Successful CVR is not just theory. My colleagues have published a number of case studies and best practice profiles on systems achieving CVR in recent years (see here and here for two of my favorites). The latter piece is definitely worth reading; it shares the "inside story" on achieving CVR from executives at some of the most progressive health systems in this area. In particular, I'm impressed with Banner Health's success in achieving CVR at-scale, across multiple states, and with a mixed medical staff.
Rather than dig into the mechanics of CVR, I want us to think more about the type of leadership that makes it successful. I pose two questions to leaders reading this post:
- Have you created the necessary and sufficient conditions for CVR to occur at your organization?; and
- Are you willing to address difficult issues with your medical staff, or is the relationship with your physicians so tenuous that even discussing CVR is enough to send them (or their referrals) to your competitors?
Overcoming the tension about these issues is key to success. One hallmark of the organizations leading the way on CVR is that they have moved so far past the "difficult" conversations around that topic that it is the medical staff themselves—employed, affiliated, and independent—who are taking the lead in driving the initiative forward. That is enviable.
In an interview with my colleague Eric Larsen, Howard Kern, CEO of Sentara Health System, addressed this issue head-on. I find this statement very compelling:
We spent a lot of time developing a mission statement that says, "We need to drive best practice, and we need to take out unwanted variation."
And our physicians were critical; physicians from every part of the company worked together to establish a clinical leadership council. I knew that if we were ever going to get quality and performance where we need them, we had to get clinicians to drive it. And ultimately, we're going to drive cost too—but I knew we were never going to get credibility with clinicians unless we had quality first.
We had a very important saying about quality of care benchmarking: "Your quality is only getting better to the extent it is improving at a rate equal to or faster than other top performing health systems in the market."
I think Howard's remarks make two important points. First, they reinforce the idea that the medical staff must lead—not just be "on board with"—quality efforts to push CVR forward. Second, they reinforce an often-overlooked reality: If your organization is not leading your market in CVR, you cannot credibly claim to be serious about clinical quality, nor can you credibly claim to be a patient-centered organization. To put it bluntly: If you are not leading your market in this most essential of areas, why should patients, employers, or payers choose you to provide their care?