Joanne Conroy, MD


Changing Our Optics on Innovation in Academic Medicine

Several years ago, we observed the emergence of the role of Chief Innovation or Transformation Officers at academic medical centers across the country. These roles were created as deans and CEOs realized that incremental adjustments were inadequate to prepare for the dramatic changes in health care. Changing how we view our responsibilities for the health of patients, adopting a different payment framework, and reengineering how and where we deliver care will require cultural changes that can only be described as daunting.

We have come to realize, however, that relying on job titles may be limit our ability to identify and connect those who are responsible for transforming academic medicine. There are many senior leaders in charge of clinical integration or organizational strategy—roles that are not about market share but are focused on envisioning what the future clinical enterprise will look like, and creating the organizational competencies to adapt and guide their institutions to that new space.

These leaders came from very different backgrounds, but all are passionate about transforming care. Many will be attending the first National Health Care Innovation Summit, to be held in Washington, DC, June 10 through 12. The summit is the collective brainchild of Molly Coye, chief innovation officer at UCLA, Carol Emmott from Russell Reynolds, and Wendy Everett from NEHI. There is a great dynamic when we bring together people who are running toward change rather than away from it! Of course, there are the shared war stories—trying to standardize simple clinical care pathways in a bureaucratic structure where everyone has veto power; and the frustrations with the slow pace of change—but there is real energy and excitement among these leaders who are all learning together.

I love to highlight people who aren’t just talking about change but really experimenting with it. We know that patients with behavioral health diagnoses in addition to other co-morbidities are high utilizers of health care, much of it delivered on an urgent or emergent basis in the wrong settings. The leadership of Maimonides Medical Center (Pamela Brier, Karen Nelson, MD, and David Cohen MD) are focused on addressing this problem.

They have developed the Maimonides Mental Health Home, which has some very bold goals: to identify and address the full range of behavioral, medical, and social problems affecting seriously mentally ill patients; foster collaboration and the timely exchange of patient information among involved providers using a health IT-enabled, multi-provider, virtual mental health home; and drive measurable improvements in health outcomes for the seriously mentally ill population, who often also suffer from chronic co-morbidities. Their target population is 7,500 adults with serious mental illness in 11 zip codes in southwest Brooklyn. Their goals are to reduce preventable emergency room visits by 40 percent, inpatient admissions (psychiatric and medical) and 30-day readmissions among the target population by at least 30 percent, and reduce the total cost of care for the enrolled population by 8.1 percent over the course of the project. The cumulative cost of care savings should exceed $40 million over three years.

The project integrates the diverse array of providers who deliver care and support for the seriously mentally ill in Southwest Brooklyn: primary care providers, mental health care clinicians and professionals, hospitals, home health agencies, social services providers, select specialists who address the prevalent co-morbidities of this population (e.g., cardiologists, endocrinologists, ophthalmologists), intensive case management providers, supportive housing organizations, homeless shelters, Assertive Community Treatment teams, correctional services, and payers. There is tremendous energy around this initiative, which could easily be a model for management of other chronic diseases.

Not all innovation requires such a bold project. Dr. Greg Makoul at Saint Francis in Connecticut, who serves as Senior Vice President for Innovation and Quality Integration, points out that you don’t need an expensive infrastructure to begin thinking differently. Many more of us can innovate within our own environments by just changing our “optics” on what is possible. Dr. Bob Wachter, in his blog last week, related a conversation he had within the UCSF Department of Medicine when he took a quick poll about how many people were involved in projects to improve quality. Lots of hands were raised. Safety? About half. Patient experience? About a third. Cost? One or two shy hands went up. Wachter argues that we need to start thinking about waste reduction as often as we think about quality, safety, and the patient experience.

Value is about all of these and thinking differently doesn’t cost anything! This is something that any of us can do: choose a target that is meaningful, understand the variables, analyze the consequences, determine how to measure success, create a plan, gain support, analyze outcomes, and take another run at further improvement.

Effecting change is far more satisfying that being subjected to change. Residents and students will notice, and model your behavior. We need to demonstrate to them that it is important to ask “why?” as often as we ask “why not?”

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