Brent James' message for health care leaders, particularly at standalone community facilities, is pretty blunt: "The short message is change or die," the chief quality officer and executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare told me during an interview yesterday afternoon.


OK, I acknowledge that I'm using James' most dramatic quote in hopes of capturing your attention, but isn't that what us bloggers are supposed to do? And, honestly, isn't he right?

James took some time to talk with me about a newly released IOM discussion paper, "CEO Checklist for High-Value Health Care." The document is the result of a collaboration between executives from some of the nation's leading health care systems, including Intermountain, Denver Health, ThedaCare and Virginia Mason. Discussions leading to Tuesday's publication actually took root six or so years ago, James says, when the IOM convened a roundtable of health care heavy hitters to talk about quality, value and cost. From those discussions, which were led by former Mayo CEO Denis Cortese, M.D., the IOM splintered off a smaller group of execs to take a deeper dive not just on how they've created high value care, but also how to share that knowledge.

The CEO checklist isn't really a checklist, at least not in the way we've come to think of checklists in health care. It isn't a prescriptive set of procedures that one must follow like the surgical checklist, for instance. Rather, it is a more of a call to action for senior executives and trustees. There are 10 broad statements, divided into four categories:

Foundational elements
• Governance priority — visible and determined leadership by CEO and board
• Culture of continuous improvement — commitment to ongoing, real-time learning
Infrastructure fundamentals
• IT best practices — automated, reliable information to and from the point of care
• Evidence protocols — effective, efficient and consistent care
• Resource utilization — optimized use of personnel, physical space and other resources
Care delivery priorities
• Integrated care — right care, right setting, right providers, right teamwork
• Shared decision making — patient–clinician collaboration on care plans
• Targeted services — tailored community and clinic interventions for resource-intensive patients
Reliability and feedback
• Embedded safeguards — supports and prompts to reduce injury and infection
• Internal transparency — visible progress in performance, outcomes and costs

Read through the document and you'll find some excellent case studies from the partner organizations, detailing how they achieved high value and lowered costs.

"The reason that you see larger integrated systems pushing so hard is we figured out the business model," he says. "If you look at the groups involved, we have real community value."

While this initiative certainly isn't the first to try and spread best practices, and it won't be the last, James says that it is critical that hospitals begin doing a better job of knowledge sharing. He points out that while Intermountain is a large system, the vast majority of its 22 hospitals are in rural communities. They can't survive on their own, he says, they need the knowledge sharing that comes from partnering with other institutions. Granted, they can tap into the vast resources that Intermountain has to offer. But it is illustrative of what needs to happen nationwide, he says. That doesn't necessarily mean consolidating or merging with another provider. What it does mean is being willing to share best practices with competitors and physicians. It means forming partnerships with insurers and employers as well. And it means organizing the entire delivery system around those processes. It's a mammoth culture change for many institutions, but one that is absolutely necessary, he says.