2013 is a reality-check year for the American healthcare system, and the biggest need for innovation is on the organizational side. Surging demand for healthcare is putting pressure on providers to streamline. Hospitals are reshaping the ways teams of physicians and nurses deliver care, while business owners are preparing for the coming sea change ushered in by the Affordable Care Act.
At the 2013 Healthcare Symposium at the McCombs School of Business, health industry experts and academic researchers discussed these issues and other challenges.
Rethinking Hospital Teams
Patient care in hospitals is traditionally coordinated within teams in which the same doctors and nurses work together shift after shift. However, an emerging “pod” system — in which the members of a team come together for only a single shift or less — is rising in popularity. The pod model, which relies on a dynamic called teaming, is designed to help fluid groups learn to act like a team.
“Teaming is people who don't know each other well and have to get up to speed,” said Amy Edmondson, a professor of leadership and management at the Harvard Business School. “It's teamwork on the fly.”
Edmondson says it helps to have a “team scaffold,” a set of defined roles and authorities that guide team members as they adjust to the new system. For example, even though its membership will vary, a pod would always include an attending physician, a couple of residents, and three nurses. The team scaffold brings accountability, belonging, and a greater sense of interdependence, Edmondson says.
It is also useful to establish operational and behavioral norms across the whole organization, so that everyone entering a pod, even for a short time, can be aware of the same expectations.
Teaming helps increase the psychological safety for reporting errors, Edmondson said. Promoting a culture of “blame-free reporting” — in which team members are encouraged to report their mistakes openly so the whole team can learn from them — is one way leaders can “lower the cost of speaking up and raise the cost of silence,” Edmondson said. “Failure has to be reframed.”
Rationing is Reality
Critics of Obamacare have raised concerns about healthcare rationing — the fear that a growing number of patients will force hospitals to limit the amount and quality of care they provide. Rationing is already occurring implicitly at many U.S. hospitals, says Terry Jones, an assistant professor at the University of Texas School of Nursing.
“When the time available is not enough to fill the demands for their care,” nurses often have to choose which care can be withheld or postponed with the least harm to patients, Jones said.
Jones surveyed hundreds of registered nurses and found that implicit rationing happens in most institutions, though not routinely. Ninety-seven percent of respondents said they had been forced to ration care at least once, but those situations came up only “slightly more than rarely.”
Meanwhile, McCombs Senior Lecturer Kristie Loescher is looking for ways to cut waste and inefficiency at emergency rooms. Working with LaTashia Kiel, an RN at Seton Hospital, Loescher examined a new program called Flexflow, which identifies ER bottlenecks with the goal of getting patients in and out faster.
The program set a series of targets, such as having nurses give each patient a quick evaluation within five minutes of arrival to determine how quickly he or she will receive treatment. Since last fall, patients’ “door-to-MD” time has fallen below the program’s benchmark of 30 minutes, and the percentage of patients who left without treatment fell from 7 percent to 3 percent.
Healthcare Reform for Business Owners
Many small business owners are uncertain about how the Affordable Care Act will affect their bottom lines. In a panel session at the symposium, Loescher argued that giving more people access to healthcare should mean losing fewer work days to illness and injury, and it would also make it easier for people to change jobs or starts businesses without worrying about losing benefits.
“The challenge is paying for it,” she added. “Letting people die is cheap. Letting them lead productive lives is expensive.”
Selvadas Govind, senior manager of CPA firm Weaver LLC, said the ACA might prompt many small businesses to quit offering insurance to employees, because the fine for doing so works out to about $200 per employee per month — much less than the typical cost of paying for insurance. It might also prompt companies to hire more part-time employees, who don't have to be insured under the act.
David Chao, chief technology officer of research firm The Advisory Board, discussed new business opportunities opened up by the ACA, in areas such as software and technological consulting. For examples, hospitals and physicians could hire firms that can help collect and analyze the large volume of data they will be required to process under the act.
Other Innovative Ideas
Young Patients Seek Health Info Online — With the vast amount of medical information available on the Internet, the general public can make more informed decisions about diagnoses and treatments. But how are they actually using the information? A study by the UT School of Nursing’s Bo Xie found that young Americans seek out health information online an average of six times a week, compared with about 3.5 times a week for the older group in Xie’s survey.
Successful Simulations — Computer simulations can help forecast the spread of disease-resistant superbugs, predict the performance of hospital staff teams, and prepare for workforce shortages of nurses and primary care physicians. But designing these simulations is not an exact science, says McCombs Associate Professor Edward Anderson. “It's a hint that you've built a good model if the result surprises you in some way, and if, after you think about it, the surprise makes sense.”
Streamlining Drug Development — The process of developing new drugs and bringing them to market is becoming more complex, expensive and time-consuming, especially in the current regulatory environment in the U.S. A study by University of Texas researcher Alexandra Stone and McCombs Professor of Management Janet Dukerich identifies factors that can affect the speed with which a drug moves through the development pipeline, including: a drug’s technical characteristics, the use of outside components in creating it, and the manufacturer’s scientific capabilities and level of experience. They found that drug manufacturers in other countries are able to get their products to market more quickly than American companies are, suggesting a need to streamline the pipeline system and allow U.S. firms to start earning returns earlier in the development process.
Reporting by Steve Brooks, Sarah Beckham and Rob Heidrick