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Relying on ’15-minute huddles’

Marc Harrison, M.D.,  CEO of  Salt Lake City-based Intermountain Healthcare, based in Salt Lake City,  writes in the Harvard Business Review about his system’s intense use of “15-minute huddles” to maximize care and efficiency.

“At Intermountain, the 15-minute huddle is the key. It enables knowledge from activities throughout the organization in the previous 24 hours to escalate up to executive leadership — Tier VI in our model — and be addressed.

“Using that 15 minutes effectively requires structure: Each huddle has a leader; the participants are designated, as is the recorder of the data; the huddle is scheduled; and the categories of reported information are captured on a prepared chart. We have four fundamentals of extraordinary care that are covered in our daily huddles: safety, quality, access, and stewardship of resources so they are used to provide the best possible care. Across those fundamentals, eight key topics are reported every day. They include potential serious safety events that could have harmed a patient, caregiver injuries, and reported downtimes (of equipment, elevators, systems or processes, for example).”

To read the article, please hit this link.

Changing executive behavior in healthcare

“The behavior of senior executives, and especially the CEO, is known to be directly related to an organization’s performance. In 2017, we reported on five behavioral dimensions required to build a culture of continuous improvement: willingness, humility, curiosity, perseverance, and self-discipline. Does changing leader behavior to embody these qualities lead to better patient outcomes? The leadership team at Zuckerberg San Francisco General Hospital (ZSFGH) has been studying this question over the last year and has determined the answer is yes. We will describe the outcomes ZSFGH has achieved since creating specific behavioral expectations for its leaders.”

“One step toward developing an improvement management system is defining what people should be working on. This is called True North, a handful of metrics that allow everyone to know what’s most important and whether the organization is making needed progress. ZSFGH adopted six True North goal areas — equity, safety, quality, care experience, workforce care and development, and financial stewardship — and decided how to measure each performance category. These measures are ZSFGH’s must do, can’t fail metrics for organizational performance.”


To read the entire piece, please hit this link.



Renaissance in independent practices seen



Bundled payments and ACOs side by side

In an NEJM Catalyst piece, Poonam L. Alaigh, M.D., executive vice president for corporate development at Remedy Partners, writes about how to make Accountable Care Organizations and bundled payments work side by side. Among Dr. Alaigh’s conclusions:

“Federal policymakers have recently indicated that they expect far greater returns on their investment in payment reform and they are prepared to hold stakeholders’ feet to the fire. They’ll likely do so by eliminating Medicare value-based care participation options that lack downside risk, which fail to hold organizations accountable for negative performance.

“Provider organizations must become adept at delivering care under both of these models as we shift from volume to value-based care. This approach provides an innovative platform for primary care and specialty care integration. ACOs and bundled payment systems are an opportunity for health care providers and payers to work in unison toward improving health for patients and better managing costs. Leaders should be seeking to build on the last several years of experience and momentum by aligning these initiatives and mobilizing these complementary programs while internally leveraging economics of scale and driving increased return on investment.”

To read the whole piece, please hit this link.


To reduce overtreatment, add chairs


“The Doctor,” by Luke Fildes


At a Kaiser Health News event in Washington, D.C., reported on by FierceHealthcare  attendees heard some little discussed and inexpensive ways to reduce overtreatment. One suggestion, by Jacqueline Kruser, M.D., was to add chairs in hospital rooms to make it easier and more relaxed for physicians to talk with patients about their treatment goals..

Another idea, of Ranit Mishori, M.D., was that primary-care doctors—who typically have years-long relationships with patients—should collect a rundown of some  points about patients’ lifestyles, care goals and personal values into their histories.

Fierce said that that, paraphrasing Mishori, “can help guide the conversation about whether a patient wants to undergo the lengthy process of recovering from surgery or pursue a less aggressive option after an injury. Having that information in their electronic health record can later ensure that information sticks with them no matter where the patient is treated.”

To read the whole article, please hit this link.

Population-health approaches seen needed to address high-need GI patients

MedPage Today reports:

“As in other medical conditions, a small fraction of high-need, high-cost patients with gastrointestinal (GI) and liver diseases contribute disproportionately to hospitalization costs, according to a nationwide database analysis published in Clinical Gastroenterology and Hepatology.

“The study found that across five common diseases, patients in the top two deciles of hospital utilization accounted for well over half of hospital costs and those in the top decile accounted for more than a third of costs, and in one case, reached almost 40% of costs.

“‘Population health management strategies directed toward identifying these high-need, high-cost patients and implementing multi-component chronic care models may improve the quality of care and reduce costs of care,’ the study’s senior author, Siddarth B. Singh, M.D., of the University of California at San Diego, told MedPage Today.”

To read the database analysis, please hit this link.

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

Time pressure on physicians makes teamwork more important

Fred  N. Pelzman, M.D., writes in his Med Page Today column that physicians’ short time with physicians means teamwork is essential.

Among his suggestions:

  • “Consider scheduling an appointment with PCP for medication review.
  • “Consider scheduling an appointment with PCP for pain assessment in older adults.
  • “Consider scheduling an appointment with PCP for functional status assessment.
  • “Consider scheduling an appointment with PCP for advance care planning.
  • “Consider scheduling an appointment with PCP for use of high-risk medication.
  • “Consider educating member/caregiver regarding cardiovascular and respiratory symptoms.”



Calif. physician sues, asserting hospital poaching killed his practice

— Photo by Etan J. Tal

Old warning in Cornwall.


Becker’s Hospital Review reports:

“A California OB-GYN physician filed a lawsuit against Covina, Calif.-based Citrus Valley Health Partners, claiming the hospital negotiated in bad faith to buy his practice and proceeded to lure away and hire several other physicians at the practice, forcing its closure, according to San Gabriel Valley Tribune.

“Here are five things to know:

1. “Carlos Beharie, M.D., owned and operated West Covina-based Citrus Obstetrics and Gynecology since 2002. During that time period, the practice grew to comprise a total of five physicians and delivered between 80 and 100 babies per month, Dr. Beharie told the publication.

2. “According to the lawsuit, Citrus Valley Health Partners offered to purchase Dr. Beharie’s practice in early 2017, but offered $1 million for the practice, despite the fact the practice brought in revenues of at least $1.4 million annually.

3. “Negotiations between the two organizations reportedly stalled in August 2017. Two months later, three physicians employed by Dr. Beharie informed him they planned to leave the practice and instead work for Citrus Valley Health Partners, the lawsuit states.

4. “Dr. Beharie said he was forced to close the practice in January. A lawyer for Dr. Beharie told the San Gabriel Valley Tribune Citrus Valley Health Partners used information made available in negotiations to subvert the practice, essentially causing it to close.

5. “Citrus Valley Health Partners did not comment on the pending litigation, but said one of its hospitals had worked closely with ‘physician groups’ to provide care to residents in the San Gabriel Valley.”

To read the whole article, please hit this link.


How to benefit from design thinking

In NEJM Catalyst, Amy Compton-Phillips, M.D., and Namita Seth Mohta, M.D., look at how healthcare organizations can best benefit from design thinking. Among their observations:

“NEJM Catalyst Insights Council members say the top organizational issues that would benefit most from design thinking are workflow, for staff and patients alike, and patient-facing activities such as scheduling appointments. In written responses, survey respondents single out scheduling as a poorly designed aspect of care delivery, citing issues with skills of centralized schedulers, the need for provider input on scheduling, and an abundance of inefficiency. More executives (41%) and clinicians (39%) than clinical leaders (29%) rank patient adherence/compliance with therapy among the issues that would benefit most from design thinking approaches.”

To read their whole piece, please hit this link.


Developing physician leaders in the new healthcare world


Caryn Lerman, Ph.D.,  and J. Larry Jameson, M.D., both of the University of Pennsylvania, write in NEJM Catalyst about leadership development in the new world of medicine.

Among their remarks:

“We believe it is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders….”

“Physician leaders were traditionally selected on the basis of their national prominence and excellence as master clinicians, star researchers, and revered educators. These credentials remain important, but they aren’t sufficient in the current health care climate. Given the high rate of turnover among physician leaders such as department chairs and deans, we can no longer afford to neglect the skills that are essential for leaders to succeed. We believe there is a need for a new generation of leaders who can promote strategic and cultural alignment in the face of rapid change. … We suggest that health systems focus on three key strategies for promoting the effective development of physician leaders.”

“First, such systems could build a diverse pipeline of future physician leaders from within the organization. This approach would expand the pool of potential leaders, allow emerging leaders to take on progressively increasing responsibility, and ensure that leadership strategies are aligned with the organization’s culture and priorities. …”

“Second, health systems could implement a deliberate process for rigorously mining talent pools, whether internal or external. The most promising leaders are those who not only have experience and a compelling vision but also exemplify the core values of the institution and can engage and inspire others to rally around a shared vision. Physicians are understandably passionate about their own clinical specialties and research areas, but leaders need to understand, respect, and support the diverse interests of their teams and the institution in a balanced way. Physician leaders also need to partner effectively with nonphysician colleagues, including business leaders, administrators and nurses.”

“Third, health systems could implement structured processes for ‘onboarding’ and methods for gathering feedback. For example, listening tours that allow newly appointed leaders to solicit viewpoints from current leaders, faculty, and staff are invaluable for learning cultural norms and strategic priorities for the new role. This process also serves to establish new collaborative partnerships and build credibility for the new leader.”

To read the article, please hit this link.

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