Changing Healthcare through Clinical Transformation

By

Kevin Fickenscher, MD

Many societal and market forces are demanding change in health care.  At the same time, there is virtually no debate that the United States offers one of the most advanced health care systems in the world from a technological perspective. Our access to state-of-the-art medicine, coupled with well-trained clinicians, has resulted in the ability to provide truly life-saving interventions for individual patients. So why is there a need for change?

Clinical Transformation – The Imperative.  The value of health care services – like any other product or service – is determined by a combination of technical quality, service quality and cost. Many critics of the current health care delivery system argue that the value society receives is declining because our nation’s health care costs are increasing much more rapidly than general inflation. These critics also contend that service quality is flat or declining, and technical quality is highly variable and thus, undependable.

Against this backdrop are many other issues which seem to be accelerating the need for change in health care.  They include: 

• Globalization – Economic globalization is precipitating profound and irreversible change in industry after industry throughout the United States.  Unremitting competition is forcing all sectors of the economy to examine cost structures for possible economies, demonstrate quality, provide service and meet “value” standards. Health care is no different than another industry facing such challenges. 
• Consumerism - We are also experiencing a major shift in who is paying for health care in the United States and, the consumer is in now in the driver’s seat.  With the move toward health savings accounts and increased out-of-pocket co-payments, the consumers are fast becoming much more expert in making decisions on how to invest in their health care.  And, this trend will only accelerate in the coming years.   
• Demographics - There is no doubt our nation is aging at a rapid rate. The aging populace is fostering a national debate on how best to manage the future funding of Social Security, Medicare and a host of other social programs. The impact of the demographic change is clear and, significant change in our approach to health care finance should be expected by everyone. 
• Reimbursement and Regulatory Pressures – The simultaneous ratcheting down of payments by government-based programs with increasing reliance upon personal, out-of-pocket payments by consumers is forcing the industry to “do more for less.” Just as other industries which have crossed this bridge before us – airlines, utilities, technology, and communications – the health care industry is now facing unyielding cost pressures. The unfortunate paradox for health care is that as a business it lives in the quiet schizophrenia of operating in the environments of consumerism and regulation, simultaneously
• Clinical Workforce Shortages – There is a growing consensus that health care is facing an inadequate supply of clinicians of all types. Continued reliance upon a manpower intensive delivery models that do not fully embraced technology as an enabler of the care delivery process will be problematic.
• Biotechnology - Genomics, nanomedicine and rapidly changing approaches to pharmaceutical developments are but a few examples of the many exploding breakthroughs occurring in the field of biotechnology. These new medical devices, drugs and delivery mechanisms will impact where and how care will be delivered and with greater disruption than at any point in human history.
• Information Technology.  The digitalization of data, availability of bandwidth, and the use of new and flexible software applications for tying disparate information together are all creating new possibilities in the health care computing world. The ubiquitous nature of telecommunications has begun to move from changing our daily lives and affecting our expectations to changing our work lives and affecting our requirements for how work is accomplished on behalf of patients.

All of these changes present many opportunities and create many more forces for change in the industry.  So, what is clinical transformation about? 

Clinical Transformation.  Health care is a complex industry generating high societal and personal expectations from users, payers, and observers. It also hosts a diverse set of constituencies with competing demands and requirements. With the increasing consolidation of the health care industry, leadership plays a critical role in fostering successful change and performance improvement, which requires internal discipline and ongoing focus over an extended period of time.  Clinical transformation is a key component of this change as defined accordingly:  a comprehensive ongoing approach to care delivery excellence that offers value while  measurably improving quality, enhancing service, and reducing costs through the effective alignment of people, process and technology.

A framework for organizations to consider in adopting a health care transformation agenda follows a relatively simple framework:

• People – It should go without saying that successfully carrying out a major change is dependent on people, and specifically on the support of those people most affected by the potential changes. In the case of clinical transformation, many professional disciplines are involved, each with a rich history of training and experience which informs how clinical work should be carried out.
• Process – The entire area of process is frequently the most misaligned element of a technology deployment strategy. Without adequate attention to fully understanding the current state of how work is accomplished, a clear vision of the future state for how work should be done, and the capabilities of the systems to be deployed in support of the future state; the transformation effort is placed in jeopardy. The end result is that new work is designed into the system without removing old work resulting in a situation whereby new work is piled on top of old work, creating more work, which is ultimately rejected by physicians, clinicians, and other workers intimately involved in the care delivery process.
• Technology – As a major investment for the health care organization, the decisions surrounding the approach to technical deployment are a critical foundation for success. However, too often the approach used in deployment initiatives is haphazard; it does not use a methodology, framework or apply evidence-based standards. Discussions related to the technology are “deferred” or “delegated” to the technology departments. Yet, the decisions related to the approach for deployment can have lasting and far-reaching implications across the organization.

The success of any clinical transformation initiative is dependent on how value is driven through the organization with the appropriate involvement/integration of people, process and technology. That value is created through the effective integration of the three management areas of focus:

• Change – dealing with organizational issues derived from the interaction of people with the way they do their work.
• Implementation – resulting from the intersection of process with the technology (e.g. clinical information systems) used to support work processes.
• Enablement – assuring the proper use of technologies by focusing on how people use them effectively

Summary. No doubt clinical transformation and clinical process improvement are the essential work required for health care organizations. A strategy that involves the right people using a disciplined process with the appropriate technology will yield an approach to clinical transformation that can be driven across an organization and, ultimately create value for the organization and the people for whom it provides care.

Dr. Fickenscher serves as Executive Vice President and provides thought leadership related to healthcare transformation and strategy for Perot Systems.  He can be reached at: kevin.fickenscher@ps.net.