Gone are the days when the financial world considered the health care industry “recession-proof.” (In 2016, the idea seems naïve, doesn’t it?)
The harsh realities of the “Great Recession” brought more discussion in health care of efficiency, productivity, and cost reduction. These terms can send shivers up and down the spines of some clinicians. Yet, those caring for patients see examples every day of inefficiency, waste, and misaligned incentives that wrap unnecessary costs into today’s care environment. Facing increased challenges ahead, the need to address these issues has only intensified with time.
How do we make sure — as we do the necessary work of reducing costs — that we don’t lose sight of patient safety, quality improvement, and person- and family-centeredness?
The simple answer is that clinician-led quality improvement teams and financial teams need to do this work together.
Getting Lost in Translation
Strong clinician-finance partnerships are critical as health care organizations make the transition from volume-based work to value-based care. Once established, these teams can work seamlessly to continuously improve care while reducing costs.
But how do we create those collaborations? There are often differences of perspectives, philosophies, and training that can lead to misunderstandings, miscommunication, and sometimes outright hostility between clinicians and financial staff. How do we bridge those gaps and make sure we’re not working at cross-purposes?
Let’s start by acknowledging that clinicians and financial professionals speak very different languages.
Historically, clinicians and financial analysts have operated in completely different spheres. Clinicians generally care for patients one at a time. Analysts, on the other hand, look at spreadsheets, negotiate contracts, and navigate myriad government regulations using extensive data sets in aggregate.
When budget cuts are necessary within a health care organization, the cuts are typically done in an across-the-board fashion. While seemingly “fair” because the pain is spread equally across departments, such decisions often serve to foster distrust between clinicians and finance. How often have you heard one group disparaged as “bean counters” while the other is accused of being out of touch with reality? Each group feels maligned. Each group is sure the other doesn’t understand their needs.
LEARN MORE: Moving from Volume to Value is a featured track at the 2017 National Forum.
Start From the Patient Perspective
Here are the steps that collaborative clinician-finance teams must take to successfully establish a new way of working together:
- Acknowledge that each group of professionals has both expertise and gaps in their knowledge. Concede that each group makes assumptions about the other. Agree that you’re going to put aside past differences for the sake of your organization’s patients.
- Begin from the point of view of a patient population and their care needs. Finance and clinicians work together to identify an agreed upon cohort of patients (e.g., patients with pneumonia, or those who need hip and knee replacements or CABG surgery).
- Develop a value stream map that includes both the processes and costs of care for that cohort of patients. Transparency at this step is crucial. As clinicians identify optimal outcomes, financial analysts use their aggregate data to match these with resource consumption and costs.
When executed well, this process not only develops a shared understanding of patients’ needs and costs, but builds trust and crafts a common language and work processes between clinicians and financial analysts. Clinicians can suggest care changes to improve outcomes, while analysts track proposed savings.
These partnerships and processes pave the way for organizations to work toward defining and delivering real value to the patients and communities they serve.
IHI Vice President Kathy Luther is regional lead for IHI's work in North America.
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