Forces of Change E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Jossey-Bass Public Health/Health Services Text
• Sprache: Englisch

Seitenzahl: 416

Veröffentlichungsjahr: 2012

Beschreibung

American health care has made great strides in the past hundred years. Life expectancy has increased dramatically and advances in medicine and treatments have eradicated many life-threatening diseases. However, in today's health care arena there is divergence between our health needs, the structure of our health care system, and how health care is delivered and funded.

In Forces of Change, David A. Shore has collected the leading thinking from experts in the field on how our health care system can benefit from important lessons from other industries and effect transformational change that truly serves all stakeholders well.

Contributors include Max Caldwell of Towers Watson; Michael J. Dowling of North Shore–Long Island Jewish Medical Health System; John P. Glaser of Siemens Healthcare; Ashish K. Jha of the Harvard School of Public Health; Eric D. Kupferberg of Northeastern University; Lucian Leape of the Harvard School of Public Health; Jeff Margolis of the TriZetto Group, Inc.; and David Shoultz of Philips Electronics.

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Editor’s Preface

Dedication

Acknowledgments

The Editor

The Contributors

Part One: Can We Get Better?

1 Framing the Forces of Change

The Context of Change

The Way Forward

Conclusion

2 The Market Dynamics of Health Care

Market Drivers and the Increasing Demand for Health Care

Market Threats and Health Care Organizations’ Survivability

Conclusion

3 Transformational Leadership: The Key to Success

Principles of Transformational Leadership

Practicing Transformational Leadership

Measuring Success

Conclusion

Part Two: The Elements of Change

4 Employee Engagement and the Transformation of the Health Care Industry

Towers Watson’s Global Workforce Study

Attracting and Retaining Great Employees

Taking Engagement to the Next Level: Support and Sustain

Conclusion

5 Patient Safety in the Era of Health Care Reform

The Growth of Specialization

The Growth of Measurement

A World of Change

A Paradigm Shift

Patient Safety

Conclusion

6 Health Care Reform and Technological Innovation

Capitation, Shared Savings, and the Search for Delivery System Efficiencies

Measures That Drive Health Care Quality

Taxes and Fees That May Reduce Financial Returns

Self-Funding Initiative (Class Provision)

Conclusion

7 Health Care IT: A Critical Enabler for Health Care Transformation

The Carrot and the Stick

Meaningful Use

Developing the EHR Infrastructure

The Patient Protection and Affordable Care Act

Implications for Information Technology

Future Challenges

Conclusion

8 Health Care IT: A Reality Check

Examining the Data

Conclusion

9 A Systematic Solution: Integrated Health Care Management

The Power of Systems Thinking

Health Care as a System

Toward a Systemic Solution

Integrated Health Care Management

Conclusion

Part Three: Reshaping the Organization

10 Stakeholder Interactions: Can We Transform Bad Behavior?

Appropriating a Stakeholder Perspective

Zero-Sum Games

The “Tragedy of the Commons” and Other Perverse Outcomes

Conclusion: An End to Bad Stakeholder Behavior?

11 The Trust Prescription: How Health Care Organizations Can Win the Confidence and Compliance of Their Key Stakeholders

The Decline of Trust

Why Trust Matters

The Many Dimensions of Trust

The Leader’s Job: Building Trust

Conclusion

12 A Winning Brand: Leveraging the Power of Intangible Assets

Power Brands

Reputation

Thinking about Marketing

Building and Protecting a Brand

Conclusion

13 Implementing Health Care Change through Projects

The Current State of Projects in Health Care

A New Way of Viewing Project Management

From Project to Sustainable Innovation

Conclusion: Doing Projects Right

Index

Copyright © 2012 by David A. Shore. All rights reserved.

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Library of Congress Cataloging-in-Publication Data

Forces of change : new strategies for the evolving health care marketplace / David A. Shore, editor.

p. cm. – (J-b public health/health services text ; 62)

 Includes bibliographical references and index.

 ISBN 978-1-118-09913-1 (hardback); ISBN 978-1-118-22371-0 (ebk.); ISBN 978-1-118-23700-7 (ebk.); ISBN 978-1-118-26203-0 (ebk.)

 1. Health care reform--United States. 2. Medical policy--United States. 3. Medical economics--United States. I. Shore, David A., 1954–

 RA395.A3F647 2012

 362.10973--dc23

2012009393

Editor’s Preface

Health care in the United States is a drama that, so far, has played out in three acts.

Act I began a century or more ago and might have been titled “The Age of Public Health.” What made the difference in those days were measures that we take for granted now: clean water, effective sewage removal and treatment, and rules and procedures to ensure sanitation in food preparation, hospitals, and many other venues. Public health agencies took the lead; individuals had to do little but comply with the new ways of doing things. The results were spectacular. The incidence of many illnesses dropped dramatically. Life expectancy at birth increased from forty-seven years in 1900 to sixty-eight years in 1950. Act II began just before the middle of the twentieth century and could be called “The Age of Heroic Intervention.” Now what counted for health care was the development of effective treatments that could be administered by individual doctors and nurses. The list of these treatments is long; it includes sulfa drugs, penicillin and other antibiotics, vaccines, and safe, effective surgery. Again, patients did not have to do much to get the benefit—all they had to do was show up at the doctor’s office or the hospital. And again, the results were impressive. Diseases such as tuberculosis and polio that had ravaged families for centuries nearly vanished. By 2000, life expectancy had risen another nine years, to seventy-seven.

I am not sure when Act III began—sometime in the late twentieth century—nor am I sure what to call it. But there is no doubt we are in the middle of it right now. Today, most untimely deaths result from chronic conditions rather than from acute infectious diseases. The biggest factors determining health outcomes are no longer public health measures or medical interventions but the decisions people make every day about diet, exercise, consumption of alcohol and tobacco, and management of stress. The baton has been passed from public health agencies (Act I) to physicians (Act II) to consumers themselves (Act III). In this phase, consumers are expected to manage their own health care as well as their own behaviors. At the extreme, they research their own ailments on the Internet, then seek out a medical professional who will prescribe whatever treatment the consumer has decided is best.1

The dénouement of Act III is not yet clear, but the signs are not particularly promising. Smoking may be down, but obesity is up. Life expectancy is increasing only about a year per decade. An article in the New England Journal of Medicine in 2005 projected that it might soon begin to decline because of increased obesity and the related rise in diabetes.2 Consumers are supposed to be responsible for their own health, which means that the outcomes are likely to be radically different for different groups of people. The well educated, for instance, do comparatively well in this new environment; indeed, general education is one of the best predictors of health status. Poorly educated people do not fare nearly as well. Adults who did not graduate from high school are more than two and one-half times as likely as college graduates to be in less than very good health.3

Unfortunately, a radical disconnect exists between people’s health needs in this third act and the structure of health care. Most physician practices, hospitals, clinics, and other health care organizations are stuck in the Norman Rockwell era, with doctors seeing whoever shows up, prescribing conventional treatments, and collecting reimbursements. Nobody seems to be taking on the job of guiding consumers through the mazes of behavioral and health-related choices that confront them. As a result, costs continue to rise, and satisfaction on the part of nearly everybody involved with health care continues to decline. The system, if we can call it that, is all tangled up in itself. What used to be thought of as the Iron Triangle of health care constraints—cost, quality, and access—I now consider a kind of Gordian knot, an intractable tangled situation awaiting an incisive solution (Figure P.1). This book will try to untangle the knot, to figure out how health care organizations can change.

Figure P.1 Gordian knot.

Although the authors of the articles in this book make many references to the 2010 US health care reform law, you will see in the very first chapter that our point of view does not begin or end with health care policy. Policy sets part of the context for health care, to be sure. But it does not determine what happens on the ground. The Forces of Change model and program that I developed at Harvard focus on what health care institutions actually do. To that end, the chapters in this book focus mainly on other aspects of the health care context: the constraints and interests that shape decisions; how those decisions turn out; and what can be done to make them turn out better. We discuss organizational strategies and tactics, including seemingly commercial issues such as marketing and branding. Our hypothesis is not that health care organizations suddenly need to act like businesses, whatever that might mean, but instead that they can learn a great deal from other contexts and other industries. Health care in the United States has been called the world’s largest cottage industry. It is being dragged, often kicking and screaming, into the postindustrial age. Wise leaders will take advantage of this trend rather than, like King Canute, trying to turn back the tide.

Part One of the book sets the stage for what is to come later. In the first chapter, I frame the entire Forces of Change perspective, focusing not on how good or how bad the US health care system is but on the more profound question of why it is not better than it is. I describe some of the factors that set the context for health care leaders’ choices, and I attempt to sketch the basics of a way forward. In Chapter Two, Eric D. Kupferberg outlines the major forces shaping the health care marketplace and the threats that organizations are now confronting. In Chapter Three, Michael J. Dowling shows in detail exactly what is possible for an individual institution to accomplish. Chief executive of the massive North Shore-Long Island Jewish Medical (LIJ) Health System in New York State, Dowling offers a compelling account of how transformational leadership can create an organization that serves all its stakeholders well.

Part Two then plunges into the nitty-gritty—the factors that affect change, the interests that must be taken into account, the obstacles faced even by the reforms that everybody seems to think are a good idea. Max Caldwell, of the consulting firm Towers Watson, shares some of his firm’s latest research on employee engagement in health care in Chapter Four, and Lucian Leape, perhaps the nation’s foremost expert on patient safety, discusses in Chapter Five, the very-much-mixed record of US health care organizations in reducing their rates of medical errors. David Shoultz, of Philips Electronics, analyzes the likely impact of recent reforms on technological innovation in Chapter Six.

Information technology—IT—is the foundation for Chapters Seven, Eight, and Nine, just because it is so often seen as a potential savior for the US system. John P. Glaser, of Siemens Healthcare, and Ashish K. Jha, of the Harvard School of Public Health, explore what electronic health records can and cannot accomplish and why they have been so slow to catch on. Jeff Margolis, of the TriZetto Group, proposes a new way of thinking about health care and shows how IT can be the basis for a far more systematic approach to care than we have yet been able to realize.

Part Three changes the focus. It looks at how health care organizations can go about making the changes they need to make and how they can distinguish themselves in the marketplace from their competitors. Chapter Ten, by Eric D. Kupferberg, analyzes stakeholder conflicts and the zero-sum games they often produce, concluding with some thoughts about how stakeholders can move beyond this kind of unproductive behavior. The following three chapters, all by me, look more closely at individual organizational responses. Chapter Eleven examines the critically important role of trust in creating an organization that really does perform better and is seen as performing better by its stakeholders. Chapter Twelve shows that organizations cannot be satisfied with outperformance; they also have to use the tools of marketing, such as branding, to ensure that their accomplishments are understood by patients and other stakeholders. Chapter Thirteen, finally, examines how organizations actually make changes on the ground, through projects. It describes the unsound state of project management in today’s organizations and outlines what I think is a far more fruitful app­roach. I have added an editor’s introduction and a summary to each chapter for ease of reading.

The famous Chinese curse or blessing, “May you live in interesting times,” certainly applies to the current state of affairs in health care. These are interesting times, exciting as well as frustrating, because health care is in so much flux. I am sure the other authors in this book would join me in my curiosity to see how Act III plays out. In the meantime, I hope this book helps you to understand and take on the challenges of the present moment and to capitalize on its many opportunities.

—DAVID A. SHOREHarvard School of Public Health

Notes

1. The three acts are neatly summarized in a slide prepared by Elizabeth L. Bewley of the Pario Health Institute. See the presentation “Consumers Need to Become CEOs of Their Own Health and Health Care,” Third National Consumer Driven Health Care Summit, October 20, 2008, http://www.ehcca.com/presentations/cdhcsummit3/2_04.pdf. Accessed January 15, 2012. Life expectancy data are from Elizabeth Arias, “United States Life Tables, 2006,” National Vital Statistics Reports 58, no. 21 (June 28, 2010). See table 12, “Estimated life expectancy at birth in years, by race and sex: Death-registration states, 1900–1928, and United States, 1929–2006.”

2. S. Jay Olshansky et al., “Potential Decline in Life Expectancy in the United States in the Twenty-First Century,” New England Journal of Medicine, 352, no. 11 (March 2005): 1138–1145.

3. Robert Wood Johnson Foundation, Commission to Build a Healthier America, Reaching America’s Health Potential: A State-by-State Look at Adult Health, May 2008.

To Charlotte, Doug, Alyssa, Mom, and Dad with love, respect, and admiration: Your encouragement and support have laid the foundation for all aspects of my life, including this book. Also to my coauthors and the alumni of the many Forces of Change programs whose contributions made this book what it is.

Acknowledgments

I would like to say a few words about the people involved in producing this book. The chapter authors were selected for their expertise. Each has taught in the Harvard School of Public Health Forces of Change executive programs, co-taught my Forces of Change graduate course, or both. Collectively, they represent thought leaders across a spectrum of critical areas in health care. It has been an honor to collaborate with them on this work.

I extend special thanks to Holly Zellweger, my longtime colleague, who served as project manager for the book. Her contributions over the years and to this book are immeasurable, however broadly fit into the two domains of form and substance. She is remarkable in both. Her footprint has been on the Forces of Change body of work from the beginning. Holly also was the driving force in submitting the completed manuscript on time, a rare feat in the publishing world.

Thanks also to Christina Thompson Lively, research associate at the Harvard School of Public Health, who not only made significant contributions to the book but has over the years made significant contributions to the Forces of Change model and curriculum.

I thank research assistant Chen Zhang for his careful attention to detail as we prepared the manuscript for submission.

I extend a special thank you also to John Case: a delight­ful collaborator, a consummate professional, and an all-around class act.

I would also thank the following reviewers for their thoughtful and valuable feedback on the draft manuscript: John Denning, Richard Gregg, and Stephen Wagner.

Finally, I wish to thank Andy Pasternack, senior editor at Jossey-Bass, for his vision and support throughout this project.

The Editor

David A. Shore, PhD, served as an associate dean at the Harvard School of Public Health for nineteen years. He founded and directs the school’s Forces of Change Program and Trust Initiative. He established, directs, and serves as faculty in the Programs in Project Management in Health Care at the Harvard School of Public Health. The programs are based on his Project Activa­tion Management System (PAMS), which focuses on successfully launching change initiatives in health care. Shore also served as executive director of the Center for Continuing Professional Education at the school.

Shore regularly delivers keynote addresses and workshops to many industries in various national and international settings. He has consulted on six continents. He has had the honor to deliver the keynote address to four annual Corporate Branding conferences of the American Management Association. He chaired and delivered the keynote addresses at the 2009, 2010, and 2011 World Congress Leadership Summits on Project Management for Health Care Executives. In 2010, he conducted the first national study on the state of project management in US hospitals, in collaboration with Towers Watson.

He is the author of numerous articles and other publications, including his books: The Trust Prescription for Healthcare: Building Your Reputation with Consumers (Health Administration Press, 2005); The Trust Crisis in Healthcare: Causes, Consequences, and Cures (Editor, Oxford University Press, 2007); High Stakes: The Critical Role of Stakeholders in Health Care (Oxford University Press, 2011); and now Forces of Change: New Strategies for the Evolving Health Care Marketplace (Jossey-Bass, 2012). His forthcoming book will focus on launching successful change initiatives in health care.

Shore’s work on creating a unique and sustainable compe­titive advantage is well known for building constructive links between theory and practice and providing a path to action.

The Contributors

Max Caldwell is a managing director in the Talent and Rewards segment of Towers Watson. He leads their Global Data, Surveys, and Technology line of business, which combines consulting, data, analytics, and software to enable more intelligent management of human capital. In twenty-five years of consulting to business leaders, Caldwell has focused on improving business performance through enhancing leadership, talent, and organization effectiveness. He has also led Towers Watson’s biennial Global Workforce study, the most extensive research of its kind on what drives the motivation and performance of employees around the world.

Michael J. Dowling is president and chief executive officer of the North Shore–Long Island Jewish Medical (LIJ) Health System, the largest integrated health care system in New York State. Before joining North Shore–LIJ Health System, Dowling served in New York’s state government for twelve years, including seven years as state director of health, education, and human services and deputy secretary to the governor. He was also commissioner of the New York State Department of Social Services. Before his public service career, Dowling was a professor of social policy and assistant dean at the Fordham University Graduate School of Social Services and director of the Fordham Campus in Westchester County. Dowling grew up in Limerick, Ireland. He earned his undergraduate degree from University College Cork and his master’s degree from Fordham University. He also has honorary doctorates from Hofstra University and Dowling College.

John P. Glaser, PhD, is chief executive officer, Health Services Busi­ness, Siemens Healthcare. Previously he was vice president and chief information officer, Partners HealthCare. Glaser was the founding chairman of College of Healthcare Information Manage­ment Executives (CHIME) and is past president of the Healthcare Information and Management Systems Society (HIMSS). He is past president of the eHealth Initiative and was a senior advisor to the federal Office of the National Coordinator for Health Information Technology. He holds a PhD in health care information systems from the University of Minnesota.

Ashish K. Jha, MD, MPH, is associate professor of health policy and management at the Harvard School of Public Health and associate professor of medicine at Harvard Medical School. He is also associate physician at Boston’s Brigham and Women’s Hospital and VA Boston Healthcare System. Over the past three years, he has served as special advisor for quality and safety to the Department of Veterans Affairs. Jha is a practicing general internist with a clinical focus on hospital care. The major themes of his research include (1) quality of care provided by health care systems with a focus on safety, efficiency, and effectiveness; (2) health information technology as a tool to reduce disparities and improve the quality, efficiency, and safety of care; (3) disparities in care, with a focus on the quality of care provided by minority-serving providers; and (4) hospital governance and its impact on quality of care. He is a graduate of Harvard Medical School.

Eric D. Kupferberg, PhD, received his doctorate in the history and sociology of science from MIT. He is the senior assistant dean of academic and faculty affairs at Northeastern University’s College of Professional Studies, where he directs the master of science program in regulatory affairs of drugs, biologics, and medical devices. Kupferberg is also the associate director of Harvard School of Public Health’s Trust Initiative. Before arriving at the College of Professional Studies, Kupferberg helped direct the public programs at Harvard Medical School’s Division of Medical Ethics. For more than a decade, he has taught at Harvard University and MIT on such topics as successful strategies for the evolving health care market, the history of microbiology, scientific understandings of alcoholism and drug addiction, and the development of science policies. Kupferberg is coauthor of the book High Stakes: The Critical Role of Stakeholders in Health Care (Oxford University Press, 2011).

Lucian Leape, MD, is a health policy analyst whose research has focused on patient safety and quality of care. Before joining the faculty at Harvard in 1988, he was professor of surgery and chief of pediatric surgery at Tufts University School of Medicine and New England Medical Center. Leape is internationally recognized as a leader of the patient safety movement. He has written widely about the application of systems theory to the prevention of adverse events, disclosure and apology after injury, reforming medical education, and assessing physician competence. Leape is a graduate of Cornell University and Harvard Medical School.

Jeff Margolis is executive chairman of WellTok, Inc., and chairman emeritus of the TriZetto Group, Inc., which he founded in 1997. He has extensive experience architecting and managing information technology and services for some of the nation’s largest and most innovative health care organizations. Margolis is former senior vice president and chief information officer of FHP International Corporation, a $4 billion health care company. He is also former chairman of the Managed Care Executive Group. A certified public accountant, Margolis received his bachelor’s degree in business administration/management information systems from the University of Illinois.

David Shoultz has worked on public policy issues in Washington, DC, for more than thirty years. Shoultz began his Washington career working for six years in the United States Senate. After leaving the Senate, he was with Varian Associates, a diversified high-tech company with a significant medical technology business, where he ran the Washington government relations office. Later Shoultz opened and ran his own government relations firm, serving clients in the health technology field. Currently he is the senior director, federal government relations and policy (health care), at Philips Electronics, a global health and well-being company with a significant manufacturing presence in the United States.

Part One

Can We Get Better?

1

Framing the Forces of Change

David A. Shore

EDITOR’S INTRODUCTION

Many people outside the US health care industry focus their attention on national reform efforts, the most recent being the Patient Protection and Affordable Care Act passed by Congress in 2010. Because the course of reform is hard to predict, the real challenge for industry leaders is to improve their own organizations—to make them better today.

Doing so will not be easy, as this chapter explains. Leaders face a series of potential pitfalls, any one of which can derail change efforts. The chapter also describes a way forward. By discarding old assumptions and mapping out a path to change, leaders can avoid the obstacles and bring about real improvement in their organizations.