Think of the possibilities if we could do this within a hospital:

Imagine a global corporation - maybe a software company or an accounting-consulting firm - in which people at all levels and positions could interconnect and network together, and then solve problems together. A company with an internal intranet containing an internal Facebook, blogs, work logs, etc. fully searchable by anyone else in the company. Perhaps employees anywhere in the world could connect in any way they needed to: video conference instantly from their laptops, or leave video messages for each other.

If all the talent in the company could connect easily, that could bring enormous innovation acceleration. Problem solving could be far more efficient. Maybe David in the office in Singapore has already solved a problem now facing new person Carly in the office in Boston? What if Carly could type in a few key words and learn that David dealt with the same issues last month?

While I’ve heard of companies trying to better connect their workforces through intranet applications, I haven’t heard of too many turning all or most of the process over to all employees, especially the younger generation (but please comment and tell me who is doing this if you know).

The first company that achieves this extreme interconnectivity would instantly have tremendous leverage against competitors from an enormous boost in productivity and innovation.

Connect:  Extricate!  Communicate!  Innovate!

Encourage employees to solve problems by connecting and empowering them.  Remove traditional barriers (I work on the 7th floor, I work in Radiology, I’m a nurse) and allow innovation from below: give employees the tools to communicate with each other and access to actionable data.  This challenging time is not one in which to exert more control; for it will be the free organization that will prosper.

Another reason that the reality of health care delivery going global should be a consideration in health care transformation thinking (from the Los Angeles Times):

Low cost isn’t the only reason Americans are traveling to foreign countries for healthcare. Timmi Ryerson of Vista, Calif., went abroad looking for expertise she couldn’t find at home.

Her deteriorating hip led her to India two years ago for a procedure known as hip resurfacing. The surgery has been performed for years in Europe and Asia but was still new in the United States.

Vineet Nayar at Inverted Wisdom (a Harvard Business Publishing blog) asks an intriguing question:

As time passes by, people and things change. Now, what if time passes by and people change, but things that should change, don’t?

Health care is steeped in tradition.  While other businesses have flattened their organizational structures and empowered front-line workers, on the whole health care has grown more bureaucratic.  Actually, health care has approached this issue in an almost completely opposite fashion.  Remember the empowered country doctor?  I don’t either, but I have read that they existed at one time.

Mr. Nayar continues:

It is not a stationary relic I’m talking about. I’m talking about the brand new dinosaur on the block - the classical management pyramid. Time has come to dismantle it and adapt to a new evolutionary and unstructured model that leverages the team effect to ensure that companies can lead change rather play catch up or be left behind.

The prevailing notion is that health care is constantly changing, that’s true.  But backward incentives have mucked up our ability to respond.  The reality is that the majority of stakeholders in our industry have become reactive to change instead of leading it.

Again, Mr. Nayar:

Yes, the traditional pyramid management structure needs some unstructuring. Flexibility is the key to survival in the 21st century, and organizational structure is no exception. It needs to be open to change, to take any shape that’s best suited to the organization.

Leadership would do well to shun the ‘Me’ approach and deregulate, decentralize and transfer a substantial part of the organizational control to the frontline.

Logically, the health care organizational structure should be devised so that the complete focus is on the patient’s needs.  The Cleveland Clinic is trying by integrating its service lines into institutes dedicated to health care conditions.  Cleveland Clinic CEO Dr. Toby Cosgrove:

I think the model where we bring together all the expertise (cardiologists and surgeons under one roof, for example) will be a tremendous benefit for clinical care. You get wonderful things from proximity (conversation and innovation). The line between medicine and surgery is blurring. Innovation takes place on the borders of disciplines.

Delivering health care requires a tremendous amount of organization.  The complexities of this industry (uber regulation, 24/7/365 operation, numerous specialties, etc.) make it difficult for executives to let go of their control.  But the complexities also make it that much more important that control is released to the talented workers on the front line. Mr. Nayar:

Simple as it may sound, the truth is that this is a very tough task. The question we must ask ourselves is whether we have within ourselves the fortitude to deconstruct the traditional power centres so that more emphasis is placed on the troops instead of the General.

Difficult it is, but necessary.  Quality would improve if it were released to the people who truly understand quality and can provide it its necessary attention.  Technology may reach its full potential if the people who use that technology become the decision makers on implementation.  Services would benefit the patient if we organized around the patient’s health care needs.  We need to stop building barriers and start tearing them down.

We should organize around collaboration and continuity and integration.

Maggie Mahar at Health Beat Blog recently wrote about the high level of care delivered at the Mayo Clinic and the power of integrated delivery systems:

The variation suggests that it may not be the Mayo “system” that lifts Mayo’s flagship Minnesota hospital above the tide. Rather, some observers suggest, it may be the highly egalitarians and collaborative “culture,” which puts patients ahead of everything and everyone else, that makes the Mayo Clinic in Rochester, Minnesota so special.

Nevertheless, the 2008 Dartmouth Atlas does provide sufficient data to support the thesis that integrated delivery systems are likely to provide the most efficient high-quality care. And the report makes it clear that Mayo is not the only integrated system that stands as a benchmark for excellent collaborative care. Both Intermountain Healthcare (IHC) in Utah and the Sutter system hospitals in Sacramento are singled out for praise.

One last time, Mr. Nayar:

So, do we have the vision to look upon our organizations as collaborative and evolutionary life forms that must keep changing along with the marketplace? Do we have the humility to step out of our egos and hand over the mike to our subordinates? Do we possess the courage to unstructure an existing, rigid regime that we have known to work in the past?

We often accept the verdict of the past and slumber into the cushioned inertia of best practices, until the need for change cries out loudly enough to stir us out of our comfort zones. It is time.

Embrace change, lead change.  It is time, indeed.

Bob Laszewski at Health Care Policy and Marketplace Review highlights a recently released Robert Wood Johnson Foundation Synthesis Project report authored by Paul Ginsburg from the Center for Studying Health System Change.

“High and Rising Health Care Costs: Demystifying U.S. Health Care Spending” is very interesting reading.  This especially:

If the efficiency of the delivery of services could by increased by 20% over 10 years, this would roughly close the gap between health care spending and GDP over that period.

Mr. Laszewski explains:

The bottom line is that if we want to contain our health care costs we need to find productivity improvement in things like technology use, treatment patterns, and administrative overhead.

…

The big-ticket play is in productivity—the more discriminate use of medical technology, consistently practicing outcomes-based medicine, and reductions in system overhead particularly in the insurance system.

moving.

New hero: Phillip Newbold, CEO of Memorial Hospital in South Bend, IN, and the self-described “champion of innovation” at the hospital.  The hospital’s website is Quality of Life dot org, tremendous!

See previous posts on innovation centers here and here and here and here.

The Wall Street Journal brings news of the coolest innovation center yet:

The Innovation Café is an unusual teaching laboratory created by Philip A. Newbold, the veteran chief executive of this midsize community hospital and health system. He converted a failed delicatessen into a venue where staffers and outsiders can learn to craft new ideas.

[snip]

It was a tour of an innovation training center for Whirlpool staffers that sparked the establishment of his teaching lab. He persuaded his employer to become the first U.S. community hospital with an innovation research-and-development budget. The board committed up to 1% of annual revenue for innovation activities. That equals about $4 million a year. The hospital ended up spending just $195,000 in 2005, $622,000 in 2006 and $711,000 in 2007 on innovation efforts such as venture start-up costs and staff training. But the increase in related operating profit was as much as three times the annual expenditure.

Other cool stuff from Mr. Newbold: visits other innovative businesses, rewards staff for “good tries,” developed private label health drink through strategic partnership, worked with IDEO, developed a cryo tank, and shares his innovation ideas with others in the health care field.

Wal-Mart is opening its first Marketside store (yes, that Wal-Mart).  The concept is a 15,000 square foot (much, much smaller than the Super Wal-Mart) neighborhood market.  It’s meant to compete with Tesco’s Fresh & Easy entrance into the United States.

The Financial Times reports the new concept “marks a dramatic break with the branding of the rest of Wal-Mart’s more than 3,400 low-cost US stores.”

What does this have to do with health care?

The trend.  It’s smaller, manageable, intimate, community-like.  If a Super Wal-Mart is 1000+ bed quaternary hospital, then a Marketside neighborhood market is a … to be determined.

Some may think it’s a retail clinic, but the analogy doesn’t hold here.  The retail clinic depends on the foot traffic generated by the big box retailer or pharmacy.  It’s not a specialty hospital either, not enough product offerings.  Most likely it’s a health delivery concept that hasn’t reached the masses yet, like the medical home or micro practice.

Regardless of what it actually is, the concept of neighborhood health care delivery is much more desireable than the mass production of a primary care clinic attached to a super hospital.

Jen McCabe Gorman passed along a link to a video via Twitter Tuesday.  It’s a Modern Healthcare highlight reel of the Rocky Mountain Roundtable 2008.  The theme of the short footage is generally about bettering wellness prevention and chronic disease management.

Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group, emphasized community solutions, especially community-based health centers for all patients.

Dr. Tuckson’s talk focused on a four-step approach to improving prevention efforts and disease management:

1. Better leadership

2. Better strategic planning

3. Support research

4. Integrate prevention into clinical care through IT

All good points.  However, his quote about step two is bothersome.  Dr. Tuckson said, “We gotta get better strategic planning, we play around with prevention. ‘I heard a good idea the other day, let’s try that.’  That’s foolishness.  We need data, information that’s locally specific that says ‘here are the problems in our zip code and here are things we need to get at.’”

If trying new ideas is foolishness, fools are what we should aspire to be.

Granted, planning around prevention would improve through locally gathered data.  It would tell us a community’s greatest needs and then we would apply proven methods to address them.  That’s fantastic.  And some day it may work like that.

But varying needs will require solutions of many different feathers.  How do we find such solutions?  When researchers, doctors, public health officials, citizens, patients, etc. say, “I heard a good idea the other day, let’s try that.”

Tom Peters:

If Randomness Rules then your only defense is the so-called “law of large numbers”—that is, success follows from tryin’ enough stuff so that the odds of doin’ something right tilt your way; in my speeches I declare that the only thing I’ve truly learned “for sure” in the last 40 years is “Try more stuff than the other guy”—there is no poetic license here, I mean it.

You have to try stuff to find winners.

It’s wonderful to hear an executive from a private insurer pushing these ideas.  But throwing out the engine (good ideas) that will create innovative solutions to solve our oppressing health care issues is unwise.

Dr. Richard Reece on vertical vs. lateral health care thinkers (via Kevin MD):

Vertical thinkers dig deeper and deeper holes across the health care landscape. At the bottom of each hole, you will find a world class expert. The only problem is the various vertical holes don’t connect. One specialist may not know what the other specialist is doing and may have no means of communicating with him/her colleagues or hospitals.

The lateral thinker, on other hand, roams the countryside looking for connections, seeking ways to put things together into an integrated whole, searching for a system blending relationships and eliminating care gaps, and hunting for self-organizing information platforms and disruptive innovations that lower costs and that work outside traditional specialty silos.

Read his very interesting (and spot-on) post.  It’s amazing how many of our problems we could solve with a proper focus on primary care.

Another story of a frustrated primary care physician forced to experiment with the trials and tribulations of going solo.

This doctor’s decision was driven, in part, by a sabbatical in Sweden.  Imagine these requirements in American medicine:

The Swedish doctors were equally worried about his American ways. The clinic chief swiftly laid down the rules. Oldenburg was to take a half-hour morning coffee break, like everyone else, and then a lunch break from noon to 1 p.m. and another half-hour afternoon coffee break. During these breaks, he was to socialize with his co-workers, including lab and cleaning staff, and there was to be no shop talk.

I know, I can’t either.