Matt's Profile

Did you already bring in patient representatives ? In our hospital we have a form client representative counsel that is part of a discussion like this. And they can help in defining, either by themselves or organising the right input from patient groups, the opinion of the patient. For example, it is hard to hide behind ‘staffing’ as an argument when patients tell that it is mainly attitude they would like to see improve.

Is a financial incentive really necessary ? People working in a non-profit academic center are probably better motivated by having an excellent research environment. Good facilities, research support on IT, administration, regulations (IP), etc. Also the ability to hire an excellent staff is probably more important than getting a bonus. But maybe I’m naive, coming from outside of the US ……

I agree with other responses that sending text messages is bringing down the no shows, although it’s hard to get some good figures in the net effect.
But, sending a message should be part of a broader strategy to engage and interact with the patient. In our hospital we started last year with getting a better understanding of all our interactions with the patients. This includes all administrative, scheduling, clinical and non-clinical interactions. We mapped this using concept of patient journey mapping. By this we identify how we can improve our communication with the patient and also understand better how to create an uniform experience for the patient.
By creating an uniform experience a patient has easier acces to hospital information (simple logistics, like where to park), to disease specific information (guidelines, decision aids, background info on their disease) and their record. With this the patient will be more engaged and I think this will result in better communication from the patient to the hospital also. And thus also result in less no-shows

First of all it’s a good thing that you’ve defined a strategic plan where to head as an organization. The problem you describe is not only about communication, but also about the execution of the plan. It seems to me that the execution is also top-down. And 400+ projects is a lot, there is no way that people who try to do their daily job are keeping up with that.
I would reconsider the approach. You can use the 12 themes and the defined projects as ‘a menu’ and ask the departments which themes and within the theme which projects they think are applicable for them. Sort of asking them to subscribe. Projects that no one subscribes can be put on hold, this gives also an overview on which topics the ‘energy of the organization’ is good. Next step then is to define with the departments that subscribed an execution plan.

Ofcourse I understand that it might be hard for your organization to redefine the approach, but you have to rethink buy-in from the ‘regular physicians’ or the transition will be really difficult.

This is a general problem within a lof of organizations. Your serviceline is part of a bigger organization for a reason, but there is no way that goals on a service line level can be defined top-down. In my opinion you (as an organization) should rethink what goals and constraints are defined on the organisational level (in terms of finance, HR and quality) and what is left as responsibility to the departments / service lines. Where to draw the line is situational. Problem you see often is that too much is defined on an organizational level because top management would like to be in control on too much detail.

The main risk is that you create a small hospital for each IPU, that is probably not efficient. So the real challenge is to create small ecosystems within the structure of the larger organization.

The main purpose of an IPU is to organise the care around the patients medical conditions. In larger institutions this often conflicts with both the physical as well as the functional organization. It might help to use elements of ‘systems thinking’ here. In particular the principle of ‘maximal cohesion, minimal interfaces’ is helpful in rethinking your processes and responsibilities. By doing this you can define what processes and responsibilities you would like to group in the IPU and which ones can ‘live outside of the IPU’. For the last category, you then need to define clear interfaces in terms of agreements with the ‘mother hospital’. In my opinion those agreements will be mainly on using facilities, IT, general staff. And ofcourse on budget constraints and on general (hospital wide) quality indicators that you as an IPU need to comply with.

HBS has stuff on this: https://www.isc.hbs.edu/health-care/vbhcd/Pages/integrated-practice-units.aspx