The specific details of Advocate’s model yield several general lessons for physician engagement at any organization. First, physicians must be represented at a decision-making level across all levels of the organization—from governance down to the unit level. Second, metrics generated with the participation of physicians will ensure the greatest physician buy-in. And third, giving physicians a stake in the out- comes of process improvement initiatives matters, whether that stake takes the form of a financial or nonfinancial incentive. Nurses. Arizona-based Scottsdale Health System has a strong shared governance program with its nursing staff. If department metrics are not where they should be, then the system will provide nursing staff with the support needed. At the same time, nursing staff understand that they will be accountable for improving the metrics. One example of this shared sense of accountability and commit- ment can be seen when system leadership identified an increase in pressure ulcer rates at one of the facilities. Two nurses traced it to a defect in mattresses affecting 600 patient beds that were then replaced at no charge by the vendor. Since the discovery, the pressure ulcer rate has decreased to zero in the intensive care unit. The presence of nursing experience and expertise on process improvement initiatives—again, starting at the top and going down to the unit level—is a common factor among most of the providers interviewed for the Value Project. Peter Markell, CPA, CFO of Partners HealthCare in Boston, Mass., notes that many hospitals have adopted Lean meth- odologies, derived from Toyota’s production practices. “Under the Toyota model, you let people on the floor make decisions,” he says. “Nurses are the people on the floor.” Engaging Finance and Administrative Staff in Value Engaged clinicians are essential to value creation, but so are engaged finance and administrative professionals. “The CFO needs to be glued at the hip with the quality officer,” says David Bernard, vice president of finance, The Methodist Hospital System, Houston, Texas. “Revenue depends on quality.” Many of the CFOs interviewed for the Value Project note that engagement with quality requires a change in mind-set for the finance executive. “Not putting an initial focus on cost was something that required a leap of faith on my part, but I’m now a believer in this approach,” says Kathy Arbuckle, CPA, CFO of Marriottsville, Md.-based Bon Secours Health System. Clinicians are engaged by quality and service improvements for the patient; any resulting cost reductions become a natural outcome as variability in clinical processes is reduced and inefficien- cies in care delivery are identified and removed.
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- Fall '16