My group, Anesthesia Medical Consultants provides care predominately for the Spectrum Health System. Both of these entities are the result of merger processes which took place eight years ago. Both AMC and Spectrum are now the 800 pound Gorillas for west Michigan.
Many services in the system are dominated by large, single specialty groups like ours. The system would like these groups to work more closely with it and each other in strategic planning, expansion of the referral base, common electronic record, integrated clinical pathways and, of course, cost control. The docs want little of it. They believe that the administration wants nothing more than control of their practices and revenues. Do we need all that when we are busy and providing good care?
Of course some of the specialties would like to expand or develop new clinical programs but they believe that the system should provide the facilities and get out of the way. So the conflict is a desire for clinical growth with both sides unwilling to cede control of the process.
A couple of weeks ago I was reading the STS/SCA guideline on “Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery”, a much needed and very good piece of work. Section seven addresses using a multidisciplinary approach to develop institutional transfusion guidelines and point of care testing. How many places have done that? Section eight discusses Total Quality Management (TQM) in blood transfusion and conservation. For those of you who have developed guidelines have you instituted TQM? These two recommendations help take you from being a good shop to a great shop, in my opinion.
So what is the common thread between professional distrust and guideline/TQM development?
Guidelines, point of care testing and TQM require a level of multidisciplinary commitment and participation that rarely exists in a private practice environment. The doc’s scratch in the game is meeting time and a willingness to submit to a guideline instead of individual practice preferences. The hospital has to commit the resources for point of care testing, data management and quality support personnel. Big investments by both groups. A level of integration that few private practice institutions have.
Survival in an environment of increased competition for fewer resources will require greater integration of a hospital and its medical staff. Quality programs can serve as the spring board for that integration. Successful quality programs have commitment of time and resources by both physicians and hospital for the good of the patient (which is what both sides say they care most about.)
Quality is hard work, takes leadership skill, time, money and process knowledge. It can result in a level of trust and cooperation that has not existed before. It improves patient outcomes, supports program development, builds practices and improves the bottom line for all involved. Clinical quality is an integration and survival tool. Always the optimist; you can call me naïve. I’ve seen other attempts at cooperation based on joint business ventures end up in bickering over money and leaving some stakeholders in the cold. Quality programs are inclusive of all clinical stakeholders and it is patients not currency we are working for. Let’s get at it! (posted for Rob Dean)