You can tell a lot about people by how they load a dishwasher.


When I load the dishwasher, I want to get it over with and achieve an acceptable outcome. The dishes are always in the same positions, and they get clean. Competent, but nothing special. 

My kids are a bit less invested in the job. For them, placement is haphazard, but most of the dishes get loaded and reasonably clean. 

At the office, some dishes make it into the dishwasher, and some don’t. Those that do are beyond haphazard. We’re all invested in our jobs, but in dishwashing? Not so much.

My wife doesn’t do the dishes often, but when she does, I can only marvel at the number of dishes she can fit into the dishwasher, the innovative positions, and the ability for water to reach each surface. She loves the challenge.

As healthcare organizations take on the challenge of making major improvements to quality and efficiency, the level of investment will make the difference between modest change and breakthrough results. This month’s hfm cover story, “A Statewide Partnership for Reducing Readmissions” by HFMA’s James Landman, shows what a breakthrough improvement strategy looks like. The article explores a collaboration to reduce readmissions rates across Illinois hospitals launched by BlueCross BlueShield of Illinois, the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine, and the Illinois Hospital Association, along with strategic partner the Society of Hospital Medicine.

At the outset, it’s clear that innovation is at work. The group recognized that tackling the problem at the individual hospital level would only go so far, and that physicians, hospitals, and payers need to collaborate for readmissions to be reduced. Yet this approach also creates the challenge of achieving a high level of investment across all the people and organizations involved.

Landman’s investigation finds several factors key to fostering this investment:

  •  Executive champions in each organization. For example, one facet of the program requires that each hospital identify an executive champion and a hospitalist champion.
  •  Access to data. Commitment is fueled by access to data necessary to understand readmissions by patient, facility, service line, and physician.
  •  Support of financial leaders and staff. Achieving financial support requires an understanding of the true financial impact of reducing readmissions in both fee-for-service and value-based payment systems.
  •  Trust among multiple stakeholders. Shared desire to solve this problem and willingness to embark on it together are critical to achieving full engagement in a complex journey like this one.

For everyone involved in a healthcare improvement initiative—whether conceiving the project, leading a team, investigating root causes, carrying out corrective actions, or communicating results—these factors will build an environment that transcends competence and creates enthusiasm and innovation. Nothing less will move health care into the future.

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