HBR: Five examples of great health care management.

Writing in the Harvard Business Review's "HBR Blog," Dr. Thomas Lee discusses five innovative practices being integrated at hospitals and health systems around the globe—and advises fellow providers to take note.

Lee, who served as the former network president of Partners Healthcare and now works at Press Ganey, highlights:

• Increased transparency at University of Utah Health Care. The health system posts on its "Find-a-Doctor" site all comments—both negative and positive—received from patients after a visit. While the system at first received some grumblings from physicians, the increased transparency has actually led doctors to provide higher levels of care, as they "understand that every patient visit is a high-stakes interaction." The public commentary—most of which has been "extremely positive"—has helped system leaders understand the quality of care being delivered at the facility, and has made physicians "better and more compassionate caregivers."

"I'm not too happy with this doctor": More on U of Utah's policy.

• Creating a culture of shared responsibility at Mayo Clinic. Lee notes that when he visited the clinic, he saw physicians willing to go beyond their specialties to deliver "first-rate, coordinated care" to patients. For instance, he said, if patient was referred to a heart specialist for shortness of breath, but the real problem turned out to be lung disease, the cardiologist would continue to play a role in the patient's care to make sure "all the loose ends are tied up during and after the consultation" with the pulmonary specialist. Said one clinician, "We know that these patients did not come here for us as individuals. They came because we're the Mayo Clinic. So we all know that they are not really 'my' patients – they are 'our' patients."

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• Working as one, coordinated care team at Northwestern Medicine's Integrated Pelvic Health Program. At Northwestern Medicine in Chicago, the system's Integrated Pelvic Health Program calls on surgeons with expertise in gynecology, urogynecology, and colorectal surgery to work together with physical therapists in the treatment of individuals with incontinence, uterine and vaginal prolapse, anal fissures, and fistulas. Lee notes that he has also seen great examples of teamwork at Hennepin County Medical Center in Minneapolis, Minnesota, which put a dental center next door to an ED, and the University of Utah, which places case management staff within hospital ICUs. He says that co-location is imperative to real teamwork and that teamwork is critical for good patient care.


• Addressing socioeconomic issues at Contra Costa Health. After conducting a patient survey that found that patients at safety-net clinic Contra Costa Health, lacked access to many basic needs like food and shelter, the clinic began working with HealthLeads, an organization that helps address problems that fall out of the range of traditional health care services, such a providing patients with access to food subsidies, housing leads, and employment opportunities. Within weeks of the partnership, Contra Costa physicians said they could see real changes in some of their patients with chronic conditions. Said one physician, "I felt like I had finally been a good doctor to him and it wasn’t due to anything I learned in medical school."

• Consolidating care at the London Stroke Institute. The city of London in 2010 made the decision to care for stroke patients at just eight of its 34 hospitals, meaning about two dozen other facilities had to stop offering stroke services—some "kicking and screaming" about it. But limiting care resulted in a decrease in morality for stroke by 25% and a reduction in total spending for stroke patients by nearly 6%.

Concludes Lee, "None of [these concepts] required much in the way of capital investment. But all of them required (and continue to demand) expenditure of social capital, changing the way people work together." He concludes, "the results are impressive" (Lee, "HBR Blog," Harvard Business Review, 11/6).

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