The problems that ail the American health-care system are numerous, complex, and interrelated. In writing about how to fix our chronically dysfunctional system, Hoffman and Emanuel recently cautioned that single solutions will not be effective.1 In their estimation, “individually implemented changes are divisive rather than unifying,” and “the cure … to this complex problem … will require a multimodal approach with a focus on re-engineering the entire care delivery process.”
If single solutions are insufficient (or even counterproductive and divisive), health care’s key stakeholders must figure out how to work more effectively together. In a nutshell, effective collaboration is critical. Those who collaborate well will thrive in the future, while those who are unable to break down silos to innovatively engage their patients, colleagues, and communities will fail.
Our Tradition of Teamwork
Hospitalists understand the importance of collaboration, as teamwork has been a fundamental value of our specialty since its inception. We have a rich tradition of creating novel, collaborative working relationships with a diverse group of key stakeholders that includes primary-care providers (PCPs), nurses, subspecialists, surgeons, case managers, social workers, nursing homes, transitional-care units, home health agencies, hospice programs, and hospital administrators. We have created innovative, collaborative strategies to effectively and safely comanage patients with other physicians, navigate care transitions, and integrate the input of the many people required to manage day-to-day hospital care.
These experiences will serve us well in a future in which collaboration is essential. We should plan to share our expertise in creating effective teams by assuming leadership roles within our institutions as they implement collaborative initiatives on a larger scale through such concepts as the accountable-care organization (ACO).
We should furthermore plan to seek out new, collaborative opportunities by identifying novel agendas to champion. Two critically important, novel agendas for hospitalists to advance are:
- Enhanced physician-patient collaboration; and
- Collaboration to share and propagate new innovation among hospitalists and HM programs across the country.
True Collaboration with Patients
In my last column, I wrote about how enhancing the patient experience of care will have far-reaching, positive effects on health-care reform.2 Attending to the patient experience has been proven to enhance patient satisfaction, care quality, and care affordability. Initiatives to enhance care experience thus hold promise as global, Triple Aim (better health and better care at lower cost) effectors.
The key to improving patient experience is patient engagement, and the key to patient engagement is incorporating patient expectations into the care planning process. The question thus becomes, “How do physicians identify and appropriately act on patient expectations?” The answer is by collaborating with patients to arrive at care decisions that respect their interests. Care providers must work together with patients to create care plans that respect patient preferences, values, and goals. This will require shared decision-making characterized by collaborative discussions that help patients decide between multiple acceptable health-care choices in accordance with their expectations.
SHM is commissioning a Patient Experience Advisory Board to identify how the society can support its members to effectively collaborate with patients and their loved ones. Expect in the near future to learn more from SHM about how to truly engage your patients to enhance the value of the care you deliver.
The Commodification of Health-Care Quality and Affordability
I recently learned of a subspecialty group that had created a new clinical protocol that promised to deliver higher-quality, more affordable care to their patients. When asked if they would share this with physicians outside of their own group, they flat-out refused. What would motivate a physician group to refuse to collaborate with their community to propagate a new innovation that promises to enhance the value of health care? The answer may lie with an economic concept known as commodification.
Commodification is the process by which an item that possesses no economic interest is assigned monetary worth, and hence how economic values can replace social values that previously governed how the item was treated. Commodification describes a transformation of relationships formerly untainted by commerce into commercial relationships that are influenced by monetary interests.
As payors move away from reimbursing providers simply for performing services (volume-based purchasing) to paying them for the value they deliver (value-based purchasing), we must acknowledge that we are “commodifying” health-care quality and affordability. By doing so, the economic viability of medical practices and health-care institutions will depend on delivering value, and to the extent that this determines a competitive advantage in the marketplace, providers might be reluctant to share innovations in quality and affordability.
We must not let this happen to health care. Competing on the ability to effectively deploy and manage new innovations to enhance quality and affordability is acceptable. Competing, however, on the access to these innovations is ethically unacceptable for an industry that is indispensable to the health and well-being of its consumers.
Coke and Pepsi do not provide indispensable products to society. It is thus fine for soft-drink makers to keep their recipes top secret and fight vigorously to prevent others from gaining access to their innovations. Health-care providers, however, cannot morally defend refusing to share new products and processes that decrease costs, improve patient experience, decrease morbidity, prolong life, or otherwise enhance quality.
We must, therefore, strive to continuously collaborate with our hospitalist colleagues and HM programs across the country to propagate new innovation. When someone builds a better mouse trap, it should be shared freely so that all patients have the opportunity to benefit. We must not let the pursuit of economic competitive advantage prevent us from collaborating and sharing ideas on how to make our health-care system better.
Fixing health care is complicated, and employing collaboration in order to do so will be required. Hospitalists have vast experience in working effectively with others, and should leverage this experience to lead the charge on efforts to enhance physician-patient collaboration. Hospitalists should strive to continuously collaborate with their colleagues to ensure open access to new discoveries that improve health-care quality and affordability. Those interested in learning more about how to be successful collaborators might find it helpful to seek out additional resources on the subject. Collaboration, by Morten T. Hansen, is a good source on how to turn this concept into action.3
- Hoffman A, Emanuel E. Reengineering US health care. JAMA. 2013;309(7):661-662.
- Frost, S. A matter of perspective: deconstructing satisfaction measurements by focusing on patient goals. The Hospitalist. 2013:17(3):59.
- Hansen M. Collaboration: how leaders avoid the traps, create unity, and reap big results. Boston: Harvard Business Press; 2009.