The antidote to this fragmentation is integration, the most hotly discussed concept in health care today. What stops skilled, motivated people from making health care better, more integrated and ultimately more sustainable? The answer is the organizations in which they work and the pressures, incentives and regulations under which they operate. Three compounding problems inhibit large-scale, sustainable change. The first is organizational myopia. Organizations have a tendency to think that they’re basically good but that the health system in which they operate doesn’t support them properly. The second is the ability for transactional reform to trump transformation. I define transactional as “doing things better” and transformational as “doing better things.” Often it’s is easier and less threatening to make seemingly important but small changes than it is to hold individuals, organizations or systems to account for transformational change that will produce better care and value. The third is that large-scale change is as much an emotional issue as a technical one, which is rarely understood. A compelling vision of a better future needs to be communicated in a way that energizes and motivates. This means that staff members can relate to it, shape it and, crucially, feel empowered to challenge the status quo. In a recent survey of hundreds of health care leaders across the developed world, we found that while 73% of them thought their country’s health care system required “fundamental” change, only 35% felt change was needed in their own organization. Health care leaders often see the need for system-wide change before they see the need to transform their own organizations. They realize the scale of transformation required but believe that it’s somebody else’s problem. When this belief is coupled with a deeply transactional culture focused on incremental improvements, the status quo is unassailable. So what can we do? A recent report fromthe Institute of Medicine in America’s landmark report, identified four ingredients for a high-quality care system: having the right vision; designing clinical processes from the patient’s perspective; integrating organizations into systems; and successfully managing environmental factors such as regulations and financing. I’ve seen health systems in Japan, Singapore, Spain, New Zealand and the U.K. that show how population-scale health care with these ingredients can be achieved. But the best one I’ve worked with is the Geisinger Health System in Pennsylvania, which provides complete care for more than 2.6 million people. Its core way of working, ProvenCare, is built around population health and using data and clinical evidence to redesign care systems. Its structures and processes have been reengineered to maximize value. There is a
culture of safety and quality, and patients are involved in their own care. The payments system encourages the organization to get care right the first time, in the most appropriate setting. Geisinger had the audacity to try to change the way health care is provided and paid for in America, and it has succeeded in reducing mortality and costs while substantially improving quality. Its journey to become one of the world’s most innovative health systems has largely taken place during the 15-year tenure of Glenn Steele. When I spoke to Steele about what he learned as president and chief executive from 2000 to 2015, several things stood out. First is staying power. Steele was only the fifth leader that Geisinger had had since its establishment, in 1915, and his strategy remained consistent throughout his tenure at the top. The first clinical specialties started adopting ProvenCare in 2003, and the organization has been working through the rest for the past 12 years. This consistency, twinned with early successes, has made wider change possible. Steele freely admits that some of the founding principles of the transformations he drove were built more on beliefs than evidence. But once years of data had been amassed, bigger and bolder transformations could be achieved. Making these changes required skill, will and time underpinned by rigorous process. This is the paradox of change: It requires continuity and consistency. Health care leaders don’t spend enough time with other parts of the system, and they don’t place enough faith in their ability to develop and implement sustainable solutions to problems. So it’s easy to see why they spend their energy doing things better rather than doing better things. Nobody gets held to account for producing a more sustainable health system; they just get rewarded for surviving in the existing one. Health leaders need to recognize that they’re not alone in grappling with their health systems, and they shouldn’t be afraid of attempting to change them. They should remember, however, that transformation is impossible without continuity.
MARK BRITNELL Mark Britnell is the chairman of KPMG’s global health practice and the author of “In Search of the Perfect Health System.” © 2015 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate
mcmsonline.com/round-up
|
19