Case Study Intermountain Healthcare

Performance Management at Intermountain Healthcare Key Points   Operational focus - strategy rather than management. How will the organization prepare for the future if their primary customer (government) reduces spending? How will they address decreasing revenues caused by their increasing effiencies?

What do you consider to be the key issues for quality improvements in the NHS quality-improvement program as it goes forward?

Integrated Care Collaboration maintains a health information exchange called the ICare system. Through this system Integrated Care Collaboration has worked towards identifying needs of Central Texas and improving healthcare access to those who need it. Integrated Care collaboration has been nationally recognized and has been accredited with the the Texas Health Information Exchange Accreditation Program (TXHIEAP) and the Direct Trusted Agent Accreditation Program (DTAAP). Both accreditation programs are dedicated to ensuring proper use of HIEs and compliance with federal and state laws as well as HIPAA. Texas Health Information Exchange Accreditation program focuses on proper exchange of patient information while Direct Trusted Agent Accreditation Program is geared toward recognizing excellence in data processing and transactions

Partners HealthCare is a non-profit, health system located in Boston that created a data based transformation (Davenport, 2013). It integrated a new system that aligned the participating organizations to cohesively run as one and to help shape the future of the organization. The system didn’t stop there as it was responsible for bettering the patient financing experience and the delivery of healthcare information to other organizations (Davenport, 2013). The initial goal of the organization was making patient care more affordable and accountable by providing integrated, evidence based, patient-oriented care.

In today’s time, the hallmark of the US health industry is to form integrated delivery systems. An integrated health delivery system is an arrangement of health professionals and health care facilities that provide health services within a continuous organization of delivery. These systems will allow the purchaser and consumer of health care service to receive all the needed services within a all-in-one delivery system that would facilitate the needed access to the appropriate level of care at the appropriate time (Professional Issues). I.D.S presumably will also provide higher quality services and more patient centric care at relatively lower costs (Effects of Integrated Delivery Systems on Cost and Quality). To best understand integrated delivery systems (IDS), it is helpful to contrast the IDS model with health service delivery under the traditional fee-for-service (FFS) arrangement.

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

The institute of Medicine (IOM) has defined quality healthcare as safe, effective, timely, efficient and patient-centered care that is given to an individual regardless of their race, gender, financial status or health status (Wood & Haber, 2014). Quality initiatives are designed to help maximize efficiency; decrease poor work performance and resolve workforce problems through leadership, commitment and involvement (Abdallah, 2014). Abdallah (2013) also noted that trained physicians can help with the implementation of quality culture and employee morale, and it can help with the collaboration of ACNP and physician management. According to Chorostecki et al. (2015), interprofessional (IP) care includes shared decision-making, collaborative problem solving, respect in the work field, and equal contribution among all healthcare team members. Implementing effective interprofessional collaboration can help enhance quality care in hospital, acute, home or office settings (Chorostecki et al.,

The third long-term goal of a health care organization like a hospital is remain compliant and achieve and maintain accreditation. This can be achieved through other long and short-term goals. If the short-term goals of self-assessments, education, and implementation of quality improvement processes are put into place, the organization can be successful with their quality management program. Upper-level management will need to address this success and work to ensure that the policies and procedures put into place are maintained.

McLaughlin, C.P., & Kaluzny, A.D. (2006). Continuous Quality Improvement in Health Care, Third Edition, Jones & Bartlett Publishers, Sudbury, MA.

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

The healthcare industry has intensely advanced throughout the world, in turn changing the principles that incorporate the practice and culture of nursing practice. Altering the model of care to a patient-centered mode signifies an organizational culture shift and requires the participation of executives at the senior level (Cliff, 2012). To practice this care to provide the best care possible, it goes beyond the nurse to all healthcare professionals and senior leadership. The days of patients and nurses following a physician’s order without favor to care has now loaned themselves to more of an interdisciplinary approach to practice. Though, it is encouraged that the patient makes decisions for themselves, after receiving the proper education and information on their condition. Part of the patient-centered care is to be the patients’ advocate, by letting them know you are there for them when they are unable to speak and advocate for themselves and what is in their best interest. That goes in hand with educating them on “self-management of care, health literacy, patient, and family education through nurse-patient communication and interaction (Finkelman & Kenner, 2016, p. 271).”

al., 2012). Trying to get the leadership motivated with adapting to TQM was a challenge in the beginning. The enthusiasm of top leaders has caused the TQM process to become effective. Although Health care has a complex adaptive system, leadership is crucial in implementing an improvement system (Sollecito & Johnson, 2013). The strengths of the TQM process were the support of the chamber of commerce, implementation of a quality improvement plan, adapting a successful way to measure improvement and development of cost effective techniques (McLaughlin, et. al., 2012). Corporate headquarters was totally involved in the TQM program with the CEO John Kausch as an active member of the Total Quality Council of the Pensacola, Area Chamber of Commerce (McLaughlin, et. al., 2012)

Intermountain Healthcare (IHC) is a not-for-profit and integrated delivery system that provides coverage and care mainly in Utah and the southeastern part of Idaho. IHC has been the leader in developing and executing electronic medical records, in applying the principles of quality measurement (QI) and improvement to health care, and approaching to managing heath care delivery by integrating clinical transformation, launching, and focusing on data. They have 28,000staffs which include 700 physicians in a multispecialty group practice. IHC also operates 21 hospital. The company was also financially stable and bringing their cash value to $242 million dollars.

A patient centered medical home (PCMH) could integrate patient care. A patient centered medial home is a team of healthcare providers coming together to improve the health of a specific population. A PCMH is designed to integrate primary care and specialists into improve care coordination, safety and quality.(Stange, et al 2010) A PCMH would also improve physician training and development to provide a commitment to treat the whole patient, rather than just one part.(Stange, et al 2010) Healthcare fragmentation can also be limited through improved communication between providers using e-mail and social media tools such as facebook and twitter.

Building upon the knowledge gained in its previous attempts, over the next several years, IHC went about creating the infrastructure necessary to support such a model. IHC reorganized its management teams to include “a clinical administrative structure to be the clinical counterpart of the administrative structure at each level of the organization” (Bohmer, 2002). Guidance Councils (consisting of a physician leader and nurse manager) were formed for each clinical program and were responsible for coordinating program goals, management strategies and data collection across the system. Within the Guidance Councils were interdisciplinary Development Teams who identified “the key work processes and medical conditions for which protocols should be developed”, then created, implemented and refined said protocols (Bohmer, 2002). This was made possible by engaging practicing physicians (who were wisely reimbursed for their time) in the process, which gave them both the direct experience of the systems they created (be it paper or computer) and a provided feedback loop within the clinical community. Furthermore, IHC created a culture around process improvement, organizing “everything around value-added (front line) work processes” while offering “extensive training in clinical process improvement” as well as operational process improvement (Clark, 2010).