Change in Health Care: Clinical, Administrative, Both?

There is a distinction many physicians see in their health care organizations between clinical and administrative issues. More often than not, many physicians feel that they should worry about the clinical side while administrators worry about administration issues. This perspective is recently illustrated in a question of whether content involving Accountable Care Organizations (ACOs) and their implementation are appropriate subject matters for a clinical grand rounds presentation. Historically grand rounds presentations  center on clinical medicine subjects only.

It is clear that clinical knowledge is essential to quality patient care. Yet the implementation of that knowledge into processes that create positive outcomes is no less important. The fact of the matter is that the mission of all health care entities is to improve the health of their patient population. They essentially manage the access of individuals to the system, add value in the form of medical care, and hopefully observe a positive effect upon release. All of this is done with the desire to minimize mistakes and create the highest quality in the care delivered.

The founders of the ACO initiative envisioned health organizations that would be responsible for all of the care of a patient population. Whereas, in the past, systems were judged on the merits of the individual physicians, ACO organizations will be judged on the outcomes of their patients. It will no longer be good enough to be a high quality clinician. Since outcomes will be the basis for quality judgment, it follows that all physicians will be judged by the performance of the organization as a whole. Individual physicians who believe they are delivering the highest quality of care will be dependent on other providers in the patient care chain as well as the processes that govern their movement through the system.  In other words, the process of patient care will be as important as the clinical knowledge behind the care. As it should be, the only thing of importance will be the patient’s outcome and their safety.

The U.S. health care system physicians have no shortage of clinical knowledge. Yet when outcomes are examined, we seem to fall behind and the system is not especially safe. Clearly the deficit lies in the implementation of the clinical knowledge used to produce positive outcomes.  ACO’s will be designed to measure organizational outcomes and their financial viability will be subject to these metrics. No longer will the clinical be separated from the administrative. All providers will need to be responsible for obtaining clinical knowledge as well as the business knowledge involved with implementing safe, high quality care delivery processes. The founders of the ACO concept, I believe, understood this and it is this concept that will likely advance the quality, safety and efficiency issues that are the focus of future health care change.

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