In my opinion, you can only find out how to mix oil and water when doing an experiment. At Radboudumc we’re doing an experiment on population based payment for Parkinson patients in a well defined area. We’ve set this up as an experiment together with the two largest health insurers in our region and we’re learning together. We’re meeting on a regular basis and discuss the outcomes as well as the costs in the whole system (thus also outside our hospital). We’re supported in this learning by health economists from ErasmusMC and Radboudumc. Our biggest challenge is developing the right outcome indicators for population based payment. E.g., we thought the amount of hip fractures would be a critical indicator, but it seems the it is not sensitive enough. We’re still in the experimental phase and did not move to population based payment completely.
On the way, we’re learning interesting stuff. E.g., that out clinic patients benefit more from treatment by our ParkinsonNet physical therapists
then regular physical therapists. Only by sharing knowledge between the health insurer and us we were able to make this visible and publish the result in Lancet Neurology (https://www.parkinsonnet.nl/media/15339055/editorial_lancet_neurology.pdf)
At Radboudumc we are also in the process of developing IPU’s for several patient areas (also cardiovascular) and are looking at best practices. Our conversations with Michael Okun from University of Florida Health helped in understanding the development process of their IPU’s. They started developing an IPU for Movement Disorders already in 2002 (https://movementdisorders.ufhealth.org/about/). He advised to define a transition phase and give the professionals space and time to go ahead. His biggest challenge was to let each IPU see that the future is in their own hands: watch, dream, plan. Once they saw the opportunities most of them moved automatically and only few people did not step in the bus. The largest work was to unravel finances from departments to the IPU’s and create joint facilities where it makes sense.
In the Netherlands patients with urgent health problems (in evenings, nights or weekends) can call the telephone number of a regional urgent care clinic (centrale dokters post) which are almost always located near and work closely together with an emergency post. They get a well-trained triagist on the line to provide the right care which can be medical advice via telephone, a meeting at a nearby primary care facility (e.g. with family physician), home consult of physician, ambulance or referral to emergency care. There is a website (thuisarts.nl) and an app (moetiknaardedokter.nl) which help patients with deciding when to go to a physician. The better the cooperation between the urgent care clinic and the emergency room the more patients the urgent care clinic is able to take over and the more the emergency room has capacity for complex urgent care (substitution of care). In the period between 2012-2015 the amount of patients going to the emergency room decreased with 5,8% nationally and the amount of patients moving to the urgent care clinics increased with 3,3% nationally.
In our conversations with partner organizations we try to explicit the cooperative work to be done. Not only the why and what, but also the how.
We use the BART model (Green & Molenkamp, 2005) to explicit the boundary, authority, role and task of our cooperative work.
We also use a model with five conditions for an optimal cooperative relationship (Kaats & Opheij, 2012) for identifying where we meet and where we don’t:
– Do we have a shared ambition?
– Do we do justice to each other interests?
– Do we work together in a constructive way?
– Do we organize professionally in line with our ambition?
– Is it a meaningful process?
If you’re interested I can send you the first article as that’s in English. The second article unfortunately is in only Dutch.
In our organization we have only fixed and no variable component of staff salaries. We do not match individual performance with financial rewards. The only incentives are at the team, department or organizational level and the rewards are small (like financing an extra day out for the team).
We stimulate innovation and cost reduction via specific innovation subsidies and teams, departments who safe money are allowed to use it for innovation.