{"id":1277,"date":"2024-10-16T05:43:00","date_gmt":"2024-10-16T05:43:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=1277"},"modified":"2024-10-16T05:43:00","modified_gmt":"2024-10-16T05:43:00","slug":"the-clinical-enterprise-is-the-beating-heart-of-health-systems","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=1277","title":{"rendered":"The Clinical Enterprise is the Beating Heart of Health Systems"},"content":{"rendered":"
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By JEFF GOLDMSITH<\/p>\n

As health systems struggle to emerge from the post-COVID financial crisis, the importance of the clinical enterprise to these systems has dramatically increased.\u00a0 Healthcare organizations are getting larger, as failing enterprises are absorbed into growing systems.\u00a0<\/p>\n

Yet clinicians of all stripes but particularly physicians feel a deepening sense of alienation from the expanding care systems in which they work.\u00a0\u00a0 In many \u201cwanna-be\u201d health systems, the clinical \u201centerprise\u201d\u00a0 is a loosely connected roll-up of independent practices held together by RVU-based compensation plans and a common corporate logo on the door.\u00a0<\/p>\n

A roll-up is not a credible foundation for a system, but merely a holding action.\u00a0 If you have lost your clinicians, you do not have a franchise!\u00a0 \u00a0\u00a0<\/p>\n

In an age when clinician burnout and moral injury threaten the well-being of care givers, how care systems foster caregivers\u2019 commitment to their enterprise has become the central strategic challenge.\u00a0 When one looks at the leading enterprises in healthcare- from the Mayo Clinic to Johns Hopkins Medicine \u2013 they have one thing in common.\u00a0 They are not only led by clinicians, but the clinicians there work together both to maintain high clinical standards and develop and propagate clinical innovation.\u00a0\u00a0<\/p>\n

This commitment has a direct financial consequence for health systems.\u00a0 In an environment where an increase percentage of health care revenues are \u201crisk\u201d revenues, having affirmative control over the cost of delivering care is the key to the organization having a future. Ultimately, that control comes not from clever compensation schemes, but from how clinicians behave in working together to manage their patients.\u00a0<\/p>\n

To be clear, the clinical enterprise does not mean that all clinicians are salaried employees.\u00a0 In some organizations like Kaiser Permanente, for example, clinicians are employees of the Permanente Medical Groups, a closed panel entity which provides most of Kaiser\u2019s clinical care.\u00a0 \u00a0<\/p>\n

But in many organizations, clinicians may be independent practitioners or members of affiliated medical groups, but are still actively involved in the governance of the clinical enterprise.\u00a0 In academic institutions, not all members of the clinical enterprise are full time faculty.\u00a0 And not all of them have MDs after their names, but are advance practice nurses and other clinicians with post-graduate degrees.\u00a0\u00a0<\/p>\n

<\/span><\/p>\n

Rather, the successful clinical enterprise is characterized by;<\/p>\n

1)\u00a0a common value set<\/strong>\u00a0which defines what constitutes quality medical practice.\u00a0 This value set embodies the beliefs and values that animate clinical care, and is maintained and reinforced by educational programs, awards and recognition, and high standards for promotion and compensation<\/p>\n

2)\u00a0rigorous quality and safety standards<\/strong>\u00a0\u00a0 Rather than being paralyzed by requirements to document dozens or hundreds of clinical standards, clinicians are held to high expectations for collaboration and patient outcomes.\u00a0 Those standards evolve and improve as clinical medicine advances.<\/p>\n

3)\u00a0high levels of collegiality and mutual trust<\/strong>\u00a0 \u00a0At its base, quality patient care requires collaboration, and that collaboration cannot take place without high levels of trust-both in clinical judgment and behavior.\u00a0 One can conceive of a high functioning clinical enterprise as interlocking circles of trust- between the clinician and patient (and their family), between the clinician and his\/her circles of consultants, between that circle and the clinical and administrative teams which support their care of patients and between all those circles and the managements that supervise them.\u00a0\u00a0 Absent collaboration lubricated by trust, patients experience their care as a sequence of missed connections or dropped batons (where they are the baton).\u00a0 Those circles of trust act as shock absorbers for the inevitable surprises and events that crop up in the care process.\u00a0<\/p>\n

4)\u00a0\u00a0effortless communication and consultation<\/strong>\u00a0\u00a0 In this complex collaboration, clinicians rely on high-functioning information technology to share information with colleagues about patients and get feedback from them about next steps.\u00a0 The electronic record is not simply a static electronic version of the old paper chart, but a communications tool to support patient care.\u00a0 One reason the electronic health record has not achieved its potential is that this communication function is often a stepchild of the billing functions of clinical IT.\u00a0\u00a0 \u00a0Effective communication is vital to assuring timely and safe management of patient problems, as well as \u201cpatient progression\u201d through the care episode -an increasing concern with length of stay in hospitals rising post-pandemic.\u00a0 That increasing length of stay is a direct financial threat to hospitals in particular under Medicare\u2019s prospective payment system or under risk contracts with private health plans.<\/p>\n

5)\u00a0inspirational leadership<\/strong>\u00a0\u00a0 Maintenance of high clinical standards and morale is not going to be guaranteed by artificial intelligence, clinician MBAs or clever compensation models.\u00a0\u00a0 Inspirational leadership is the animating force in a high-functioning clinical enterprise.\u00a0 Leadership by example- living the values of the organization- is the essential ingredient of that enterprise. Fostering and maintaining collegiality begins at the top.\u00a0<\/p>\n

How do you know that you have a high functioning clinical enterprise?\u00a0\u00a0 Because clinicians in that enterprise feel and behave like owners.\u00a0 They feel they can effectively address and change factors that interfere with effective patient care and that damage morale, \u00a0cause moral injury and waste their time (the scarcest resource in most healthcare enterprises).<\/p>\n

There is no better diagnostic for the absence of a sense of ownership in an organization than a movement to unionization among practicing physicians.\u00a0\u00a0 The movement to unionize clinicians is not driven by money, but rather a feeling of disempowerment, that clinicians cannot count on management\u2019s commitment to changing the things that prevent them from being effective caregivers.\u00a0 \u00a0\u00a0<\/p>\n

A danger of the wave of consolidation now underway is that systems will outgrow their nervous systems- that they will not reach the clinics, ORs, ICUs and physicians\u2019 offices where all the value is created. Clinical enterprises that connect with and animate their workforces will have a prohibitive competitive advantage in the coming era of clinician scarcity as the baby-boom physicians and other care givers retire.\u00a0\u00a0<\/p>\n

In an effective clinical enterprise, physicians and non-physician colleagues feel a sense of efficacy in changing things that harm their patients or their practicing colleagues.\u00a0 \u00a0It is not mass and scale, or wealth, that will determine who survives and prospers in this coming healthcare environment, but the ability of clinicians in the clinical enterprise to work together effectively to meet our needs. \u00a0The health and vitality of the clinical enterprise is the single most important factor in the success of healthcare enterprises large and small.<\/p>\n

Jeff Goldsmith is a veteran health care futurist, President of Health Futures Inc and regular THCB Contributor. This comes from his\u00a0personal substack<\/a><\/em><\/p>","protected":false},"excerpt":{"rendered":"

By JEFF GOLDMSITH As health systems struggle to emerge from the post-COVID financial crisis, the importance of the clinical enterprise to these systems has dramatically increased.\u00a0 Healthcare organizations are getting larger, as failing enterprises are absorbed into growing systems.\u00a0 Yet clinicians of all stripes but particularly physicians feel a deepening sense of alienation from the…<\/p>\n","protected":false},"author":0,"featured_media":1276,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-1277","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/1277"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1277"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/1277\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/1276"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1277"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1277"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1277"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}