Using a Collaborative to Build a Clinically Integrated Culture

To succeed in emerging payment models, providers must cooperate to improve patient outcomes and control costs. This requires not just new workflows, but a new provider culture. 

The traditional fee-for-service payment model rewards the isolated efforts of providers. But patient outcomes are not maximized by individual effort. They are maximized by team effort. In accountable care systems, providers must coordinate their efforts to improve health outcomes and contain costs. Systems must transform both clinical operations and clinical culture to achieve success. One proven strategy for developing a new provider culture is to create a Practice Transformation Collaborative.

What is a Collaborative?

A Practice Transformation Collaborative is a longitudinal and interactive learning program that helps healthcare providers understand and use the tools of quality improvement. It brings together physicians and key clinical team members to learn practice management and quality improvement principles. It focuses on specific quality metrics and the best evidence-based means to reach them. Participants receive practical guidance on improving office efficiency and effectiveness. They share their experiences, receive peer support and learn best practices from one another.

Used effectively, a Practice Transformation Collaborative can help providers within a clinically integrated system become adept at improving population health outcomes and simultaneously minimizing costs.

Well-designed collaboratives share six key elements:

  1. Clinical leaders with quality improvement experience. Effective programs are spearheaded by clinicians with experience in quality improvement. A good candidate might be a physician with a Master of Public Health or Master of Science degree in Quality Improvement. Support faculty should include physicians and nurses with experience, certification, or training in quality. Successful teams also benefit from instructors with expertise in lean process improvement.
  2. An operational director. A collaborative is a large undertaking that needs a focused director. Responsibilities include developing the budget and curriculum, setting up meetings, enrolling providers, developing promotional materials, designing incentives, and organizing ongoing events. This role does not need to be a full-time position. In smaller organizations, these responsibilities could be handled by a Physician-Hospital Organization director, a Quality Improvement director or someone in business development.
  3. A curriculum. A strong curriculum will introduce participants to the concepts of population management, clinical integration, process improvement, chronic disease management, and practical statistics. It is important to include a “workshop” component that gives participants an opportunity to work together, compare notes, and learn from real-life projects.
  4. Peer-to-peer Interactions. The heart of a Collaborative is the peer sharing process. Instructors teach principles and give assignments, but the true learning occurs as clinicians attempt to change specific processes back in their practices and then share what they have learned with their peers. Participants can learn just as well from successes as they can from failures, and the personal sharing of successes and failures, insights, struggles, and innovative ideas is both practically useful and motivational for others in the group.
  5. An ongoing support structure. Devise ways to support providers between sessions. One option is to require participants to turn in monthly progress reports on their projects. This could be as simple as a one-page form for reporting accomplishments and challenges. Monthly conference calls help keep participants focused on program goals. In addition, create a “tool kit” (patient education hand-outs, chronic disease management protocols, etc.) to support participants in their efforts.
  6. Strong incentives for provider part.icipation An organization could provide points towards incentive payment thresholds for collaborative participation. Other options include providing a stipend or arranging for participants to receive continuing medical education credit. It is also possible to obtain specialty board credit towards recertification for those fully participating in the collaborative.

Executive Sponsorship is Critical

As with all change initiatives, executive commitment is critical to a Practice Transformation Collaborative. Effective collaboratives are backed by a key executive leader who supports the concept, works to secure resources and provides high-level sponsorship.

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