The hard part: from innovation to implementation
There is demand for high-quality healthcare at lower costs.
So goes the mantra that has been repeated countless times in recent years. But it’s when that mantra meets reality – particularly in the form of those healthcare systems increasingly focused on putting new technology, and the new data that come with it, with new care delivery configurations – that things can get interesting.
Take, for example, a recent piece at the Health Affairs blog. Penned by Jeff Selberg, Prabhjot Singh and Jorge Alday, all stakeholders at the Peterson Center on Healthcare, the article describes the Center’s efforts, in conjunction with Stanford University, to identify best practices across the US primary care system and put them to work in one system. Having identified 11 such best practices, the Center is testing “how to replicate the features of the 11 exemplary practices to improve healthcare practice across the country on four dimensions: clinical and functional outcomes, the experience of care, clinician engagement, and total cost of care.”
They spent a year of “hands-on facilitation with practice teams to establish clear care team roles, reorganize workflows, and use data to measure change and integrate patients into the redesign, we are now replicating the model in three practices, in New York, Missouri, and Minnesota.”
At first blush, the project may seem like no shortage of other initiatives currently underway, but what strikes us as different is the authors’ obvious understanding that, despite all the best efforts at innovation, the US healthcare system is not very good at disseminating successful steps forward once they’ve been developed and tested in one-off situations.
Viewed one way, you could say they’re trying to take a page from peers in the private but non-healthcare sector.
“Those driven by investment models,” they argue, “think in terms of time and cost of execution and the returns they can expect. If value is not delivered, they are out of business. They see opportunity driven by value-based payment; population demographics; and a growing demand from consumers, employers, insurers, and government to get better outcomes for their spending. In this world, implementation speed, rapid customer feedback, network effects, predictable returns on investment, and brand engagement signal success.”
There’s no shortage of healthcare innovation, they note, but the weakness of the healthcare system is what they diplomatically call “perhaps a lack of focus on execution” once innovations have been developed.
“It is in this gap between health services research and market-driven service design where we believe the core of a rapidly self-improving health care system can be built. We believe that our collective ability as a health care sector to understand the relationship between these two worlds and to apply learning from each will determine how quickly we can evolve to higher-value health care.”
In more practical terms, they say, “We will ask ourselves: Does the replication result in significant enough improvement to warrant further investment to spread the model more broadly across the country? Do the benefits outweigh the costs by a significant margin? Can we reduce the costs of replication as we scale the effort while we learn how to generate even greater benefits?”
There are challenges galore, including “deeply held institutional norms, long-standing relationships, and engrained processes,” but by focusing on what actually works, both clinically and financially, they hope to succeed based “the unifying idea” that everyone’s experience of the US healthcare system, patients and providers alike, can and should be improved.