Earlier this month, the New England Journal of Medicine (NEJM) published a Perspective article by Richard Bohmer entitled, “The Four Habits of High-Value Health Care Organizations.” The full text is available online.
The premise is that while successful organizations may vary in structure, resources, and culture, there are key similarities in approaches to care management. Though the article pertains more to large institutions, the four habits identified are likely to be helpful to even the smallest of practices:
- Specification & Planning
- Infrastructure Design with a Focus on Microsystems (see Dartmouth microsystem academy)
- Measurement & Oversight
How can you apply these habits to small practices implementing/optimizing health IT? For specification/planning, does your practice incorporate standardized workflow processes including intake of patients by staff, algorithm-based screening, and order sets for common clinical situations? How about use of clinical decision support? Standard referral processes and policies regarding information sharing for transitions in care? Does your practice analyze the patient population served to identify groups who might benefit from standard interventions (i.e. vaccinations) or management (i.e. depression screening)?
What about infrastructure design? Does your office make sure that staff are practicing to the highest level of their license, skill, and knowledge (including the clinicians)? Do you ensure that all of the necessary supplies, equipment, and technology are readily available when needed? Does the leadership of the practice set overall objectives (clinical and operational) and then plan accordingly to make certain that there is alignment across the practice, that staff are advised and trained to help achieve those goals, and that the office budget reflects these priorities?
Bohmer points out that measurement and oversight is often driven by external factors and organizations. However, high-value practices use measurement to support internal evaluation of processes and performance management according to the goals set by the team. In many cases, these metrics go well beyond those required for external entities — and since they are aligned with the goals/objectives of the practice, they are often (and should be) more meaningful.
Finally, if a practice doesn’t engage in self-study how can it be sure that the processes set in place are achieving the ends desired? For example, if evaluate of adherence to a condition-focused practice guideline demonstrates that Physician A is doing better than Physician B, the team should determine why the difference exists to help the entire practice deliver higher quality, more cost-efficient and patient-centered care.
Be sure to read the article for more details and add your comments below.
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.