SAN DIEGO — The pressure on hospitals to change how they operate, and to do so quickly, is tremendous. That was a common theme running throughout many of the sessions at the Leadership Summit this year, but there also were signs that hospitals may be up to the task.

Pressure is coming on multiple fronts. Retailers such as CVS and Walgreens are creating competitive pressure by seeking and taking bigger chunks of traditional health care’s business, and that is expected to continue. One of the keys to that scrap will be access — traditional health care is going to have to adopt more consumer-friendly hours, according to Jim Bonnette, M.D., an executive vice president for Advisory Board Consulting, who spoke on Sunday. "Convenience will trump all kinds of stuff if it's important" to the consumer, he said.

Competition also may be coming from the tech world. As Bonnette noted, tech giants like Apple and Google are making transparent moves to expand in health care. "They don’t hire chief medical officers for fun," Bonnette said. "They might be thinking about getting into your business."

At the same time, many of the largest commercial health plan payers — companies like Disney and Walmart — are demanding better value from the providers they include in their health plan networks and want to partner on that mission.

Listening and reading about such big-picture changes is important and captivating, but far-removed from the day-to-day business of caring for patients. That's why it was a treat to sit in on what were my two last sessions of the summit.

My final breakout educational session reminded me of the importance of front-line clinicians in all that is going on in health care. In it, two executives at Christus Santa Rosa Health System in San Antonio and their consultant outlined some of the ways the system tries to engage clinicians and the whole staff in quality improvement efforts. An important part of that process is getting ideas for improving quality directly from the hospital floor, said Patty Toney, vice president and chief nurse executive. Also key is making it easy for clinicians to do what they need to do to improve quality.

And importantly, Christus Santa Rosa, in an effort to address the pace of change question, is trying to measure its success and failures in real time, as much as possible.

For example, instead of relying on its government-mandated HCAHPS results alone for self-evaluation, the system also conducts a three-question survey with patients to try to quickly target problems with responsiveness in caring for patients. The results are made available immediately.

The final keynote speech, by Benjamin Carson, M.D., a pediatric neurosurgeon, an opponent of Obamacare and a potential presidential candidate, finished his talk with a story of his grueling effort to be the first to successfully perform a certain type of surgery to separate conjoined twins. He described an unlikely but heartwarming outcome that was a victory for the twins involved and for a traditional black teaching hospital in South Africa. His talk drew a standing ovation from attendees.

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