OHSU, Salem Health, Tuality Healthcare leaders convene to define a shared vision, expectations and plan for collaboration

February 17, 2017

Freezing temperatures and icy road conditions could not stop leaders from the OHSU Practice Plan, Salem Health, Tuality Healthcare, OHSU Partners and Adventist Health from convening earlier this month for a daylong retreat to articulate a shared vision for improving the health of Oregonians. Physicians and administrators from the organizations shared a lofty, important goal: creating value through integration at a time of unprecedented change in the health care environment.

The case for change is clear and the spirit of innovation that has informed many health care initiatives in Oregon is present. Shaped in part by outside forces – federal payment models emphasizing value instead of volume, a marketplace dominated by mergers and acquisitions, patients wanting better access and cost transparency – attendees at the Feb. 3 retreat demonstrated an equal amount of interest in creating an Oregon-built, physician-driven solution to better serve Oregonians and patients from around the nation.

Attendees shared ideas for population health improvement, integration of care, communication between organizations, ways to decrease costs and much more. The need to promote provider wellness was emphasized throughout the day.

"There are necessary requirements in defining our shared vision, but we also have to work together to restore the joy of practice for our clinicians" said Anthony Masciotra, M.B.A., C.P.A., chief executive officer of the OHSU Practice Plan. "I firmly believe that a network of hospital and clinic facilities supports this vision, but what really drives integrated quality care is the engagement and alignment of our providers. We want to get to know each other."

Building the team, defining the game plan

Integration has been a defining feature of all OHSU Partners affiliations, which currently include OHSU, Salem Health and Tuality Healthcare (Adventist Health, OHSU and OHSU Partners have signed a non-binding letter of intent to pursue an affiliation). This allows providers to maintain independence while collaborating between facilities with different employers. It is distinct from the national trend toward consolidation. John Hunter, M.D., F.A.C.S., interim dean and board chair, OHSU Practice Plan, posed the question at hand with a sports analogy. "Can a diverse group of practitioners, with different backgrounds, employers and geographies, put on a single jersey and play for the same team?" In short, he said, "we want to commit to one integrated team and define the initial playbook."

Masciotra kicked things off by socializing the eight strategies of OHSU Partners aimed at bringing sites together in a clinically integrated way. Details are important in this wide-ranging work, and a considerable amount of time was spent discussing a "game plan" for bringing the playbook to life. Table participants considered questions such as, "What messages and approaches best speak to physicians?" "How will consensus best be obtained and documented?" "What data and information are needed to select areas of clinical focus?"

Based on physician engagement groups organized in Portland, Salem and Hillsboro, everyone is interested in aligning and being part of the solution but participation comes with a caveat: the return on their investment of time must translate into improved quality and efficiency of their practices. Without this, clinicians are at risk for burnout. Burnout is multi-factorial in origin, but can affect the quality of patient care, as well as provider satisfaction and retention. This is a national problem and not exclusive to clinicians, but a focus of the retreat was how it affects clinicians across OHSU Partner sites.  

"It is important to periodically take a step back to honestly evaluate how we are doing our clinical work," said Mark O'Hollaren, M.D., vice president for strategic outreach at OHSU. "Numerous studies have shown that we often spend two hours of administrative and computer time for every hour we actually spend with patients. We can do better. We need the clinicians to engage to help make the system better for both patients and themselves, and we need to share practice improvement and evidence-based practice tips across OHSU Partner sites."

Dr. O'Hollaren reported that clinicians within the focus groups expressed similar concerns regarding electronic health record time constraints, and emphasized the importance of effective, predictable and efficient communication. In other words, work-life balance is a real issue, and clinical integration efforts to improve patient care quality and cost control also need to support providers and help make their lives better. Dr. O'Hollaren will be working with Nate Selden, M.D., Ph.D., professor and chair of neurological surgery, OHSU School of Medicine; Ralph Yates, D.O., chief medical officer, Salem Health; and others on the physician engagement effort across OHSU Partners sites.

The vision of access at OHSU Partners

If clinician engagement goes hand-in-hand with wellness and professional satisfaction, so does access to services and patient satisfaction. Kevin O'Boyle, vice president of ambulatory services for the OHSU Practice Plan, updated the group on the OHSU-wide initiative of improving access and working collaboratively as a system to ensure that patients and referring providers can have their clinical needs addressed in a timely and efficient manner.

O'Boyle spoke about the key components of access (availability, a platform for seeing patients, a platform for operations and the impact for providers), metrics that will be used to gauge success and an evolutionary chart that depicts the stages of the work at hand. "Our success is predicated on having good data, standards, organizational learning and leveraging technology to enhance the way we see patients," said O'Boyle, who is the co-executive sponsor for the OHSU access initiative along with Masciotra, Dr. Hunter and Mike Bonazzola, M.D., chief medical officer of the OPP.

"Changing the way we lead"

Atul Grover, M.D., Ph.D., executive vice president of the Association of American Medical Colleges, delivered the keynote address. He talked about the intricacies of federal reform for the academic health center and encouraged the group to engage trainees and students in the process of adaptation.

The need to "change the way we lead" was scattered throughout Dr. Grover's presentation. Leadership, he said, can be in the exam room, in the academic department or in the patient care system as a whole.

Although health care may not be known for rapid change, Dr. Grover encouraged the audience to be unafraid of speedy progress. "How do we move from thinking about being incremental and always having all the data to being transformational when we think about change?"

Bringing the playbook to life

Examples of clinical integration within OHSU Partners are springing to life in a variety of areas.

Matthias Merkel, M.D., Ph.D., associate professor of anesthesiology and perioperative medicine, OHSU School of Medicine, described collaboration between OHSU, Salem Health and Tuality intensive care units to manage capacity and develop inter-institutional, standardized work. Plans may include an "eICU" model integrating telemedicine between sites, a unified approach for transporting critical care patients and other platforms for ICU-based collaborations.

"There's a self-sustaining momentum," said Dr. Merkel, who is also director of adult critical care at OHSU. "Most of this is doable without more resources. We just need to be more coordinated and aware."

A structure for keeping the momentum and providing aligned leadership is equally important. The recently-formed Clinical Integration Committee consists of two physician leaders and one nurse leader from each institution. Its co-chairs will then bring ideas to the executive management committee of OHSU Partners, where decisions will be made. Membership of the CIC includes:

• From OHSU: Renee Edwards, M.D., M.B.A., professor of obstetrics and gynecology; Atif Zaman, M.D., M.P.H., professor of medicine; and Dana Bjarnason, Ph.D., R.N., N.E.-B.C., chief nursing officer
• From Salem: Kendall Graven, M.D.; Christine Clarke, M.D., president and president-elect, respectively, medical staff executive committee; and Sarah Horn, R.N., chief nursing officer
• From Tuality: Patrick O'Leary, M.D., general surgeon; J. Kim Thiringer, D.O., community provider and otolaryngologist; and Eunice Rech, R.N., M.S.N., M.S.H.S., chief clinical officer

The Clinical Integration Committee and providers from OHSU Partners organizations are already organizing efforts to achieve OHSU Partners Clinical Guidelines and an evidence synthesis service. This effort to create "one standard of care" throughout the organizations will also include implementing and evaluating best practices and evidence-based practice education.

Work teams met to identify opportunities to improve clinician engagement in the eight OHSU Partner strategies, integration of care across our system, and being a part of the same team. Ensuring that clinicians have a voice and help drive the care model will be critical to success.

Next steps will help solidify the journey for all involved – clinicians and administrators alike. OHSU Practice Plan leaders will summarize the feedback they heard and convene multi-disciplinary, cross-institutional councils who will work together to create clinically integrated systems of care. The adage "many hands make light work" will undoubtedly apply during this important moment for health care integration in Oregon.