Clinical Integration – The Link to Special Relativity

einstein1Journalists ask, ‘What does Clinical Integration look like?’  Like Albert Einstein wrote in 1905, it depends upon the observer.

To the patient, its better care experience due to more appointments, easier appointing and navigating, all information available in the moment of shared-decision-making, and all clinicians seem to know each other and trust each other. And that care experience is predictable and reliable (standardized) regardless of the location in which he/she receives care.

To the system-wide CFO, its higher margins for a single clinical service line or all service lines. For example, the production cost of total hip arthroplasty rises year-over-year at a rate less than the rate of revenue for that procedure. That margin occurred because the docs, nurses, pharmacists, physical therapists, improvement engineers and case managers collaborated to reduce (a) clinically unwarranted variation in physician practice patterns and (b) wasteful team workflows.

To the doctor, it’s better professional fulfillment because she doesn’t have to fight as hard for her patient to receive a prompt, goal-directed consultation in Neurology or well-organized home care following hospitalization. A reduction in the time that elapses between onset of illness and definitive treatment is a reliable marker for Clinical Integration (CI); if cycle time doesn’t fall when compared to baseline, CI wasn’t created  (see ).

To the ICU nurse, it’s fewer terminally ill patients on the ventilator, because the Palliative Care consult was performed 6 days after diagnosis, rather than 6 days after intubation.  And she has 3 physician caring for Mrs. Brown, with one of them conspicuously serving in the role of Attending Physician, rather than 6 docs with no Attending.

To the system quality officer, it’s higher HEDIS scores, better Joint Commission appraisals, and fewer events of patient harm or allegations of medical-malpractice, because of less clinically-unwarranted variation in the practice patterns and workflows for patients with similar conditions.

To the Brand & Marketing Department, it’s more patient testimonials on Facebook for why care at St. Neighborhood is better than care at St. Midtown.  And they have more requests than ever to sponsor branded public events.

To the CEO, its higher margin and marketshare over time (lagging indicators), due to the success of the colossal changes in operations, informatics and culture depicted above (leading indicators).

So the manifestations of Clinical Integration, like space and time, depend upon the observer, just like Einstein said.


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