Want to innovate on care delivery? Here's how to spread reforms

Nine tips to promote large-scale delivery transformation

Writing in Healthcare: The Journal of Delivery Science and Innovation this month, health policy experts C. Joseph McCannon and Aaron McKethan outline nine management strategies to promote large-scale delivery transformations at health care facilities.

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The authors say the "essential" strategies draw on their experience implementing national initiatives at CMS, the Center for Medicare and Medicaid Innovation (CMMI), and the Office of the National Coordinator for Healthcare IT.

According to the report, hospital and health care facility leaders should:

1. Pursue clear, bold, time-limited goals. "Leaders at all levels of the system must take responsibility for delivering quantifiable change on discrete timeframes," the authors write, adding that workers focus less on possible failure when there are clear goals and timelines.

2. Introduce multiple incentives for implementing new models of care delivery. Leaders should give thought to what motivates their providers—not just financial incentives—such as the desire for recognition and professional advancement.

3. Actively remove barriers to achieving goals. Leaders should periodically hang back and assess providers' progress—sit "on the same side of the table" as them to "regularly identify challenges and actively address them."

4. Focus on the customer. Instead of conducting retrospective studies, leaders should go out into the field and actively study local approaches—using technology that measures real-time results, if necessary.

5. Invest in change management skills. "Clinical training and training in health care administration does not equip [providers] to manage complex, transformative change of the kind currently underway," the authors write, recommending that leaders think outside the box when it comes to customizing training for their providers.

6. Emphasize testing. Real change happens when leaders actively measure the rate at which their new practices improve—through "intensive day-to-day management," instead of the "watchful waiting" approach clinical trials employ.

7. Provide data to support local improvements. All available data should be used in helping leaders "understand their populations and identify opportunities for improvement." Moreover, leaders should supplement formal data with self-reported data and smaller samples.

8. Insist on formative evaluations. Leaders should blend formative and summative forms of evaluation in promoting a "positive bias" across the working environment.

9. Remain attentive to innovation in diffusion. Organizations should invest in the "immature field" of new technologies and social media to discover innovations and attract capable individuals to implement the promising practices.

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"While there is no panacea, these strategies should augment the powerful policies and incentives in the [ACA] and the efforts of payers, providers, and patients to help spread effective innovations," the authors write, adding that if successful, the strategies "should also create a system considerably more capable of delivering national and local change, ready to take on future challenges and continuously improve outcomes and value in service of American patients and families" (McCannon/ McKethan, Healthcare, December 2013).

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