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Continuous learning drives healthcare improvement

February 20th, 2013

by Judith D. Bentkover

The challenge of creating a new healthcare system--one that is integrated, patient-centered, data-driven, delivers coordinated care, fosters continuous improvement and emphasizes value and care outcomes--is extraordinary in its complexity and magnitude, and cannot be achieved simply by adopting new IT systems or implementing new clinical guidelines.

Yes, these are essential tools for better managing healthcare, but innovative technologies and systems facilitate and do not drive large-scale change.

Transformative change starts with leadership. Not a top-down, command and control style of leadership, but rather leadership that sets the course and then recognizes the task ahead demands the institution summon commitment, expertise and experience in support of a shared vision.

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This style of leadership is based on collaboration and infuses high levels of teamwork in organizational practices. For this to take place, leadership must first establish a culture that supports and encourages partnership and group effort through processes that are built upon the continuous learning and innovation essential to drive transformative change.

Establishing the New Culture
Change begins at the top. The first and most critical task of any leader is setting the tone for the organization. For any organization to significantly change how it operates, management must establish clear strategic goals and expectations, communicate those strategies to the entire organization and consistently demonstrate its commitment to those strategic goals. Leadership must be able to secure the buy-in of staff, engage them in finding solutions and be willing to hold them accountable for achieving the results.

For example, Craig Samitt, president and CEO of Dean Health System in Wisconsin, has been a strong and effective advocate for change. He has remarked there is “danger in the belief that the status quo will prevail” and has challenged Dean's physicians and entire staff to actively engage the patient in decision making. He also has made great strides in integrating patient satisfaction and service measures alongside quality metrics.

Beth Israel Deaconess Medical Cente's preventable harm initiative is an instructive example of this strategy. The leadership has clearly articulated a strong commitment to eliminating preventable harm. By embracing this kind of ambitious goal, the hospital sends a clear message that it is unacceptable to think some level of harm is unavoidable. Leadership has radically recast the culture of patient safety at the hospital and reinforces its commitment by announcing hospital defects publicly and regularly reporting on the results.

Encourage Continuous Learning and Improvement
A defining characteristic of modern healthcare is the rapidly accelerating increase in information that is available to clinicians and administrators for delivering care and managing systems. Further, the healthcare reform law includes powerful incentives for driving rapid and continuous innovation. For example, Medicare's Hospital Readmissions Reduction Program relies on relative standards based on comparisons with other hospitals rather than fixed metrics.

As a result, hospitals need to continuously reduce readmission rates to avoid potential fines. Not only does this goal place a high premium on the need for sophisticated systems to manage the flow of information, it also requires a commitment by the organization to build and incorporate processes for continuous learning, knowledge sharing, innovative change and improvement.

Hospitals, such as Seattle Children's Hospital, have adopted methods including continuous performance improvement (CPI) that empower teams of doctors, nurses and other staff to constantly question how things are done and to recommend operational changes that will improve efficiency. Seattle Children's estimates it has made more than 1,000 procedural changes that together have significantly improved quality and patient satisfaction while reducing costs.

Similarly, Geisinger Health System of Pennsylvania built an "innovation architecture" that engages stakeholders in continuously examining and considering redesign of care models to achieve higher quality, more efficient care. Furthermore, Geisinger encourages care teams and administrators to share this information across disciplines, so best practices diffuse rapidly throughout the organization.

Conclusion
The common ground among healthcare providers who successfully transform how they deliver care is the ability to weave together strong leadership at the top while empowering front-line staff to implement the actual changes necessary to advance strategic goals. These elements of successful leadership require that leaders point the way, allow management to figure out how best to execute the strategic plan and then hold everyone accountable for the results.

Judith D. Bentkover, PhD, is an adjunct professor of Health Services, Policy and Practice at Brown Alpert Medical School and the academic development director in the Executive Master of Healthcare Leadership program at Brown University. She also is president and CEO of Innovative Health Solutions, which provides research and strategic analysis to healthcare manufacturers, providers and payers.

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