Joanna K

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I have enjoyed this discussion. Perhaps related is that of a new service that has recently entered our community, Direct Primary Care. These patients pay a flat, monthly retainer fee for a full range of comprehensive primary services (routine care, regular check-ups, preventative care, and care coordination) increased access to a physician, quick appointment scheduling, and more thorough visits (Each MD has 600-1000 patients/physician rather than the typical 2000+). Each visit is then only $20. This is a contract, not insurance, and does not meet the ACA needs. Patients are still encouraged to get health insurance to cover larger expenses, catastrophic events, and services outside of primary care. Monthly fees are age based and max out at $120 for a family. I have to admit that I even thought about it in addition to my employer-provided, high-deductible health plan when I considered that one PCP visit for cost is $150 for a sick visit. It is especially good for a younger single person that could go on a high deductible plan and carry this for only $25-$35 per month. They claim that this is possible as a business model by eliminating the paperwork associated with insurance companies & government agencies. If interested, more info on this specific service in my community can be found at

Your story is all too familiar to me. Here are a few things that we have been successful with:
-System Strategic Service Line (SSL) to align for clinical standardization & spread of best practice, growth, marketing, supply chain, capital & IT, employee training standardization, and innovation.
-System-wide physician decision making model via a quarterly System Strategic Collaborative Council
-System-side subspecialty councils
-Efforts to shift elective, lower-risk procedures to community hospitals (ortho SSL does this well with elective joint replacement)
-Efforts to evaluate patients prior to transfer (so we aren’t just shifting the mortality to the academic medical center)
-Allows us to align marketing efforts
-Allows coordination of equipment & supply chain buying power
All of that said, new system c-suite leadership at my facility is shifting away from SSL’s to even further centralize the clinical work under one office (and move those resources to spread councils to more departments). I fear that they underestimate the importance of the relationships in the work that has been accomplished thus far as well as the time spent on important business initiatives beyond clinical standardization.

By shifting to the model that you’ve indicated, it allows you to align specialties of planned growth with the multi-disciplinary team needed to support this revenue center. Because as volume grows, support services may be impacted by an increase in demand. If aligned, you’ll see increased communication and ensure that plans are in place to ensure that they can meet the demand.
Also consider leveraging Lean at your system to see each of these as a value stream.

Looking back at how this situation came about, it’s the well-known scenario that just because someone is good technically (research, etc) and leads as a subject matter expert, we assume that they will be a good leader. We’ve made that mistake at my health-care system as well. In your scenario, where it is a single strong person that you cannot separate from, I favor a discussion to more deeply trigger these research interests partnered with the hospital’s need for innovation that can result from this research. Play to the ego and strengths that others do not have in this research field. You really need for her to focus on this research and need to help to make it her idea. Then find her a bigger lab space that just happens to be farther away from the core of the department. Best of luck.

On May 12, 2017, Joanna K commented on Patient Experience :

I agree with Jkal. And key to employee engagement and staff acceptance is understanding the WHY behind the operational asks that we make to enhance quality & safety. Without the WHY, any additional tasks become simply more work and increases the risk for work arounds, etc. As for the patient experience, the hospitality industry has highlighted that the customer experience will never exceed the employee experience. Very interconnected.