Two approaches to redesigning inpatient care

A new inpatient care model that used multidisciplinary accountable care teams (ACTs) reduced the length of stay and cut additional costs, but did not affect readmission rates or patient satisfaction ratings, a study published in the Journal of Hospital Medicine found.

Still, participants following the interpersonal collaboration model thought it improved safety and the quality of care provided, researchers from Indiana University said.

Interpersonal collaboration was one of three foundations of the accountable care teams, according to an announcement from the university. The other two were enabling data-driven decisions and providing leadership.

Tools to support the teams could include monthly reviews of unit-level data, providing leadership by designated hospitalists and specialty leaders, and daily huddles to discuss what patients will need after leaving the hospital, according to the announcement.

"This evidence-based care concept could be adapted by medical, surgical or other inpatient units anywhere based on the foundational domains supported by locally relevant and institution- specific tools," said lead author Areeba Kara, M.D., a hospitalist with Indiana University Health Physicians and an Indiana University School of Medicine assistant professor of clinical medicine, in the announcement.

Meanwhile, an article in the Harvard Business Review argues that "radical redesign of care-delivery processes is the only way to change an organization's expectations" and provides a road map to help frontline workers conceptualize better ways to deliver care.

In his article, Thedacare Center for Healthcare Value CEO John S. Toussaint, M.D., suggests the following steps for creating that road map:

• Designate one unit as a "model cell" for developing innovative care processes
• Create a core team to drive efforts to redesign care
• Define goals and ensure that's where redesign efforts are focused
• Have the designated unit do the work of implementing redesign and testing its success
• Scale the initiative across the organization if it succeeds

"It seems counterintuitive to take this kind of an inch-wide, mile-deep approach to radical redesign," Toussaint wrote. But, he said, "empowering your own frontline caregivers to build new standards of care, giving each site the power to adapt them and then encouraging everyone to continuously improve them is the best way to achieve better outcomes."

Hospitals also develop in-house innovation centers and evidence-based practice centers to drive innovation.