5 Ways To...

Karen Wagner

For many providers, finding examples of variation among physicians and within hospitals is not the hard part; figuring out what to do about it is. Scripps Health in San Diego recently implemented a comprehensive plan to reduce variation at its five hospitals. Here, Lisa Thakur, corporate vice president of operations for Scripps Health, shares the health system's most successful strategies.

Break through the silos. Create a management structure that fosters decision making across a system, rather than only at one facility. Scripps intersected the vertical management team (e.g., CEO, CNO, COO) at each hospital with a horizontal layer: The COOs became corporate-level vice presidents responsible for specific medical, clinical, support services, and administrative services divisions across the system. The structure enables a broader, systemwide view of opportunities and creates a means to more easily develop and implement best practices, Thakur says.

Prioritize. Undertaking too many initiatives aimed at reducing variation can be overwhelming and can impede success. Instead, focus on those projects that appear to be easy to implement and can offer quick, significant ROI while maintaining or improving quality. Emphasize the need to focus on the goals of the organization as a whole, rather than the individual priorities of departments, hospitals, or facilities. "What might be important to one hospital might not be a priority for the health system right now," Thakur says.

Aim below 100 percent agreement. When a number of representatives from different clinical and administrative areas are involved, reaching a unanimous decision is nearly impossible. Aim for an overwhelming majority instead. If a Scripps Health committee obtains 70 to 80 percent approval on a matter that is up for discussion, that is good enough for the health system to move forward, Thakur says. "We're not going for 100 percent. We can't get anything done that way," she says. Also, when committee members or their representatives are not present for meetings, they defer their votes to the majority.

Put physicians in the driver's seat. Employ a physician champion in each clinical area to obtain buy-in. Use physicians to decide which initiatives should be given priority and which would be better addressed later on. Understand what specific data, such as quality indicators and outcomes figures, physicians want to review. Then, supply physicians with the data, minus any recommendations or conclusions. "We just provide the data in the manner in which they want to see it," Thakur says. "When they have the same information, they mainly come up with the same decisions as our leaders do."

Avoid ill-fated attempts to engage physicians or staff. For example, focus change efforts on physicians who already are engaged. Constructive collaboration requires a strong relationship, so if such a relationship has not already been established, attempts at achieving improvement may be futile. Some physicians may not be willing to spend their time working on initiatives that benefit only the hospital. "You're never going to have every physician in every type of specialty want to collaborate," Thakur says. "So we focus our attention on those who are engaged."

Karen Wagner is a healthcare freelance writer, Forest Lake, Ill. (klw@klw.ms).


Publication Date: Wednesday, August 01, 2012

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