All of the “players” in health care are getting bigger. Consolidation is the name of the game as hospital systems hire more physicians, multi-hospital systems merge, insurers develop their own “captive” provider networks and new hybrid organizations, like CVS/Aetna (and maybe Walmart/Humana) are coming with dizzying frequency. Some of this feels to me like an arms race, with size (and its attendant market power) itself the goal, rather than growth as a means to assemble the right combination of resources at the right scale to improve care.
Even so, I believe scale can improve care. Given where I sit, I don’t suppose that is much of a surprise, but I would go further to say that organizational heft is now necessary to provide high quality care through enhanced and better coordinated access to the right technology, the right providers and the right services, when and where patients need them.
It is in that context that I found a recent opinion piece in JAMA an important read. In it, the authors present a thoughtful theoretical framework for considering the potential downside of the growth of provider organizations. Titled “The Risks to Patient Safety from Health System Expansions” it includes new threats to patient safety and suggests potential strategies for mitigating them, summarized in this table:
(Click image to enlarge)
It is important to note that the authors do not advocate limiting the size of provider organizations or retreating from the prevalent plans for growth to avoid these risks. Rather, they conclude: “Institutions must actively plan for, monitor, and manage the resulting risks as part of a comprehensive strategy, including sharing data on quality and safety, and sharing oversight of care for the joint patient population.”
Makes sense to me. What do you think?
I took advantage of the holiday slow-down in routine meetings to visit our Health System’s new serious transmittable disease unit – the “Ebola Unit” – at Glen Cove Hospital. Wow!
I had the good fortune to have Darlene Parmentier, the nurse manager of the unit, tour me around and explain how patients will be cared for. Darlene is an experienced clinician and had a ready answer for every one of my questions. In fact, she had answers for lots of questions I never thought to ask! Despite the fact that the physical space had been transformed from an unoccupied “regular” hospital inpatient unit into a highly specialized containment and care facility in just days, I was amazed at the thoughtfulness of the design. Here are just a few of the salient features:
- A dedicated pathway (including a dedicated elevator) from an external ambulance bay directly into the patient care area
- Ample living space for care givers who may choose to stay on the unit between shifts, complete with thoughtful touches like a ping pong table and an X-box
- Designated training areas, recognizing that continuous simulation and drilling are integral to the effectiveness of the unit
- Well marked “zones” that correspond with the risk of contact or exposure to infectious agents, and dictate the different the levels of personal protective equipment that must be worn
- The pervasive evidence of planning, not just for the range of clinical challenges that may arise, but also for the needs of patients’ families, the impact on caregivers and the reaction of the community and news media
Overall, I came away incredibly impressed. Once again, our Health System has stepped up to do the right thing for our patients and our staff, and I am confident that any patient who needs treatment there will get great care.
Let’s hope it never happens. Continue reading System Readiness
With the first – and probably not the last – documented case of Ebola in New York last week, the reaction of State and local governments was big news, and the preparations of the North Shore-LIJ Health System kicked into a higher gear.
New York City Mayor Bill DeBlasio, flanked by the President of the city’s Health and Hospital Corporation, Dr. Ram Raju, and the city Health Commissioner, Dr. Mary Travis Bassett, gave a news conference. I thought they struck just the right balance of information and reassurance, and grounded their responses in what is known about the disease. In discussing the movements of the patient, a physician who had been working in West Africa with Doctors without Borders, prior to his admission to Bellevue, they repeatedly stated that he had posed no threat to the general public. Indeed, they cited the case of the man who died of Ebola in Texas, who had spent days living with family members at a much more advanced stage of his illness, and did not transmit the disease to any of them. Of course, 2 nurses who later cared for him did, but he was far sicker by then (which means he had a much higher viral load, and was correspondingly more infectious), and we now know they likely had inadequate training and personal protective equipment.
Continue reading More on Ebola
I have a pretty well-rehearsed answer for anyone who asks me what my role is all about. For those unfamiliar with the North Shore-LIJ Health System, I rattle off a few key statistics (16 hospitals, $7 billion in revenue, 48,000 employees) and then give a brief description of our clinical service lines, the ambulatory services division, which provides operational and back-office support to our physician practices, and the medical group, which integrates clinical services. Continue reading Planning for the future