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Health Care Organizations Are All Talk, No Collaboration

Op-Med is a collection of original articles contributed by Doximity members.

Modern Healthcare recently published its list of the 50 most influential clinical executives of 2019. The program honors physician and nurse leaders who are deemed by their peers and an expert panel to be the most influential clinicians in terms of demonstrating leadership and impact. The majority work in large health care systems and health insurance companies. 

Perhaps the most impressive observation about the current list of individuals – several of whom I know personally – is not only what they have accomplished, but also what they propose to accomplish in the short term. I carefully read the vignettes of all 50 honorees and distilled the goals most commonly shared by these clinical executives. In no particular order, the top 10 goals are:

1.  Prioritize social determinants of health

2.  Utilize genomics to advance personalized medicine 

3.  Address mental illness, addiction and the opioid crisis

4.  Strive for a wider application of telehealth medicine; envision “health care with no address”

5.  Use artificial intelligence to improve operations and care delivery

6.  Revamp medical education, ensuring that students are immersed in clinical training from the beginning of medical school

7.  Assist providers in adopting population health initiatives under value-based reimbursement methodologies

8.  Apply modeling and predictive analytics to identify and treat high-risk/high-cost patients

9.  Improve the work-life balance of clinicians; address burnout and assist clinicians involved in medical error

10.  Focus on patient care improvement initiatives:

(a) Improve care for patients with chronic diseases

(b) Help vulnerable populations gain access to care 

(c) Improve transitions of care 

(d) Improve electronic data exchange

(e) Integrate mental health services across other disciplines

(f) Address health disparities and work toward optimal health for all

Few would disagree with the importance of attaining these goals. The problem, however, is that these brilliant leaders, along with their strategic, often hand-picked leadership teams, seem to be going it alone, working in relative isolation within their organizations and with limited resources and outside funding. National accreditation and certification organizations, meanwhile, have significant clout and push their own agendas, which are generally focused on the most basic quality and safety initiatives rather than innovative ways to transform the U.S. health care system. This observation led one review article to conclude: “Whether accrediting organizations are truly ensuring high quality health care across the United States is a question that remains to be answered.”  

Don’t get me wrong. Health care accreditation organizations are vital to the patient quality and safety frontier. However, there is a fundamental disconnect between accrediting organizations and visionary health care organizations. They seem to be moving in different directions and speeds, and this is one reason comprehensive high quality health care across the United States has yet to be achieved. 

According to the Bloomberg 2019 Healthiest Country Index, the U.S. ranks 35 out of 169 countries analyzed worldwide. We lag 19 spots behind our Canadian neighbors to the north and five spots behind impoverished Cuba to the south (Spain ranks first).  Moreover, life expectancy in the U.S. has been trending lower due to deaths from drug overdoses and suicides. In fact, physicians have the highest rate of suicide among all professional groups.  On average, one physician in the U.S. completes suicide each day.

Efforts to achieve national certification standards simply maintain the status quo and do not encourage creativity and disruptive innovation considered prerequisite for medical transformation on a global scale. The organizational time and financial cost for undergoing accreditation further depletes limited resources and stymies innovation by forestalling operations critical to delivering care in entirely new ways. Yet health care organizations are continually pressured to go through the grueling accreditation process to survive for financial reimbursement, hoping to gain a competitive advantage through superior scores on usual, rather than unique, measures of quality and care delivery.  

No matter what happens in 2019 and beyond, one thing seems certain: health care accrediting organizations will have to transition to enhanced quality by adapting to forward thinking leaders intent on meeting the challenges of the evolving health care landscape. An insider’s understanding of what high-quality, population-based health care really means should trump the agenda of any overseer who increases the diversion of diminishing resources at the expense of novel patient care initiatives. To kowtow to these agencies is analogous to the proverbial tail wagging the dog. Isn’t it time for the dog to wag the tail?

Arthur Lazarus, MD, MBA is a Doximity Community Fellow and member of the Physician Leadership Journal editorial board.  He is an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.

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