Among other things, COVID-19 has taught us that we do not have the right healthcare infrastructure to truly take care of communities during a pandemic.
Too often, hospitals and health systems struggle to support appropriate care transitions. They face challenges responding to changes in healthcare consumption patterns, particularly as consumers turn to virtual options for care. They lack the tools to compete with market disruptors that offer real-time access to primary care physicians and specialists who can answer health questions quickly—and direct them to competing facilities for care.
Yet, in a survey conducted during Guidehouse’s 2020 Clinical Integration Summit, only 50% of organizations reported they had the capabilities necessary to support increased levels of risk, and 66% reported that COVID-19 uncertainty has led to the inability to make the investments necessary for capability improvements. This creates challenges while the move to value and provider-sponsored risk continues, as 74% said they plan to be in upside and downside risk arrangements within the next three years.
How can healthcare leaders drive clinical integration—and, ultimately, the move toward value—during COVID-19?
Developing a value-based infrastructure for care requires more than an investment in the latest health technologies and information systems. It also demands that providers tightly align clinicians across the continuum of care to:
Increase organizational agility, especially in adapting to change.
Intensify focus on improving clinical outcomes.
Strengthen organizational resiliency.
Enhance quality of care and efficiency, even amid the pandemic.
During Session 1 of the Clinical Integration Summit, Harry Greenspun, MD, partner and chief medical officer at Guidehouse, and Julie Teahan, change management expert and Guidehouse partner, described their collaborative work with Dan Hudson, PhD, to train clinicians and healthcare leaders on how military principles could drive healthcare value.
Hudson is a veteran who served for more than a decade, first as a US Marine and then as a Navy diver and nuclear submarine officer. He subsequently served for a decade as a reliability engineer and risk analyst for the US Nuclear Regulatory Commission before taking on his current role as the chief technology officer and chief data scientist for ReefPoint Group.
Ensure team members have the right knowledge, skills, and tools to accomplish their mission.
On nuclear submarines, the first year of a leader’s training is spent learning the knowledge, skills, and abilities of every person on the ship. “Your time is essentially spent shadowing and learning from crew members who are manning various stations throughout the ship,” says Hudson.
“You have to demonstrate that you have a deep understanding of their roles and responsibilities to supervise the operations of a nuclear propulsion plant,” he says. By the end of that year, officers are well-qualified to command each of the workstations on the submarine—and sailors are invested in their success. “They take pride in the fact that they educated you and trained you in the work that they do,” Hudson says.
In healthcare, having the right people, training, and teamwork are essential to achieving objectives. Healthcare leaders should focus on three interrelated elements to foster collaboration:
Mutual trust and goodwill
A common aim or unity of purpose
Clearly articulated roles and responsibilities
Inspire enthusiasm and devotion to the organization’s mission.
“When you understand your purpose and how it maps to the mission, you gain a much stronger grasp of the ways in which your technical skills and clinical mastery support that mission,” says Teahan. “Empowering individuals with the autonomy to apply their expertise also boosts morale.”
Organizations can move the needle on cultural improvement with little financial investment, Teahan says. Intentional thought and simple plans for improvement are key.
One place to start: Ensure that everyone not only feels free to speak up when they have concerns, but also recognizes they have an obligation to do so. This approach encourages team members to hold each other accountable for excellence in care and service.
Establish clear lines of responsibility—and empower staff to make decisions quickly in times of crisis.
“On the submarine, there is a wide range of standard operating procedures that cover the routine operations of the ship as well as emergency operating procedures that are designed to cover certain scenarios,” Hudson says. “But inevitably, an abnormal event will occur, and you find yourself in a condition that may not be covered by procedures at all.”
In those scenarios, Hudson says, “It's all about making judgment calls. You have to rely on your foundational knowledge and the theoretical principles you learned in your training to weigh the risks and quickly evaluate alternative courses of action and the potential impact on the safety of the systems and the crew.”
Reducing confusion with clear lines of responsibility and communication enables team members and leaders to make better decisions faster. Start by identifying the individuals who are closest to the problem areas and possess the relevant expertise to manage threats to healthcare value. Then, give these individuals authority to make decisions quickly, when needed.
Provide a common goal and definition of success.
In the military, this is known as a “Concept of Operations” (CONOPS): a verbal or graphic statement of a commander’s assumptions or intent. A CONOPS is designed to give crewmen an overall picture of an operation, including clearly defined goals and success criteria. CONOPS are useful tools that increase the likelihood that objectives will be achieved, even in unforeseen situations that require deviation from planned courses of action.
“So much of what we focus on in developing people in healthcare is what success looks like, but team members also have to recognize when they are on the path to failure,” says Dr. Greenspun. Leveraging CONOPS to provide a common goal and definition of success in healthcare can serve as the foundation for agility and adaptability in times of crisis, chaos, and uncertainty.
Perform “hot washes” when errors and near-misses occur.
The term “hot wash” originated in the US Army, where soldiers cleaned their weapons with hot water to remove residue after firing. Today, it describes the debriefing process that takes place with primary personnel immediately after they return from a mission or patrol. For healthcare organizations, the concept of hot washes presents an opportunity to commit to resilience and learning by using errors and near-misses as opportunities for education and improvement.
“In my observations of healthcare, I’ve found that this feedback loop is often missing,” Hudson says. In describing his experience on Navy submarines, Hudson says, “We would conjure up these hypothetical scenarios that we would put the crew through in real time, at sea, to observe how they would respond and, especially, how they communicated with one another.” Structured and standardized communication is critical to the safe operation of a submarine. “Then, we would do a hot wash afterward to share our observations, including what worked well and where there were opportunities for improvement. It’s a process that is very ingrained within the culture of the organization.”
Go beyond business as usual.
During COVID-19, clinical integration has become a necessary component for resilience and sustained growth, given the market forces that are disrupting the industry. Applying military principles to clinical integration could fuel the transformational change needed to drive success during COVID-19 and beyond.