Integrated health: a lifeline for hospital systems?

How can we ensure the sustainability of hospitals under intense budgetary pressures? A more integrated health system may be the remedy we need to curb spending, retain talent, and improve the quality of care.

To achieve the Triple Aim of healthcare — better health, better care and lower costs — integrating the many moving parts of our health systems — including primary care, community hospitals, specialty hospitals and home care — may be key.

Greater integration not only helps curb spending, it also facilitates better results and higher quality service, not to mention one of the main challenges facing small to medium-sized healthcare centers: attracting and keeping talent.

These are the findings of a study of Catalan hospitals, which looks at the keys to their success. The study was carried out by IESE's Center for Research in Healthcare Innovation Management (CRHIM) in collaboration with the Catalan Health and Social Care Consortium.

The report offers a conceptual framework for analyzing integration experiences with three main objectives: the pursuit of technical excellence (knowledge, talent, technology, facilities), process excellence (eradicating inefficiencies, coordinating processes between different levels of the system) and service excellence (the experience of patients and their families). The framework is applied to several specific cases, highlighting that the essential goal of the initiatives analyzed is attracting and retaining talent.

The report also makes five recommendations based on the experiences of the Catalan hospitals studied.

1. Start with a specific problem and personalize it

A real and urgent problem forces us to step out of our comfort zone and take a different approach. For example, in one case analyzed, a crisis is created by a lack of pediatric care.

What's more, creating a narrative to personalize a problem can help justify a proposed change. Sharing the personal perspectives of any of the parties involved — patients, doctors or nurses — is more inspiring than statistics or numbers.

2. Frame the intervention

We must define what we want to improve: be it a technical component, a management process or a service offered. And we must decide what type of structure will be used to improve connections — setting up a shared resource hub or strengthening individual links, for example.

In the initiatives studied, the focus was on improving technical expertise, including the technological infrastructure. And in all, the results were better processes and greater flexibility in resource allocation by establishing new connection points and channels. Unfortunately, none had specific indicators for evaluating the impact of setting up hubs vs. strengthening individual links.

3. Build a motivated team

Financial incentives were not the most important consideration for professionals in the hospitals studied. Instead, learning and improving medical practices were the motivators that ensured staff commitment.

Each initiative needs a leader to manage the feelings associated with the loss of control and belonging that the process of integration can create. That leader must discover what drives each of the people involved in order to draw out those elements which fit better within the team, the study notes.

4. Imagine a new way of working

Who, what, when, where, why, how and with what resources — these are the questions we must ask when imagining a new way of doing things. If it's clear what we want to achieve and why, any obstacle can be overcome.

Prototypes, interactions, and trial and error will serve as the basis for the new way of working. Moreover, pilot programs can help to create trust and involve the team by showing some quick results.

5. Learning from experience

In the cases analyzed, there were no mechanisms for promoting learning through the observation of day-to-day results, although staff was inclined to learn and pursue better protocols and procedures.

Mistakes and failures are essential to learning and improving, and deviating from expectations provides the opportunity to rethink how things work best.

Methodology, Very Briefly

The report establishes a conceptual framework using existing information on integration in healthcare systems. It analyses four Catalan hospitals with successful initiatives via interviews with those at the helm, and makes recommendations based on the information gathered.