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An assessment tool for measuring the health of healthcare workplaces


Med Page Today reports:

“According to the American Association of Critical-Care Nurses (AACN) {a good working environment} is a place where healthcare professionals can make their optimal contribution. For almost a decade, critical-care nurses have been able to evaluate the health of their work environment with the association’s online assessment tool based on its Healthy Work Environment standards.

“Now a new study finds that the tool has applications beyond critical care, and is effective for assessing the health of the work environment for interprofessional patient care teams throughout a hospital’s patient care settings.

“‘Although AACN’s assessment tool has been used primarily among acute and critical-care nurses, our findings support consideration of wider use in multiple healthcare settings’  said the study’s principal investigator, Jean Anne Connor, PhD, RN, CPNP, director of nursing research, cardiovascular, and critical care patient services at Boston Children’s Hospital. ‘Clinical leaders understand that to safeguard the quality of patient care, attention must be focused on the performance of healthcare teams.”‘

“The assessment tool is an 18-question survey designed to help organizations or departments identify areas for improvement. It assists in measuring the health of a work environment against AACN’s six Healthy Work Environment standards:

  • Skilled communication
  • True collaboration
  • Effective decision-making
  • Appropriate staffing
  • Meaningful recognition
  • Authentic leadership

“The study, published in the American Journal of Critical Care, reports the results of a two-phase administration of the tool to 2,621 patient-care employees at Boston Children’s Hospital.”

To read the full Med Page article, please hit this link.

Successful medicine is now all about teams

Harvard Business School Prof. Michael Porter writes in a NEJM Catalyst piece headlined “What 21st Century Health Care Should Learn From 20th Century Business”:

“{The} variability in patients will always persist, but what has disappeared is the ability of any individual physician to deliver excellent care on his/her own. In today’s sophisticated medicine, the patient needs a team. The ability to personalize care lies in the ability of experienced groups of clinicians working together in treating patients with similar conditions to understand how to deal with individual differences. An IPU {Integrated Practice Unit} team is far better equipped to deal with exceptional cases and deliver personalized care than the traditional model — just as SBUs {Strategic Business Units} were better able to respond to their customer needs for their product than traditional functional structures. Health care needs real teams and real IPUs that are dedicated to meeting the needs of particular groups of patients, with the same focus that SBUs allow in meeting the needs of their customers for their product.”

To read the piece, please hit this link.

Some big providers launch nonprofit generic-drug company


Intermountain Healthcare’s headquarters in Salt Lake City.

FierceHealthcare reports:

“Some of the largest providers in the U.S. have officially joined forces to launch a nonprofit generic drug company.

Civica Rx was formally established Thursday after it first announced in January. The idea, which was spearheaded by Intermountain Healthcare, drew plenty of interest from hospitals and health systems; more than 120 healthcare organizations—including one-third of U.S. hospitals—have signed on.

The company’s initial governance will include seven health systems, each of which will contribute a member to the board: Intermountain, Catholic Health Initiatives, Mayo Clinic, Trinity Health, SSM Health, HCA Healthcare and Providence St. Joseph Health.”

To read the article, please hit this link.

Future physician supply amidst the growing ranks of NP’s and PA’s


An article in NEJM Catalyst looks at future  physician supply in relation to increased use of nurse practitioners and physician assistants.

The writers conclude:

“It is unlikely that the physician supply will grow more rapidly than we project: the AAMC projects even slower growth, the number of GME slots is constrained, and even an immediate expansion of medical school capacity and training opportunities wouldn’t substantially affect the physician supply for many years. Growth in the NP and PA workforces is more uncertain. Although shorter, more flexible training requirements for these providers have facilitated an unprecedented increase in new entrants, growth rates could fall if demand for nonphysician providers is lower than anticipated and job-market prospects worsen. Major changes are unlikely, however, given the expected increases in demand for care, growing use of team-based and interprofessional practice, and the fact that NPs disproportionately serve rural and underserved populations, whose needs would otherwise go unmet.”

To read read the article, please hit this link.

3 congressmen ask for study of hospital consolidation and higher costs

Three Republican congressmen have written to the Medicare Payment Advisory Commission (MedPAC) to express  concern about whether hospital consolidation raises costs for Medicare beneficiaries. They asked the commission to begin researching the matter.

The 340B program, in particular, they said,  ”appears to be having an unintended secondary effect in encouraging consolidation.”

“Bipartisan concern over the degree to which Medicare payment policy may be accelerating hospital consolidation and negatively impacting the Medicare program has been present in Congress for some time,” wrote Reps. Greg Walden, R-Ore., Michael C. Burgess, M.D., R-Texas, and Gregg Harper, R-Miss., in the letter to MedPAC (PDF).

The legislators were worried about more than just hospitals buying up other hospitals. They also said they’re worried about hospitals buying up so many physician groups, which many experts say is driven by federal payment policies.

FierceHealthcare says that some reports have found” that consolidation can increase costs by as much as 20 percent—and one particularly concerning study found that merging hospitals had 40 percent higher prices than nonmerging hospitals.”

To read the Fierce article on this, please hit this link.

Technology to ‘save’ primary care


An article in NEJM Catalyst discusses how to use technology to “save primary care”. Among the authors’ remarks:

“{T}he provider would make the determination as to whether the patient could be treated virtually, would need to be evaluated face-to-face in an acute care environment (e.g., an urgent care center or emergency department), or could wait for a scheduled appointment with a generalist or specialist. …

“When we consider the current system, in which robust evidence and clinical decision support have been embedded into provider workflows, we can see that guideline compliance has increased dramatically, resource utilization and costs have decreased substantially, and, most importantly, patient outcomes have improved significantly.

“If we can take it a few steps further by (1) employing wearables and other devices (e.g., FitBit, Apple Watch, Amazon Echo) to passively collect waveform vital sign data; (2) allowing data science, machine learning, and prescriptive intelligence to monitor patients for physiologic distress well before it is symptomatic and even manage a portion of primary care; and (3) using providers sparingly and respectfully when human judgment or specialty or procedural care is needed, we will have done what every other industry has — we will have used technology to make our product better, faster, and cheaper. ”

To read the piece, please hit this link.

Esprit de corps essential for successful healthcare organizations


Esprit de corps is essential for well-functioning healthcare institutions, says Stephen Swensen, M.D., medical director for professionalism and peer support at Intermountain Healthcare. He is also a senior fellow of the Institute for Healthcare Improvement, where he co-leads their Joy in Work Initiative.

A NEJM Catalyst article (which includes a video link) about his talk includes this:

“Healthcare systems need esprit de corps to achieve high performance. But, as Swensen notes, ‘Most of you already knew this.’ He references a recent NEJM Catalyst survey, where respondents said the biggest barriers to high performance are unaligned goals and weak culture. Social capital, esprit de corps, helps us connect, align, and build a culture that focuses on the meaning and purpose of caring for patients and their families in the communities that we have the privilege of serving.”

“He references a recent NEJM Catalyst survey, where respondents said the biggest barriers to high performance are unaligned goals and weak culture. ‘Social capital, esprit de corps, helps us connect, align, and build a culture that focuses on the meaning and purpose of caring for patients and their families in the communities that we have the privilege of serving,”’ he said.

He notes that a third of the $3.2 trillion spent on U.S. health care is excess capacity, according to the National Academy of Medicine — approximately $1 trillion in waste every year.

“Six categories of waste build this excess capacity, and healthcare systems own the first three: overtreatment, failures of care delivery, and failures of care coordination. The ramifications of that waste, beyond money, are staggering. It hurts patients, the care team, and esprit de corps. ‘On a more positive note,’ he says, ‘this $1 trillion of waste, the excess capacity in this glass of water, is the funding opportunity for co-creating quality that will both address these defects of care and rebuild esprit de corps.”’

“How do you measure esprit de corps? By counting pronouns. When former Labor Secretary Robert Reich visited organizations to assess their vitality, he listened to the people doing the real work and counted how many times they used the pronouns “we, us  and ours.’ He also counted ‘they’ and ‘them.’ The organizations that used first-person pronouns were set up to thrive; the ones that used third person were set up for mediocrity. ‘We need to shift to the right pronouns, to have it reflect our engagement and our fulfillment in our purpose of the work we do.’

To read and hear Dr. Swensen’s remarks, please hit this link.

CMS chief says it’s time for ‘next step’ for ACO’s


FierceHealthcare reported:

“In a webinar with the Accountable Care Learning Collaborative (ACLC) on Monday, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma reiterated that it’s ‘time to take the next step’ in Accountable Care Organizations (ACOs).\

She argued two-sided risk models lead to better outcomes and lower costs, but 82% of ACOs still haven’t made the transition. CMS wants to force those remaining ACOs to switch with a new rule that would limit upside-only models to just two years. ”

To read the whole Fierce article, please hit this link.

Roundtable discussion on physician burnout


This is from an article in  NEJM Catalyst about a round-table discussion about possible solutions for physician burnout.

“Like the quality movement that has transformed health care over the past decade, solving the problem of physician burnout is a process, not a simple set of one-time fixes or action items. Think improving workflow, communication, and culture. A proper diagnosis is essential to a cure. Above all, engaged leadership is crucial to reducing burnout.

These were the takeaways from an extraordinary discussion at an NEJM Catalyst in-person roundtable, ‘Seeking Solutions to Physician Burnout,’ which brought together experts with different perspectives on this pressing issue: a medical group CEO, a chief wellness officer and leading researcher on burnout, a psychologist who created the leading survey instrument, and a consultant and executive coach for physicians and physician organizations. Sponsored by IBM Watson Health, NEJM Catalyst editors moderated the discussion, supported by survey results of the NEJM Catalyst Insights Council that point the way toward solutions to combat burnout and its causes.”

To read the discussion, please hit this link.



The personas needed for leaders of value-based care


Robert Pottharst, writing in NEJM Catalyst, discusses the personas that healthcare organizations need to move successfully into value-based care. He is chief operating officer of Cityblock Health and former  vice president for strategy and execution for Kaiser Permanente.

He identifies the key personas as:

Community connectors

Coordinated care champions

Trust-based Dyads.

Value evangelists

He concludes his essay:

‘The deliberate nurturing of specific types of leadership personas seems to be a critical factor in the successful leadership of value-based care organizations such as Kaiser Permanente and CareMore Health. The managers and clinicians who will be successful in guiding their organizations and this industry through the transformation to value-based care may consider emulating similar traits, capabilities and mind-sets. Moreover, healthcare organizations also may seek to emulate these personas when creating and filling key leadership roles. These leadership personas represent the types of magnetic leaders that young, aspiring future leaders can work with and learn from as they build their own careers.

Looking ahead, the Community Connectors, Coordinated Care Champions, Trust-based Dyads, and Value Evangelists will serve as important examples of the types of leaders who will enable organizations to succeed in a value-driven healthcare industry.”

To read his essay, please hit this link.

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