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The perfect (transformational) storm

We are in the midst of a storm. The transformation of the healthcare system and of health care delivery will undoubtedly leave in its wake an entirely new world.

It is a time of transition. As writer Erica Brown has said, at times of transition, we are neither here nor there. It can be hard to believe that temporary difficulties are only temporary. If we believe that transitional places are permanent, we are no longer on a journey of transformation; we are stuck in a place of frustration. Confusing transition with destination adds needless layers of anxiety. The future will only look like the present if you do not allow it to look like anything else.

Making this transformation is not a single step and will not occur overnight. It will require restructuring how healthcare delivery is organized, measured, and reimbursed and this is what Law 10 is all about.

There is no longer any doubt about how to increase the value of care. The question is, which organizations will lead the way and how quickly can others follow. Moreover, this transformation must invariably come from within. Only physicians and the organizations providing services can put in place the set of interdependent steps needed to improve value, because ultimately value is determined by how medicine is practiced.

In health care, the days of business as usual are over. Around the world, every healthcare system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. Healthcare leaders and policy makers have tried countless incremental fixes, but none have had much impact.

Its time for a fundamentally new strategy.

At its core is maximizing value for patients. That is, achieving the best outcomes at the lowest cost. We must move away from a healthcare system organized around what physicians do and toward a patient-centred system organized around what patients need. We must shift the focus from the volume of services provided- physician visits, hospitalizations, procedures, and tests- to the actual outcomes achieved. And we must replace todays fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care.

What are the pressures driving hospitals and other healthcare institutions to improve accountability and the integration of their services? These can be summarized as follows:

  1. The aging patient (and provider) population that will continue to shift significantly throughout the next decade
  2. The need to enhance care coordination during hospital-to-home transitions. This has consistently shown beneficial effects on cost and care quality, requiring healthcare network leaders to focus on care after patients leave the hospital
  3. Political pressures are compelling hospitals and care systems to provide efficient and optimal patient care
  4. Hospitals need to serve multiple patient populations effectively- management of population health is crucial

What are the issues that will drive transformation? These include:

  1. Increasing pressure on all healthcare organizations to become more efficient, and new payment models are critical to any improvement
  2. Lowering costs over time is essential for long-term financial sustainability
  3. New models of care emphasizing coordination across hospitals and care systems, other providers and the community are essential for quality improvement
  4. The quality of care must improve at a faster rate

In our new healthcare network for West-Central Montreal, where is our focus now? The new team is concentrating on:

  1. Aligning the hospital and all community partners, physicians and other providers across the continuum of care
  2. Utilizing evidence-based practices to improve quality of care and patient safety
  3. Improving efficiency through productivity and financial management
  4. Developing integrated information systems

In the words of Dolly Parton, “Storms make trees take deeper roots.” Once we find ourselves on the other side, we will be in a stronger position; our partnerships will be cemented and any obstacles will have been blown down. I am facing this storm, with you and for you.

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