Reality check: Coordinated care is a daunting task

This week, FierceHealthcare reported on healthcare's "dirty little secret" about coordinated care: it's not very well coordinated and no one is responsible for it.

The "secret" was aired in a Kaiser Health News/Washington Post article, in which hospital patient advocates bemoaned confusion about who is managing a patient's care, provider miscommunications, unsafe hospitalist workloads and lack of coordination among caregivers.

And exacerbating that lack of coordination is the fact that most physicians need more help than is currently available to create and sustain team-based care--key to implementing coordinated care plans.

As Lucian Leape, M.D., a Harvard health policy analyst and a nationally recognized patient safety leader, told KHN/Post, when it comes to care coordination, "we have not done enough."

Such reports make me worry that healthcare's "little secret" isn't all that little.

Hospital C-suite executives and risk managers are fully aware of the problem of lack of teamwork and poor communication. In a survey  last week from American International Group, most respondents noted the quality of coordination and communication between hospital departments can prevent them from keeping patients safe and achieving financial sustainability.

These C-suite execs and risk managers blamed a growing number of handoffs as a major coordination and communication barrier.

Providers are facing the daunting task of coordinated care in California, where a lack of coordination for low-income seniors raises the risk for patient confusion, medical errors and gaps in care, according to HealthyCal.org. One senior who had 26 different doctors and another who was on 52 medications exemplify "uncoordinated care at its worst," Jane Ogle, deputy director of the state's Department of Health Care Services, told the independent, non-profit journalism project.

To add to the difficulty, health IT tools, while poised to improve care, can create more challenges for teamwork, communication and coordination. For example, the time-lag between sending and receiving information from specialists and hospitals is often a point of contention for providers.

These reports deliver a tough reality check on the lack of coordinated care, but I still hold out hope that we'll see a more team-based, coordinated healthcare system.

It's not an easy undertaking, but I think our providers can do it. In fact, some already have. Iowa Health System, for instance, has achieved success with team-based care, proving that teamwork within hospitals and among hospitals can improve patient safety and care quality.

And let's not forget Kaiser Permanente, which uses an integrated model to better coordinate care between its hospitals and clinics. The system has served as an example of coordinated, integrated care for the state of California.

While I acknowledge that coordinating care across the continuum of care is not easy, better health outcomes and billions of dollars in savings should be a big motivation to do that hard work. 

How is your organization tackling coordinated care? What barriers have you faced? Please share your thoughts in the comments, below. - Alicia (@FierceHealth)

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