A couple of weeks ago in this space I reported on Rich Umbdenstock’s remarks kicking off the American Hospital Association’s Annual Membership Meeting in Washington, D.C. The AHA president and CEO declared that the long-anticipated transformation of health care is well under way “and there is no going back.” He described how hospitals are leading the transition with initiatives to improve quality, patient safety and efficiency that already are delivering significant results.
Today, I’m sharing the “next steps” that Umbdenstock said hospitals must take to build on the momentum. In a nutshell, they are: better use of data, better teamwork among all providers and better engagement with patients.
“We are collecting, analyzing and applying information — and transforming it into knowledge about what works, and what doesn’t, for patients,” he told the assembled hospital leaders.
For one, hospitals are stepping up their collection of data on patient race, ethnicity and language preference in a drive to eliminate disparities in care. As an interesting example, Umbdenstock cited Heywood Hospital in Alameda, Calif. “To their surprise, they discovered that every Asian patient admitted during a one-year period was suffering from chemical exposure,” he said. “Digging further, they discovered that many Asian people in their area work in environments that put them at risk for chemical exposure — from nail salons to high-tech chemical companies to cleaning services.”
The use of computerized decision support, medication bar coding and electronic health records can limit errors, improve care and “shed processes that don’t add value,” Umbdenstock said. Hospitals are even harnessing data to help with organizational design, “and getting closer to defining the size, configuration and degree of integration that will lead us to that intersection of outcomes, costs and communities.”
Teamwork — “collaboration, integration, call it what you will” — requires “all of us to step outside our comfort zones and adopt new cultural norms,” Umbdenstock said. Hospitals “are teaming up at the community level with physicians and agency leaders to journey upstream and downstream from the hospital” to design systems to keep people healthy “and attacking thorny problems like readmissions.” They’re also joining with physician practices and insurance companies to coordinate care and redesign payment and delivery systems.
He called for updates to the legal and regulatory system “that makes it difficult for physicians, hospitals and other elements of the health care system to collaborate effectively.”
Internally, hospitals are building multidisciplinary care teams, which most typically include a registered nurse, physician, social worker, pharmacist, nutrititionist/dietitian and physical therapist. A March survey by the AHA Workforce Center found that 75 percent of the association’s member hospitals are implementing multidisciplinary care teams. A January report from the AHA Primary Care Workforce Roundtable found these teams play a key role in effectively delivery primary care.”
Improving the wellness and health of individuals and communities won’t happen “unless we find ways to have patients, their families and their neighbors participate as full members,” Umbdenstock insisted. Proactively soliciting patient and family perspectives must become a routine part of hospital operations, he said, pointing to tactics various hospitals have adopted, such as establishing patient and family advisory councils, conducting rounds involving family members and putting public members on their standing committees.
“We must get better at the really hard discussions, too,” he said, “and help patients and their families plan how and where they wish to be treated when they experience advanced illnesses, including the end of life.”