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The 5 P's of perfecting site-of-care shifts

By Vidal SeegobinPaul Trigonoplos

November 16, 2022

    You know something important is happening when health systems of all stripes, regardless of how they are paid or what country they operate in, are all pursuing the same strategy.

    That's what is happening with site-of-care shifts globally.

    While the pressure to move to a faster, more consumer-focused care delivery model existed before Covid-19, the pandemic shifted us into over-drive. And with an increase in new actors providing digital and in-person alternatives, so too came an increase in questions about how health systems are supposed to react. We spent a year talking with health care leaders on how to effectively shift care without burning out staff or jeopardizing quality.

    What we found was a series of "must-haves" for any successful shift.

    The 5 P's of perfecting site-of-care shifts

    Pace: Most importantly, best-in-class approaches to shifting the site-of-care acknowledge that it's a workflow-, clinician-, and patient-related process. Whether prompted by unmanageable wait times or competitive pressures, the perspective to have is that it's better start slow and engage every stakeholder that might be affected rather than sprint out the gate.

    Plan: Our research found that care shifts are more likely to fail because of poor execution, specifically around changing clinician workflows. A care shift is re-organizing a series of decisions and hand-offs. Whether it's a digital shift or in-person site change, you want to plan an optimized series of steps. West Moreton, a provider in Australia that has partnered with Philips to shift an increasing number of specialty areas to hybrid access models, described the work of "unpacking and repacking workflows" as a key element to their success.

    Proof: Alongside workflow redesign, convincing clinicians of safety and quality is key to embedding new referral defaults. Clinicians across the globe want evidence—with a premium on local data. To hardwire the transition, London Health Sciences, who established one of the first ASCs in Ontario, Canada,  kicked-off its care shift process with a data-collecting trial period to quantify the productivity gains alongside input reductions in a high-efficiency ASC environment.

    Prestige: Workflow and care model redesign is not interesting to every clinician. But the challenge and prestige of building out something new does appeal to some. When communicating about the plan, highlight the prestige in charting a new path. Kudos is deserved when this is a first-time regional or national model that you are rolling out. It will attract those with the mindset and inclination to lean in and experiment.

    Profit: Lastly, change is not free.  In some markets the profit-sharing motivation is clear. But it's worth remembering that in most of the world, physicians are compensated on activity. Calculating the financial gains will drive wider adoption. We've heard of health system interest in joint-ventures with doctors in many of the single-payer systems around the world.

    Site-of-care shift strategy assessment


    Increased demand from growing and aging patient populations have created sustainability pressures that are straining health systems around the world. Now, as we build back from the Covid-19 pandemic, changes in policy direction, regulation, third-party disruption, and patient & clinician preferences are illuminating a path towards sustainability that many health care executives intend to go "all-in" on: shifting or expanding hospital services to be closer to the patient.

    Sourcing from over 60 research interviews with systems from around the world, we compiled a set of the ten components that all innovative, forward-looking systems have included in their plans to shift services closer to the patient. This list serves as a baseline set of areas that organizations must incorporate into their strategies to successfully achieve their care shift vision.

    Download the infographic

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