A nationally renowned acute care hospital had a challenge that many healthcare institutions face today: how to ready their organization for a very different future climate while also succeeding in today’s reimbursement environment. The very behaviors that had made this hospital so successful—a consistent and successful focus on quality, a willingness to do anything for the health of the patient, clinicians who called in a full range of excellent consulting physicians—were the same behaviors that would put the institution at risk in an environment of cost containment and accountable care.

The top team knew they had to rein in costs but were unwilling to compromise quality of care. They wanted to focus on the value of healthcare and appropriate care. And, they wanted to adapt their organization and their strong staff of attending physicians to be ready to live in a very different future, much as astronauts train to function effectively in weightlessness and on the moon. How could they create their own futurenauts, while staying true to their overall mission?

CFAR worked with the organization to identify the behaviors that would allow those within the organization to prioritize appropriate care as automatically as they now did quality. CFAR helped them address questions including:

  • What behaviors were critical for physicians on the line?

  • How could radiology contribute effective to prevent unnecessary testing?

  • What structural supports needed to be in place to help physicians decrease length of stay?

  • What capabilities did administrators need to develop to work with physician leadership and support them through the process?

  • How could they determine what standards of care were appropriate?

  • How could they engage physicians so that they were part of the solution and not undermine the process?

  • What data did they have that allowed them to track progress?

Working closely with groups within the hospital, CFAR helped them pull in the physicians, rather than push them into new territory. They learned how to make unspoken concerns explicit. For example, physicians were skeptical of some of the metrics that were used to assess appropriate care. By surfacing those concerns, the leaders of the effort learned what data would be persuasive, and helped develop those data. Rather than alienate physicians he process of learning to live in the future tired them more closely to the hospital. They wanted more connection rather than less—they embraced rather than disdained a new electronic health record, for example.

Over time, care has become more ‘appropriate’—the hospital can use the metrics it developed to see their own costs decline while sustaining the quality that is core to their mission. And, they have come to see this as an ongoing process, a change in the culture rather than a ‘project’ with a finite impact and life span. In the process, they have created futurenauts.

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