiencies and maximized resources, including using flex staffing models in one of their operating regions
The health system also expanded and grew service lines and enhanced quality innovation and satisfaction. For example, in one region, conscious sedation was used for GI care rather than the standard of care of monitored anesthesia care (MAC). Applying change management best practices, NAPA established relationships with practitioners and gained buy-in and trust to eventually shift the team from using conscious sedation to MAC anesthesia. Uniting clinical care around a common process improved patient outcomes and streamlined healthcare system operations.
"The number one thing is trust . . . you're going to change something that may affect them. You need to be involved, hands-on — they need to trust you," a consulting anesthesiologist from a medical center in the Midwest said." Give an example of how it's better for them and then show them not only statistics and data, but a trial or a pilot."
In today's increasingly complex healthcare market, providing consistent care and maintaining patient safety requires new ways of thinking. “Systemness means aligning multiple facilities and teams systemwide,” said Mr. Doerner. “This approach can maximize resources, enhance service lines, reduce operating expenses, and achieve a single mission through integrated and standardized solutions.”