How do some hospitals consistently deliver higher value? Harvard Business School professor Richard Bohmer this week in NEJM outlines four habits of the nation's highest-performing organizations.
Highly successful hospitals—including those in the High Value Healthcare Collaborative, a unique cohort of some of the nation's leading facilities—"often have unique personalities, structures, resources, and local environments," which makes it difficult for other organizations to follow suit, Bohmer says.
According to Bohmer, other hospitals should look beyond specific practices and instead examine their habits, or the "repeated behaviors and activities and the ways of thinking that they reflect and engender."
Specifically, Bohmer outlines four common habits that high-value organizations share:
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1. Specification and planning: When possible, high-value organizations base operational and core clinical decisions on explicit criteria and divide patient populations into meaningful subgroups. For example, Dartmouth's Spine Center uses a detailed intake assessment—which includes a survey, visual aids, and shared decision making—to triage patients based on the likelihood that they will achieve better outcomes with medical or surgical care.
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2. Infrastructure design: High-value organizations create microsystems to meet the needs of patient subpopulations. Within those microsystems, tasks are allocated to clinical team members based on skill and training, and assistive personnel is provided with all necessary resources through careful information and equipment supply chain design. According to Bohmer, microsystem design represents "an important shift away from general-services-organization designs that use a single platform to meet the needs of many different patient groups."
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3. Measurement and oversight: High-value organizations use measurements of clinical operations for internal process monitoring and performance improvement. They often collect more data than required by payers, regulators, and ratings agencies, and integrate quality measurement with organizational priorities. For example, Intermountain Healthcare each year uses different quality measurements to set annual quality and efficiency bonuses.
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4. Self-study: High-value organizations examine positive and negative deviations in care and outcomes. While most hospitals consider clinical knowledge to be the property of a clinician, high-value organizations also treat it as organizational property, which they use to create common tools to improve outcomes, Bohmer says.
Although Bohmer acknowledges that these habits are not necessarily unique to high-value organizations, he writes that these hospitals engage in all four tactics consistently and simultaneously. In addition, he notes that they have a comprehensive clinical management system that focuses more on clinical processes and outcomes than on resources (Bohmer, NEJM, 12/1 [subscription required]).