Brigham and Women's Hospital turns to clinicians to improve care, reduce medical expenses

Brigham and Women's Hospital takes a grassroots approach to improve its care offerings, turning to frontline staff for ideas on how to reduce waste and redesign healthcare delivery. So far the model has led to cost savings of $4.5 million and improvements in integrated care and care transitions.

The Brigham Care Redesign Incubator and Startup Program seeks ideas from the hospital's 5,000-plus clinical staffers, write a trio of doctors from the Boston-based organization in a a blog post for NEJM Catalyst. Since its launch in 2013, the program has solicited 160 ideas that were developed into 25 pilot programs that led to an estimated $4.5 million reduction in medical expenses. 

Those projects, according to the program's website, have targeted cancer treatments, obstetrics, traumatic brain injury care and chronic illnesses. One project, which received the green light in the first year of the program, focused on integrating patient-centered care for patients with chronic, critical illnesses. It ultimately reduced 30-day long-term acute care readmissions from 40 percent to 25 percent, and saved $450,000 in medical expenses per year, according to a hospital fact sheet. A second program also launched in the first year, improved care transitions for patients with uncontrolled diabetes, reducing 60-day return visits to the emergency room from 37 percent to 17 percent. 

The care redesign program, which has helped to engage close to 750 physicians, works similar to a venture capital fund, according to the blog post. The potential return on investment (ROI) is calculated for each idea so clinicians can consider the financial implications during the pilot stage. If the idea is effective during the pilot, the organization will implement it within the system. 

"Our insistence on ROI likely closed off some truly novel, blue-sky approaches to care redesign," the doctors write in the blog post. "But we reasoned that if these ideas were inconsistent with Brigham and Women's existing strategic and financial foundation, they would not be sustainable within our organization, and pilot projects would simply be an exercise in frustration."

Senior leaders review written proposals and then the semi-finalists pitch projects similar to the style of the TV show "Shark Tank." Projects are then refined over a series of months.

To learn more:
- read the NEJM Catalyst blog post
- visit the program's website
- here's a factsheet on the initial pilot projects