Americas Healthcare Transformation

A revolution in American medicine is in full swing, with the race from fee-for-service to fee-for-value at the front line in an epic battle that will transform healthcare delivery for decades to come. In America’s Healthcare Transformation, eminent physician leader Robert A. Phillips brings together key thought leaders and trail-blazing practitioners, who provide a wide-ranging exploration of the strategies, innovations, and paradigm shifts that are driving this healthcare transformation. The contributors offer a panoramic look at the dramatic changes happening in the field of medicine, changes that put the patient at the heart of the process. Among other subjects, the essays evaluate innovative high quality and low cost care delivery solutions from around the United States and abroad, describe fundamental approaches to measuring the safety of care and the impact that guidelines have on improving quality of care and outcomes, and make a strong case that insurance reform will fundamentally and irreversibly drive delivery reform. In addition, America’s Healthcare Transformation reviews the role of health information technology in creating safer healthcare, provides a primer on the development of a culture of safety, and highlights ground-breaking new ways to train providers in patient safety and quality. Finally, the book looks at reports from Stanford Health Care and Houston Methodist which outline how successful behaviorally based strategies, anchored in values, can energize and empower employees to deliver a superior patient experience. Drawing on the wisdom and vision of today’s leading healthcare innovators, America’s Healthcare Transformation provides a roadmap to the future of American healthcare. This book is essential reading for all health care providers, health care administrators, and health policy professionals, and it will be an invaluable resource in the effort to improve the practice of medicine and the delivery of healthcare in our communities and nation.

Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review

A revolution in American medicine is in full swing, with the race from fee-for-service to fee-for-value at the front line in an epic battle that will transform healthcare delivery for decades to come. In America’s Healthcare Transformation, eminent physician leader Robert A. Phillips brings together key thought leaders and trail-blazing practitioners, who provide a wide-ranging exploration of the strategies, innovations, and paradigm shifts that are driving this healthcare transformation. The contributors offer a panoramic look at the dramatic changes happening in the field of medicine, changes that put the patient at the heart of the process. Among other subjects, the essays evaluate innovative high quality and low cost care delivery solutions from around the United States and abroad, describe fundamental approaches to measuring the safety of care and the impact that guidelines have on improving quality of care and outcomes, and make a strong case that insurance reform will fundamentally and irreversibly drive delivery reform. In addition, America’s Healthcare Transformation reviews the role of health information technology in creating safer healthcare, provides a primer on the development of a culture of safety, and highlights ground-breaking new ways to train providers in patient safety and quality. Finally, the book looks at reports from Stanford Health Care and Houston Methodist which outline how successful behaviorally based strategies, anchored in values, can energize and empower employees to deliver a superior patient experience. Drawing on the wisdom and vision of today’s leading healthcare innovators, America’s Healthcare Transformation provides a roadmap to the future of American healthcare. This book is essential reading for all health care providers, health care administrators, and health policy professionals, and it will be an invaluable resource in the effort to improve the practice of medicine and the delivery of healthcare in our communities and nation.

Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.

The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

This book, n=1 is a collaboration of physician health system CEO, venture capital entrepreneur and leading global business advisor and best-selling business author. These differing perspectives provide insights into the forces transforming the global society, business and professions with a focus on US healthcare and its transformation. Healthcare leaders must develop the incisive questions that challenge the orthodoxies hindering organizational transformation. Our experience indicates leaders of successful non-healthcare organizations develop cultures of inquiry that guide their organizations through dramatic market change. Unique individuals are the driving force in the transformation of healthcare. Digitization has democratized information, which feeds the desire of people to act, behave and be treated as unique individuals. Scientific innovation is revealing the importance of our biologic individuality. The financial risk of healthcare is increasingly passed to individuals and providers, fueling changes in financial incentives. An individual with information knows their options, and wants to choose the option most suited to his or her unique healthcare needs and financial means. This profound and fundamental change in the individual’s expectations and behavior is accelerating healthcare transformation. The title of this book, n = 1, is a symbol of the uniqueness of individuals. The n=1 will transform healthcare.

This book focuses on how to lead transformative and strategic change in the healthcare industry in times of great uncertainty. Written for senior healthcare leaders, it will provide new tools, processes, examples and case studies offering an effective framework in which to transform healthcare systems. Specifically, leaders will be able to answer the following questions: • Why change? What has led us to today, and what is the current situation in healthcare? • What to change? What areas for change are most promising—areas with the greatest potential to yield significant benefits? • How to change? Will incremental changes meet the need, or are true transformations required? • When to change? Should changes start now, or should change wait for the stars to come into some special alignment? Healthcare is personal. Healthcare is local. And at the same time, healthcare is one of the greatest challenges faced by countries around the world. All major economies confront similar issues: “demand-side” growth in the care of aging populations in the face of “supply-side” resource constraints driven by ever-increasing costs of providing such care. While cultural, historical, and political differences among nations will yield different solutions, healthcare leaders across the globe must deal with ever-increasing uncertainty as to the scope and speed of their healthcare systems’ evolution. The magnitude of these challenges calls for fundamental change to address inherent problems in the healthcare system and ensure sustainable access to healthcare for generations to come. The problem is understanding where and how to change. Failures of strategy are often failures to anticipate a reality different than what organizations are prepared or willing to see. Both system-wide and organizational transformation means doing current activities more efficiently while layering on change. This book aims to provide leaders with the tools to help organizations and health care systems adapt and evolve to meet the new challenges of healthcare as it continues to evolve. Praise for Leading Strategic Change in an Era of Healthcare Transformation "The authors make the case for healthcare transformation, and more importantly outline the required steps from changing mindsets to opinions development...a useful guide for all future healthcare leaders."- John A. Quelch, Charles Edward Wilson Professor of Business Administration at Harvard Business School "There are several lifetimes of knowledge in the book about leading strategic transformation in the healthcare sector... Strategic transformation requires 2 ingredients: expertise in the healthcare sector and knowledge about leading change. This volume accomplishes both."- Karen Hein, Former President of the William T. Grant Foundation, Adjunct Professor of Family & Community Medicine, Dartmouth Medical School and Visiting Fellow, Feinstein International Center, Tufts University "An essential guide for healthcare leaders seeking to transform their organization in these demanding times."- Dr. Mario Moussa, President, Moussa Consulting and co-author of The Art of Woo: Using Strategic Persuasion to Sell Your Ideas and Committed Teams: Three Steps to Inspiring Passion and Performance

America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.