by Peter Block
Have You Hugged Your Goalie
Business News Briefs
Doctoring The Health Care
Your chairman, David Salsbury, said, “Today when
people come to us for healthcare they are being served by
team IHC.” This is the whole concept of clinical
integration. IHC was really one of the first to start
that, is that correct?
all the literature involving the clinical side in quality
improvement efforts, a large concern is on giving
physicians a sense of ownership. How did you accomplish
And as you identify outliers in the presentation of information, it has a wonderful effect. For example, if someone else is having great outcomes and keeping a patient for X number of days and you are keeping them in for X+ number of days, you could probably learn something.
it as simple as saying that the physicians will be
in-charge? What were the challenges?
do you think so many hospitals and healthcare facilities
have been slow to grasp this?
And in the health care arena that is especially true because outcomes come in so many different ways and there is a tendency to really rely on the individual art and less so on rigorous measurement and documentation over time. We are realizing that we can measure and track. We can keep a sense of the true process ingredients for making a difference.
Another component in the health care industry is that the hospitals, insurance plans and clinicians have been on different teams and still are to some extent.
There's the story about the four golfers who go golfing every Saturday and they choose balls to pair up and whoever wins the game, gets lunch bought for them. But one Saturday someone says, “Let's not choose teams until the end,” so they go through the whole golf game not knowing whether the shot that someone makes is a good one or not because they don't know who is on their team.
Well, that is sort of like health care. We don't really know who is on our team. Anybody could be on our team as restructuring occurs. Somebody who is your competitor one day could be on your team the next day.
And we've been helped a great deal by moving to an integrated system. At IHC we had our health plans early on. That brought two components together: the delivery and the health plan side working together.
More recently we've brought the physician component on board so that now we have all three components working together, which is unusual still in health care. When they are integrated you are able to keep track of things in an integrated way. When it doesn't really matter where that X-ray is given, whether it is in the doctor's office or in the clinic or in the hospital because it is all one bottom line, then you can really make a decision about how best to do that.
But as long as there are financial incentives to do it at one place over another, then it's very difficult to come up with the best way for the patient.
employees at IHC are aligned around four key objectives.
What are those objectives?
The leadership team identifies the service quality: “What do we want to stay as status quo, how much do we want to improve or did we slip for some reason?” So they are deciding what those overall objectives are for each year, the specific objectives that will indicate achieving a system of goals: “What's our cost goal for the year, what's our service quality goal, what's our clinical quality goal?” The senior leadership team, along with doctors, insurance and delivery-side members, decide where those will be for the year?
Let's say that I'm a nurse in an Intensive Care Unit. How
does that trickle down to me?
Would my ICU team have a regular meeting to look at
long have you been doing this?
you are going to be clinical about it and look at those
parts that have done well and those parts that haven't,
what are the differences and why has that occurred? Why
do you think that some have done it more easily than
As you build capacity you also want to build the alignment between individual and organizational goals. The more we can help individuals realize their goals are consistent and aligned, the better off we are going to be.
do you train or develop individual capacity?
We call them Bug Splats. They go out and experience bug splats on the windshield—experience things that aren't right and learn from that. So we are trying to, more than anything, build awareness on what service quality means and their role in that.
We are also trying to teach, employees, associates or anyone that you don't have to launch a full-blown study to have improvement. You can improve daily work through being aware of what you do and through experimentation—trying new things. It's a learning cycle—you experience stuff, but you learn by paying attention to what you experience. Then based on that paying attention, and it doesn't have to be formal measurement, you try new things to change your outcomes.
no one works in a silo. Your output is very often
dependent on someone else doing something as well. How
does one deal with that?
do I, as a manager, hold you accountable?
We set up mechanisms for recovery because we are not all going to be able to do that every time on everyday. What are the OK strategies to deal with that when it happens?
What, in your opinion, is a solution to the national
health care situation? Is there one?
For most employees, most decisions are made by a benefits purchaser who is doing it primarily based on cost. So the fact that I can't get access to my physician or the physician I want or that I've got to go to this hospital versus that hospital is taken out of my hands for the most part.
We haven't figured out a way to get patients back in the driver's seat. And that is because of cost.
There's been in recent yearsan increase in interest about
the alternative care—vitamins, supplements,
acupuncture, chiropractic care and other alternative
kinds of medicine. How do you see that being
And IHC is exploring that. From all components—the insurance component, the delivery component, building new facilities, and designing task forces for making those facilities more consistent with what we already know and what we are discovering everyday—the impact of sounds, music, family care and also the alternative cares with respect to food, diet and other practices and procedures.
What about your job and your field keeps you awake at