"Integration occurs when groups within an organization communicate effectively, share a common language and culture, and are driven by a shared purpose," says David Birdsall, MD, Vice President of Operations at Vituity. "That's quite an achievement in itself. But to realize the full benefits of integration, making integration meaningful, you need to take that collaboration a step further."
Vituity is helping administrators to do just that. On Wednesday, June 1, Vituity President Imamu Tomlinson, MD, and colleagues will present a webinar titled "Achieving Meaningful Integration Through Physician Leadership, Engagement, and Alignment."
Presenters will include:
- Imamu Tomlinson, MD, MBA, President, Vituity
- Susan Chapman, RN, MBA, Vice President of Patient Care Services, Adventist Medical Center – Reedley
- David Birdsall, MD, Vice President of Operations at Vituity
- Chad Thiesen, RN, Director of Emergency Services, Adventist Medical Center – Selma
In today's post, the presenters explore why meaningful integration is important, its benefits, and what holds health systems back from achieving it.
What Is Meaningful Integration?
Meaningful integration involves using the power of relationships to realize specific outcomes and goals. These might include reducing admissions, enhancing care transitions, or any goal that furthers the system's objectives.
Achieving meaningful integration at the system level enhances a health system's ability to manage large populations. But it's also an incredibly complex process.
"To thoroughly integrate, you have to manage transitions with care," says Tomlinson. It's all about sharing information and making sure there are clinical pathways so that care is seamless, no matter which facility or practice line is managing the transition."
A System Unites
Adventist Health – Central Valley Network is a great example of how physician alignment across a system can promote meaningful integration. The system consists of three rural hospitals spanning about 60 miles: the Adventist Medical Centers at Selma, Reedley, and Hanford (Calif.).
For many years, the hospitals and their respective departments operated in relative isolation. That gradually changed as the area's population began to tick upward.
"We reached the point where our 10-bed standby ED at Reedley was seeing nearly 30,000 visits a year," Chapman says. "To provide great care, we needed the resources of the entire system behind us. We had no choice but to change."
Down the road in Selma, Tomlinson and Thiesen were observing a similar pattern. One of their biggest challenges involved transferring Selma's ED patients to the system's only ICU at Hanford.
"Back then, admissions were handled by a patchwork of hospitalists and community physicians," says Thiesen. "There was very little consistency or accountability. It was sometimes easier to transfer a patient out of the system than to get them admitted to Hanford."
To address the issue, administrators turned to Vituity, which already staffed the EDs at Hanford and Selma. Going forward, Vituity would manage all three EDs, all three hospitalist programs, and an urgent care center. Medical directors from all sites began meeting monthly to discuss ways to improve communication, boost consistency, and ease care transitions.
The site-level teams also had many changes to make. "Dr. Tomlinson's approach really emphasized communication and getting everyone working together as one team," Chapman says. "Based on what we were hearing from our sister sites, we made a lot of changes to our own processes. We had to rethink everything about the way we delivered care."
Engagement was another success factor. "At Selma, Dr. Tomlinson really wanted everyone to be involved and sought our input," Thiesen says. "All ED team members were treated as valued partners during the planning. Some of our best innovations came from one of our techs, who's now a nurse leader here."
Within just a few months, all sites saw operational gains, including significant decreases in LOS and ED turnaround times. Transfers out of the system became a rarity.
Perhaps the biggest benefits were cultural. "On our team, everyone speaks up and everyone's opinion is valued and respected," Thiesen says. "Being on the same page helps us to adapt to changes and move quickly."
Barriers to Meaningful Integration
When so many systems desire meaningful integration, why are some struggling?
Some of the barriers are likely cultural. "Historically, physicians have enjoyed considerable autonomy within hospitals," Birdsall says. "They're used to making most of the decisions around patient care. And now that administrators are asking them to work in teams and align with big-picture goals, there's some friction."
Integration also changes established roles, which can provoke anxiety. "We're asking providers to take responsibility for new tasks that they don't necessarily have expertise in," says Tomlinson. "For example, emergency physicians may make more definitive diagnoses or write extensive holding orders covering several days of care."
And for some, there's a lack of urgency. "Not everyone in our industry has an appreciation for where healthcare is headed," Birdsall says. "Some providers don't have the resources, desire, or impetus to engage in healthcare reform, because they don't see the benefits."
But ready or not, change is upon us. And that's not necessarily a bad thing.
"Meaningful integration has to happen," Birdsall says. "And not just because the government is pushing it. We need to make care safer, more effective, and more accessible for everyone. The only way we're going to achieve that is by coming together."
Ready to take your system's integration to the next level? Register today for Vituity's webinar:
Topic: "Achieving Meaningful Integration Through Physician Leadership, Engagement, and Alignment"
Date: Wednesday, June 1, 2016
Time: 10 a.m. PST/1 p.m. ET