Building the Will for Change

By Jordan Harmon

When patients come through the front doors of a hospital, they are inevitably greeted by compassionate clinicians and staff. Why then do we so consistently fail to provide high quality, affordable care?  Much of what drives our industry is the will to help others – help families when a loved one is ill, help parents bring new life into the world, and help make tough experiences more comfortable for our patients. From the most hardened surgeon to the most operationally driven administrator, compassion is a common thread. But compassion may not be enough.

Ironically, that very culture of compassion may be a root cause of the healthcare industry’s inability to change. Many of us genuinely fear that health system changes could negatively impact patients and get paralyzed into inaction, even when obvious improvements can be made.  Until recently, there has been no burning platform to transform organizations. However, the Obama administration’s decree last week to convert 30% of all healthcare payments from volume-based to value-based reimbursement by the end of the year is a major step. Right now, very few healthcare organizations are poised to meet that challenge.

The key to making necessary changes will be harnessing the full healthcare team.  Currently, physicians are trained to be independent thinkers, nurses to be compassionate caregivers, administrators to improve the margin, and so on.  This type of independent thinking has left us with a very disjointed and costly heath care “system.” Instead, we must empower each member of the care team to be passionate about challenging current thinking and applying innovation in day to day care.  Nurses must be aided by tools to help physicians provide evidence based care options, administrators need to understand care pathways to help reduce waste, and physicians must learn to think differently and resist the urge to prescribe options that may not be the most financially viable for the patient.

Our mission at Costs of Care is to not only tell the stories of patients with large medical bills or physicians struggling to understand how to make more value based decisions but it is to also to call clinicians to engage teams to work together to figure out solutions.  Each organization has the ability to implement small changes and affect problems such as over-utilization and cost of care integration but those can only be driven by care teams coming together to tackle these issues. Through a team approach we will source our most innovative and transformational ideas to better care while also ensuring the best value for the patient.   By empowering improvement teams to think differently will we be able to harness the most caring employees to get the best outcomes.

What are some of the ways you have engaged teams in your organization to address barriers to providing value based care?  Is your organization committed to making changes necessary to empower teams to develop new solutions to integrate cost decisions at the bedside?  We would love to hear some of your struggles and triumphs.


Jordan Harmon (@jordansharmon) is the Director of Advocacy Initiatives at Costs of Care and Associate Director of Operational Excellence at Hospital for Special Surgery (HSS) in New York.  The views expressed here are solely those of the author and do not in any way represent the views of  his employer.

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