Richard L. Gundling, FHFMA, CMA, Senior Vice President, Healthcare Financial Practices at Healthcare Financial Management Association (HFMA) was a project co-chair on the IHI/NPSF Patient Safety Coalition’s Optimizing a Business Case for Safe Health Care: An Integrated Approach to Safety and Finance toolkit. In the following interview, he offers advice on the best way to bring patient safety and finance teams together to evaluate, prioritize, and fund initiatives that are sound investments for patient and workforce safety.
The Optimizing a Business Case for Safe Health Care toolkit emphasizes the need for interprofessional teamwork between safety and finance teams. How can they do this most effectively?
To help ensure that both departments can collaborate as one team, organizations should develop or identify leadership training programs to make safety leaders conversant in finance and business issues. Meanwhile, the same should be done to help finance and administrative leaders become conversant in safety and clinical issues.
We should be encouraging finance and administrative officers to periodically round with the chief safety officer and sit in on physician or nurse meetings to stay apprised of the relationship between financial decisions and delivery of care.
I’d offer these tips for getting these teams on the same page:
- Lead with quality, follow with cost — Clinicians will be much more engaged in an initiative that focuses first on improved safety and quality of patient care, but this will often require a leap of faith from finance team members. HFMA’s Value Project surveys indicate that most finance officers see a link between quality and cost improvements, yet need to verify the linkage by quantifying cost improvements. Their role is to measure and communicate that the improvement efforts are obtaining the desired results to improve total value. This helps future decisions by key stakeholders and ensures resources, including staff time, are being used for highest and best use. Organizations that lead with quality have CFOs who are true believers in the link between safety, quality, and cost-effectiveness.
- Begin team-building initiatives with willing players — Don’t start the team-building effort with groups most resistant to change. Seek out departments with strong leaders who will champion the drive for value. Establishing early wins with these groups should lessen the reluctance of others.
- Use reliable data to build trust — Finance professionals and clinicians share a mutual respect for data. The finance side of the team can go a long way in building trust among team members by ensuring the consistency and accuracy of data used to identify improvement opportunities and report on progress.
What surprised you about the discussions among the safety and finance professionals who worked on the toolkit?
At first, much of the focus was on how to make a prescriptive tool that would be ironclad and defensible. There was a feeling that for safety professionals and finance professionals to collaborate, they would need a fairly rigid “how-to” guide to build trust.
Later on, however, the group decided to provide a more open-ended guide because each organization has different needs and expectations when developing a business case. A rigid tool could get in the way of getting the safety officer and the finance officer together to work toward mutual strategic goals. The tool should facilitate their conversations, not replace them.
Finance and safety teams generally speak “different languages” because of their disparate training, perspectives, etc. How should teams address that?
It may sound obvious, but when it comes to communication, words matter. For example, a term like “potentially avoidable” may seem perfectly acceptable to finance, but suggests a failing to clinicians. Finance leaders may want to work with a small group of physicians on the language used to describe a value initiative and the metrics involved before engaging with a broader clinical audience.
Also, try to be selective. Don’t try to measure — and improve upon — everything at once. Start by identifying a few metrics that seem most significant and that clinicians perceive as within their control, and focus efforts on improving these.
Business intelligence and analytics are quickly evolving in health care. As we gain access to more and better data, the ability to convert data into actionable information is growing.
Finally, lead with quality and follow with cost. Teams will engage more readily with metrics that relate to the quality and safety of patient care.
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