7 key elements that support care redesign

care team

Effective and sustained healthcare transformation requires hard work at all levels by multidisciplinary teams, says one public health expert.

Hospitals and health systems that have had the most success in redesigning care systems have employed multidisciplinary teams that include staff members from across the facility, writes Richard M.J. Bomer, M.D., a professor at the Harvard Business School, in the New England Journal of Medicine. Clinical, nonclinical and patient perspectives must all play a role in sustaining change, Bomer writes.

Hospitals such as Seattle’s Virginia Mason Medical Center, for instance, have made small, but consistent changes over long periods, which leads to better results at the ward or clinic level, according to Bomer.

“These organizations’ experiences clarify that multidisciplinary teams must undertake this redesign work,” he writes. “The provision of modern healthcare integrates so many specialized skills--clinical and nonclinical--and patients routinely cross so many intra- and interorganizational boundaries that no single designer can create a highly functioning microsystem.”

In his research examining these successful strategies, Bomer writes that he has pinpointed seven key elements that support care redesign initiatives:

  • Many redesign teams are at work simultaneously, and some may be permanent fixtures.
  • Effective organizations recruit clinicians to lead redesign programs, and invest in promoting leadership on the staff.
  • There is a standardized process for change in place.
  • The hospital or health system has internal support resources beyond consultants.
  • Data is gathered frequently and strong measurement systems are in place to examine the effectiveness of new initiatives.
  • A group of senior leaders oversees the selection of teams, setting priorities and monitoring the progress of redesign.
  • Teams work under a universal set of values and norms.

Bomer writes that the major hurdle for many facilities is a “change in mindset,” as incremental hard work may be a tough sell to some staff members. A small-scale approach may also not help hospitals in dire need of an immediate turnaround, either, he writes.