© 2010 University of Southern California

Session V, Panel IIntegrated Health Care Delivery Systems in Action II

Organizing for Sustainable Quality Health Care

Delivery

A  Time for Change: Restructuring America’s Health Care Delivery System 

Cornell University, Wednesday, May 12, 2010

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Susan Mohrman, Center for Effective Organizations, University of Southern California

Michael Kanter, Southern California Permanente Medical Group, Kaiser Permanente 

Patti Harvey, RN, MPH, CPHQ, Kaiser Permanente Southern California Region 

Walter Allen, Coalition of Kaiser Permanente Unions

Guido Bergomi, Director, Quality & Patient Safety, Cleveland Clinic

Linda McHugh, Executive Administrator , Cleveland Clinic

 

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• Demographic trends• Escalating costs• National economic adjustments

in healthcare resources• Powerful, expensive, and

disruptive medical care technologies for treatment, prevention, and cure• Skill shortages• Active government

stakeholders• Relentless degradation of the

environment

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Definitions of Sustainability

• Development that "meets the needs of the present without compromising the ability of future generations to meet their own needs”

(Brundtland Commission, 1983)

• Our working definition of the sustainable provision of health care outcomes: the complex healthcare system operates to continually deliver high quality health, societal, and ecological value and operates with a viable economic model.

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The Health Care Eco-System May Look Quite Different in the Future

• The Cleveland Clinic and Kaiser Permanente are among those leading the way

• They are making headway with multi-faceted approaches involving integrated health care delivery and system optimization

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Principles of Health Care Sustainability

• Increase Value: Quality and impact of the health care services that are delivered and the benefits derived from health care resources

• Decrease consumption of resources that does not contribute value

• Optimize the system• Build effective work systems• Empower patients to take responsibility for

their health

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A Tale of Two Systems – Institutional Contexts

Not-for-Profit• Kaiser Permanente – Capitation and Member

Model• Cleveland Clinic—Fee for Service

Values Based

Integrated Care Focus• KP—Prevention and Life-Cycle Care;

Integration across primary and specialty care• CC—Multi-specialty care brought to bear on

patient

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Institutional Context, Continued

Knowledge Leverage and Growth Strategies• KP—increase market penetration; raise bar

for health status and outcomes of entire membership; build on deep longitudinal knowledge from millions of members

• CC—leverage cutting edge health care knowledge into new markets and services

Research and Evidence-Based Approaches

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Common Elements of Emerging Healthcare Delivery System• Comprehensive electronic medical records provide

ease of integration of care• Organizational and process integration across multi-

specialty medical system• Resource leverage through the

rationalization/system-wide integration of multi-facility system

• Work system and organizational redesign• Developing shared, evidence-based standards,

protocols, methodologies and technologies• New care modalities enabled by I.T. and other

technological advances• System regulation• Learning, innovating, and improving• Beyond “Traditional Health Care” focuses:

– Ecological impact– Health community

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Conclusion

• The major elements of the sustainability transformation of the two systems are the same

• The particular manifestations are impacted by the institution contexts and business model

The journey to sustainable health care is:SystemicMulti-OrganizationalMulti-Level