As health care organizations realign themselves to achieve economies of scale, it is not uncommon for system leaders to assume that the integration process is simply a series of operational assignments and a redrawing of the org chart.
Whether the integration effort is happening due to a recent acquisition or because different pieces have been added to the health system over time, the process should start with establishing a clear purpose for the integration — defining up front what is going to be measured and agreeing on how progress will be communicated.
Those who dive in and immediately look to eliminate redundancies may run into organizational resistance. As a result, achieving authentic “systemness” — a set of complex interconnected elements that behave as one — will take longer to achieve or may not happen at all.
Connecting action to purpose
Executives in organizations of all sizes should determine up front how decisions about integration will be aligned with the organization’s mission, vision and strategy before they commit to change. Doing so achieves two critical goals: It helps employees rally around the integration, and it sets the tone for the changes ahead.
Health care executives align a well-designed integration program with the organization’s mission in order to remove variation and improve quality while reducing overall operating costs. To the degree that the decisions about integration are also focused on care delivery and community needs, the organization’s personnel will have much greater buy-in, support and acceptance for integration.
For example, one system encouraged its providers to integrate so they could realize efficient, reliable, quality delivery of care. The merger was intended to achieve cost savings, and to fund the organization’s continued growth by improving access to tertiary and quaternary care.
Once an organization has established buy-in for the integration, the next step is achieving the appropriate level of systemness – holistic behaviors distinct from behaviors that exist in different parts of the organization. Removing variation results in increased accuracy and predictability; it is achieved by capturing and sharing consistent data among facilities, then applying those data to clinical and functional decisions.
Integration, when it’s done right and is authentic, streamlines the way people interact with one another. Integration also allows people to focus on their commitment to high-quality patient care.
Organizations that remove redundancies before creating consistency and reliability struggle with achieving true systemness. In those cases, when the quest for cost savings supersedes the original purpose of integration, system leaders may be putting themselves at a disadvantage as they implement clinical coordination to improve access to care. Once functions are collapsed or roles eliminated — without establishing a common way of operating — it becomes more difficult to remove variability.
Measurement is king
The saying “what gets measured gets done” rings true with integration. Beyond measuring cost efficiencies, there are measures for process consistency (eliminating variation) and outcomes-based measures (cost, satisfaction, quality). Objects of measurement can include but are not limited to increased access to care, improved patient and provider satisfaction, and increased use of leading practices (clinical and nonclinical).
Most organizations start integration efforts in the nonclinical functions because progress is easier to measure. For example, measuring the consistency of human resource policies, purchasing policies and procedures is more concrete than measuring the consistency of access to care.
The more uniformity the system can achieve in what it is measuring, the more it can focus on improving quality. When there is a great deal of variability, it is difficult to identify where there are opportunities to improve.
Knowing you’ve met the mark
In an integration effort, system leaders should start by establishing a clear connection to their mission and strategy. This connection will reveal opportunities for transforming services so they are more consistent and reliable. System leaders should then establish ways to measure the consistencies or absence of variations, as well as both process measures and outcomes measures. That is how the system tracks its success in achieving the benefits of scale.
Jeff Jones is a managing director at Huron in Chicago.