C&B Notes

A Team-Based Approach to Healthcare

The Cleveland Clinic is using a team-based approach to improve healthcare outcomes while simultaneously lowering costs:

In its most fundamental reform, the clinic in the past five years has created 18 “institutes” that use multidisciplinary teams to treat diseases or problems involving a particular organ system, say the heart or the brain, instead of having patients bounce from one specialist to another on their own.   The Neurological Institute, for example, provides both inpatient or outpatient care for those with strokes and brain tumors, as well as those with epilepsy, multiple sclerosis, depression and sleep disorders, among other conditions.

On a recent visit, we observed one such team, consisting of a neurosurgeon, a neurologist, a neuroradiologist, a neurologist with advanced training in intensive care, a physical and rehabilitation doctor, a medical resident, a physical therapist and a nurse.  As they made rounds from patient to patient, they had a portable computer that displayed electronic medical records so that the whole team could see how the patient was doing and plan the course of care for the day.  This team approach can improve the quality of care because all the experts are involved in deciding the best treatment option, which can save time and money.  The neurological team, by consensus, has been better able to determine which acute stroke patients need a risky and expensive treatment that involves threading a catheter through an artery in the leg up into the brain to destroy a clot.  It cut the use of that treatment in half, reducing costs and deaths and improving outcomes.

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The Cleveland Clinic’s progress in restructuring itself, said Michael Porter, a Harvard professor who analyzes health care delivery and organizational change, is “light speed” compared with other institutions.  The clinic is “a model of where we need to go,” he said,  “Not perfect, not done, but far along.”

Although this fact was buried somewhat in the article, it does also help that financial incentives for doctors at the Clinic are more closely aligned with outcomes than other practices/facilities:

The Cleveland Clinic has strong leverage to drive such reforms because its staff physicians are salaried and are granted only one-year contracts and subjected to annual performance reviews.  Those reviews apply measures of quality, like patient improvement, patient satisfaction and cost reductions.  It raises the pay of those who get high marks, reduces the pay of poor performers and even terminates some doctors who fall short.  This approach could become more widespread as more hospitals and doctors move toward the salary-based model.