Why It Matters
The transition from volume to value requires a substantial shift in leadership thinking, behaviors, and actions at all levels of care delivery organizations.
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How Leaders Think: New Mental Models for Health Care Leadership

By IHI Multimedia Team | Monday, December 5, 2016

This month, we’re featuring two excerpts from High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs, an IHI White Paper. If you want to take a deeper dive into high-impact leadership, IHI is offering three one-day trainings in 2017.

The IHI Triple Aim represents a fundamental shift in defining success for health care delivery organizations — that is, the best interests of the patient and community are served by simultaneously optimizing three high-level aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

Success for care delivery organizations in the US has traditionally been defined by increasing use of both ambulatory and acute health care services, with economic rewards for increased volume and intensity. But the US health care system is shifting toward payment and financing systems that reward reduced utilization of acute care services, improved quality, and lower total expenditures. This transition from volume to value requires a substantial shift in leadership thinking, behaviors, and actions at all levels of care delivery organizations.

The shift also demands that health care leaders at every level focus on improving the experience and outcomes of care provided and reducing the cost of care for the populations they serve. Triple Aim results in this new value-based system require leadership at all levels of care delivery organizations, whether a Federally Qualified Health Center (FQHC) community clinic system like CommUnityCare in Austin, Texas, caring for special needs populations like the homeless; an academic medical center like The Mayo Clinic in Rochester, Minnesota, treating populations of patients with the same complex disease; or a national integrated delivery system like Kaiser Permanente, providing both health plans and care delivery for employee populations.

The Importance of How Leaders Think

Mental models — how health care leaders think and view the world — are critically important because they provide the context and direction for leadership behaviors and efforts and promote innovation. The IHI Triple Aim is an example of a new way to think about health care organizational purpose and the required results. High-impact leadership requires the adoption of new mental models:

  • Individuals and families are partners in their care.
  • Organizations should compete on value, with continuous reduction in operating cost.
  • Organizations should reorganize services to align with new payment systems.
  • Everyone is an improver.

With these new mental models providing context, health care leaders define success, consider new approaches, and mobilize their staffs to adapt to the continually changing business environment and promote innovation.

More specifically, “Individuals and families are partners in their care” requires leaders to think beyond patient satisfaction and engagement. This entails a philosophical shift away from the traditional clinical interaction of asking the patient, “What’s the matter?,” to a whole-person interaction characterized by asking persons (not just patients), “What matters to you?” “Compete on value” requires simultaneous improvement in outcomes, patient safety, and service, with a relentless focus on elimination of waste and reduction in operating cost. (We define operating cost as the cost of producing a “unit” of health care, which might be defined as an entire episode of care, an outpatient visit, an emergency department visit, a hospital admission, a patient day, a clinic visit, a surgical procedure, a rehabilitation session, a diagnostic test, or some other bundling of tests and procedures to produce a definable “unit” of health care. It is intended to refer to the actual cost of production by the care delivery organization, not patient charges or price.)

The transition to a value-based system also requires leaders of care delivery organizations to rethink the design and organization of care delivery. The misalignment between payment systems and care delivery organizations drives increased cost. Indeed, in The Innovator’s Prescription, Clayton Christensen makes a compelling case that the simultaneous pursuit of multiple business models by health care delivery organizations results in increased complexity and higher cost.

Finally, “Everyone is an improver” redefines how improvement work is organized and how resources are deployed. Accelerating the pace of improvement and bolstering innovation requires that everyone in the organization see themselves as having two jobs: to do their work and to improve their work. The figure below illustrates elements of the necessary shift in leaders’ mental models as health care delivery organizations move from a volume-based to a value-based system.



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