Through Clinical Transformation
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?
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.
backdrop are many other issues which seem to be accelerating the need
for change in health care. They include:
– 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.
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.
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.
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
– 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.
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.
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
All of these changes
present many opportunities and create many more forces for change in the
industry. So, what is clinical transformation about?
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:
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.
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.
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.
resulting from the intersection of process with the technology (e.g.
clinical information systems) used to support work processes.
assuring the proper use of technologies by focusing on how people
use them effectively
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
serves as Executive Vice President and provides thought leadership
related to healthcare transformation and strategy for Perot Systems. He
can be reached at: