daily pulse (the official blog site of NursesCount)

At a recent hospital CEO forum, speakers presented examples and ideas around innovation and shared their observations and prognostications about the rapidly changing U.S. Healthcare System. Here is a quick summary of the highlights of the evening.

Healthcare delivery needs to change

The CEOs agreed that the U.S. needs to move from an episodic healthcare system to a healthcare system that is delivered in primary and ambulatory healthcare.

• We need to meet more of our patients in the outpatient setting.
• The emergency room can no longer be the first choice or “default” for access to healthcare    
• We need to move from transactional care to more of a capitated system as quickly as possible.
• We need to align the incentives to make “quality care” the way that we operate.

Healthcare must leverage technology to enable new mechanisms of care delivery

• We must be more effective in our use of resources and technology to shorten each patient visit so that closer to 100% of the interaction is focused, high quality time with the caregiver, not the administrative, scheduling, billing or medical record retrieval infrastructure.
• We need to have a real option for 5-minute WebEx type visits.                                                                                                                     (This should be a mindful complement to extended visits, not a blanket, blind replacement)
• At the same time, we need intelligent systems and experience data we already possess to leverage temporal patient-provided data and smart alerting. This will enable us to detect patient problems and actionable risk conditions even before the patient is aware of an issue or symptom.

Healthcare organizations must specialize and partner more

• We need to focus on establishing local centers of excellence
• Healthcare is better the more frequently it is delivered
• Every local organization cannot be good at every discipline
• One major IDN described how they are using other major hospitals for their specialties that they do not have (by choice)

Hospitals must get better at what we do

• Hospital leaders must realize that they cannot “make up cost on volume”
• We must be effective and affordable
• We need to reduce the variation in care in the healthcare system

High quality care is low cost care

• We need to go after the causes of (avoidable) additional cost aggressively and creatively
• Patients trying to stand up without assistance can increase treatment costs by $80K-$90K.
• Hospital acquired infections are often attributable to simple failures of basic processes

To reduce infection and errors, we must ensure that we have well-functioning teams

• To go after infections, we need nurses and doctors exhibiting best practices.
• We must reduce the (up to) 20% readmit rate. Discharges resulting in readmission can wipe-out profit, and more importantly damage our brand and inconvenience (or harm) our patient. 
• For example, we need ortho patients to go home understanding that they may not jump back on the treadmill immediately after a procedure.
• Heart patients must understand clearly that their role in their recovery involves specific lifestyle changes (and why compliance is not optional)

We need to do a better job at patient experience

• We need kind and compassionate nurses.  For the vast majority of hospitals, this is already being done very well.  However our patients need to feel our care more, and we need to increase our “frequency of touch.”  Consequently we are spending more time rounding.
• We need to keep up our great patient satisfaction scores as well as the HCAHP levels. We certainly need to maintain our great brand and reputation. What has become clear to all CEOs is that these factors collectively impact our ability to continue to attract and retain top ranking doctors and caregiver teams.  This flows to our brand and our ability to continue to acquire new patients.

Conclusions: We need to move faster

• Healthcare as an industry has moved relatively slowly in process and culture change, because we have always been cautious to “first do no harm.”
• But we need to innovate and “iterate” rapidly today in order to survive in a fast-changing and highly competitive environment that is not tolerant of laggards. 
• There is great disruption and innovation, and that is a great thing for our industry, our patients and our caregivers. 
• By embracing innovation and “rapid iteration” in our use of technology, our experiments with new processes and approaches, we will all win. 
• Failure to move ahead to innovate and “iterate” quickly is equivalent to placing ourselves at the end of the group or “the herd.”  As anyone who has ever visited a game preserve can attest, the rear of the herd is not the place one wants to find themselves in a competitive world.

“Every morning in Africa, a gazelle wakes up, it knows it must outrun the fastest lion or it will be killed.  Every morning in Africa, a lion wakes up.  It knows it must run faster than the slowest gazelle, or it will starve.  It doesn't matter whether you're the lion or a gazelle-when the sun comes up, you'd better be running.”

 -Christopher McDougall, Born to Run: A Hidden Tribe, Superathletes and the Greatest Race the World Has Never Seen