Executive digest with Anna van Poucke

Executive digest with Anna van Poucke

Organizing care to deliver value for patients requires change in five main areas. Start with a clear vision and understanding of what value means and focus energy on cohesive action across all the areas.

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Anna van Poucke

As one part of the organization starts to move, be aware that other areas need to move with it to keep a well-balanced approach. This might be off-putting at first –seemingly changing everything at once – but it does not have to be as daunting as it sometimes seems. From my work with clients and discussions with providers all over the world, I have drawn the following lessons.

Patients provide your compass

As stated in KPMG International’s What Works: Staying Power – Success stories in global healthcare, patients are the solution, not the problem. Demographic changes and changing healthcare needs create the case for change. In fact, they are the justification for any healthcare transformation program. Make sure patients and patient representatives (caregivers, etc.) are ‘at the table’ and not just at the receiving end of visionary documents and practical plans. See to it that they are placed in a position where they define what results they need and can co-create plans to deliver those results. I have seen great examples where patients defined the top 10 priority changes for the care in their health system for different patient groups (e.g. elderly and long-term conditions) and subsequently played a big role in planning how to deliver the required changes. No professional can deny changes that are at the patients’ request.

Visible outcomes can be improved, invisible outcomes cannot

Care providers that are not transparent about outcomes of care to their patients and contractors undermine their future existence. The outcomes you measure should follow directly from what patients need, and therefore be agreed on with patients, their caregivers and professionals. Make sure the focus is not just on the outcomes delivered by your single organization, but take responsibility for interfaces with other care providers and the wider care pathway.

Fantastic hip replacement results are great, but if the procedure is followed by a 5-week wait for rehabilitation, the overall outcome for the patient is questionable. I have seen from experience that it’s the organizations that are really committed to determine and measure the value they create, that are able to fundamentally improve their service and market share. Do not neglect transparency; it will change the face of healthcare in the coming years. 

Define your position in the pathway, find partners you trust

When patients are at the core of the healthcare systems (see KPMG integrated care model), a clear understanding emerges of where your organization is, or should be, positioned in the wider pathway. This will help determine if, for instance, you are looking to create a focused factory or organize coordinated care across tiers of care. The patients you care for are the starting point.

Next, find partners you trust to deliver coordinated care across the whole pathway. Strong health outcomes for patients are not just delivered in hospital, but also in people’s homes and in the community by care providers or volunteer organizations. Think about processes of coordinated care delivery, rather than entirely new systems and structures.

Several high performing health systems choose to work with care navigators or accountable lead providers, rather than get stuck in complex discussions of who is in charge of what service (see interview with Dr. Steven Laitner). The value created by working this way can be enhanced by contractors that act as informed and involved partners who contribute to creating a favorable environment for collaboration that delivers value for patients.

Centralize authority and decentralize decision making

Realizing sustainable change can demand a lot from your organization, especially the simultaneous focus on outcomes and partnership with others in the system. Governance should be focused on delivering outcomes both in isolation and in collaboration with partners. It needs to enable change, so make sure leaders set a clear vision and strategy that will enable transformation.

This needs to be combined with decentralized decision making, empowering professionals across different organizations to continuously improve the way care is delivered. This lower level decision making needs to be supported by accurate (and if possible real-time and cross-provider) information on performance levels, linked to outcome measures. Stimulate professionals to define areas of improvement and take action to improve care delivery on the front line. 

Mobilize your contractor, incentives need to change

The contractor is your partner, not your enemy, whether it’s an insurer, national government, local authority or clinical commissioning group. Realize that they hold the key for the changes that are needed. Financial incentives that do not reward change are a key blockage in many systems. Find a way to get the gears ‘unstuck’.

The approach will differ depending on your system and organization. It can mean making sure the insurer or commissioner are aligned with your goals and shape incentives to drive that change. Or it can mean taking a directive approach yourself, by becoming the lead provider and/or lead contractor in your local health system and taking responsibility for the delivery of integrated care by partnering with other organizations. 

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