Lessons on Delivering High Performance Health Care

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<p>The Commonwealth Fund's series of case studies on high-performing health care organizations seeks to highlight the programs and practices that make for effective and efficient health care delivery. The latest organizations to be profiled are Baylor Health Care System, a nonprofit integrated delivery system in the Dallas–Fort Worth area, and Hill Physicians Medical Group, the nation’s largest independent practice association.</p>
<p>As described by Tom Emswiler and Len M. Nichols of the New American Foundation, both organizations have achieved their improvements in patient outcomes and care processes by earning physicians' trust and securing their commitment to quality improvement, creating incentives and fostering competition, and enabling continuous learning.</p>
<a href="/publications/case-study/2009/mar/baylor-health-care-system-high-performance-integrated-health-care">Baylor Health Care System</a>, which in recent years has substantially improved the delivery of preventive services, lowered its hospital mortality rate, and achieved greater standardization in care delivery, stresses the importance effective leadership at all levels. As detailed in the case study, Baylor's Physician Champions program provides physicians who are early adopters of quality improvement initiatives and electronic health records with financial incentives to "spread the word" among their peers.</p>
<p>Baylor's leadership also believes in letting doctors compete. By posting unblinded patient outcome scores on the organization's intranet, the organization capitalizes on the competitive nature of physicians and their desire to be the best. <a href="/publications/case-study/2009/mar/hill-physicians-medical-group-independent-physicians-working">Hill Physicians Medical Group</a>, meanwhile, demonstrates how an affiliated group of independent physicians can improve clinical outcomes, increase efficiency, and engender physician support for quality improvement and cost-reduction initiatives. The group's leaders have worked diligently to earn the trust of doctors—often through small but important steps that show that the organization cares about the doctor's satisfaction and the practice’s success.</p>
<p>Hill found that solving minor problems without delay and paying physicians promptly engender confidence and improved communication. Hill also encourages its doctors to adopt electronic health records and other health IT by offering to lessen upfront costs and providing training, as well as fostering a culture of communication and cooperation.</p>