Supporting a Culture of Collaboration Across Health Care

MedBiquitous

Darrell G. Kirch, M.D.President and CEO, AAMCMay 14, 2008

What Worries Americans About Health Care…

…and What Role Can Technology Play in Eliminating Those Worries?

• Will there be a doctor in the house when I need one?

First-Year Medical School Enrollment Projected to Increase 21% by 2012

15,000

16,000

17,000

18,000

19,000

20,000

21,000

22,000

2002 2004 2006 2008 2010 2012 2014 2016

Existing + New Schools

Existing Schools

16,488

What Worries Americans About Health Care?

• Will there be a doctor in the house when I need one?

• Will I be able to pay the bill?

The Fiscal Reality Hanging Over America

“GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.”

– David M. Walker U.S. Comptroller General

What Worries Americans About Health Care?

• Will there be a doctor in the house when I need one?

• Will I be able to pay the bill?

• Will the system and the people in it actually “care” for me?

The Patient

The Expert

The Technology

Will technology remove all the barriers in medical education?

Discontinuity in the Medical Education Continuum

Premedical Medical School

Residency and Fellowships

Practice

The Decision Dilemma in Health Care

10

100

1000

1980 1990 2000 2010 2020Adapted from: W. Stead, Vanderbilt University

Human Cognitive Capacity

Fac

ts p

er D

ecis

ion

Clinical and Translational Science Awards (CTSA) Research Network

The Decision Dilemma in Health Care

10

100

1000

1980 1990 2000 2010 2020Adapted from: W. Stead, Vanderbilt University

Human Cognitive Capacity

Fac

ts p

er D

ecis

ion

Connected 24/7

The MCAT as the Gateway to a Career in Medicine

A Virtual World-Wide Faculty

Leaving the World of “See One, Do One, Teach One”

Source: Rhode Island Hospital Medical Simulation Centerwww.lifespan.org/rih/services/simctr/training/

Building an E-portfolio Over a Career

Medical Professional

TrustedAgentHub

DataCompilation

DataCompilation

DataCompilation

DataRepository

DataRepository

DataRepository

DataRepository

Technology as a Tool to Create a True Continuum of Lifelong Learning in Medicine

Premedical Medical School

Residency and Fellowships

Practice

Technology as a Tool to Enable Individualized Physician Learning

Premedical Medical School

Residency and Fellowships

Practice

Premedical Medical School

Residency and Fellowships

Practice Life-longLearning

Two-YearCollege

Premedical Medical School

Residency and Fellowships

Practice Life-longLearning

Pre-medical

Medical School

Residency and Fellowships

Practice Life-longLearning

Non-Premed Degree

PracticeRe-training

Life-longLearning

Will technology remove all the barriers in medical education?

No, but when used wisely, it can be a powerful enabling tool.

Will technology solve all the problems in our health care system?

Taking Physician Handwriting Out of the Equation

Photo courtesy of Evanston Northwestern Healthcare

Relegating the Medical Chartto the Museum

Real World ComparisonsAccessible to Patients

Patient Feedback Becomes a Reality

Will technology solve all the problems in our health care system?

No, but when used wisely, it can be a powerful enabling tool.

If our solving our problems in educating health professionals and

delivering health care isn’t as simple as strategically applying the latest technology, where should we turn

our attention?

Embracing a New Culture in Health Care

“Culture eats strategyfor lunch every day”

Andy Grove

Former Chairman of Intel

The Traditional Culture of Health Care

• Individualistic

• Autonomous

• Scholarly

• Expert-centered

• Competitive

• Focused

• High-achieving

• Hierarchical

Embracing an Emerging Culture for Health Care

• Collaborative

• Transparent

• Outcomes-focused

• Mutually accountable

• Team-based

• Service-oriented

• Patient-centered

If we want shared collaborative environments, we need standards.

Technology standards can ultimately facilitate collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

Standards in the absence of trust will go nowhere.

What Does This Mean for Health Care Leaders?

If “culture eats strategyfor lunch every day…”

And if a positive culture is a key source of future excellence…

How do we change the culture in our institutions?

#1 Make values explicit, and

use them visibly in everyday decisions!

#2 Align governance, leadership, and

management across organizational

and “corporate” divisions!

The Academic Health Center

Medical School

University

Physician Practice

Hospitals and Clinics

#3 Use the tools of mission-based management

to realign and maximize resources!

Program Assessment

Mission

Contribution

Financial Performance

High/LowHigh/Low

Low/Low

High/HighHigh/High

Low/HighLow/High

#4 Foster collaboration and accountability,

accepting nothing short of

high performance teams in all mission areas!

A New Model for the Organization – Creating High Performance Teams

Source: Katzenbach and Smith, 1993

PE

RF

OR

MA

NC

E I

MP

AC

T

TEAM EFFECTIVENESS

Pseudo-Team

Working Group

Real Team

Potential Team

High-performing Team

#5 Focus leadership recruitment on

organizational fit, and do real succession

planning for long-term stability!

Embracing an Emerging Culture for Health Care

• Collaborative

• Transparent

• Outcomes-focused

• Mutually accountable

• Team-based

• Service-oriented

• Patient-centered

Diffusion of Innovations

Innovators(2.5%)

Early Adopters(13.5%)

Early Majority

(34%)

Late Majority

(34%)Laggards

(16%)

“Venturesome”Respond to Innovations

“Suggestible”Respond to Change

“Deliberate”Respond to Evidence “Skeptical”

Respond to Peer Pressure

“Traditional”Respond to Authority

E.M. Rogers and C. Cassel

Culture Change as the Key to Shifting the Adoption Curve

Culture Change

Time to Adoption

Creating a Culture of Teamwork and Collaboration

Creating a Culture of Reliability and Quality in the Face of High Risk

Creating a Culture Based on “Evidence” Rather Than “Eminence”

Issacs and Fitzgerald, BMJ 319: 1618, 1999

Creating a Culture of Trust

Creating a Culture in Which All Teach and All Learn

An Integrated World of Education, Research, and Health Care – With the Patient at the Center

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