Considerations forthe case study:
Process Improvement Steps and Missteps in PopulationHealth
The forces of “status quo’ism” can be very strong. Attempting to change the status quo is often a very positive thing for an organization. It is also fraught with organizational and personal risk. It exposes legacy practice. It identifies individuals who have not necessarily performed up to par or who are desirous of maintaining control and squeezing down on any change possibility. Their motives can be varied. One has to heed them, nonetheless.
Knowing that, it is logical to ask, what is the best way to initiate real change in a healthcare organization? How do you size up the power base? How do you choose the right subject to propel the change? What are the change management methodologies that you with to consider applying? When is it time to move forward and when is it time to consolidate your own base to take the next steps? Some of the most influential individuals in healthcare today focus on changing systems of care to improve patient outcomes. If you were faced with a charge to change something significant, how would you go about it?
HighburyHealth
Highbury Health consisted of Highbury Hospital, ten Highbury Clinics (HHC), a partnership with Lady of the Lake Hospital in the adjacent county, and an affiliation with Stone School of Medicine as well as an employed medical group. Highbury Health physicians and providers also practiced at White Heart Hospital in the same metropolitan area and at eleven ambulatory clinic locations within twenty-five miles from Highbury. Nearly 50% of all ambulatory visits occurred at the main Highbury Clinic site. Highbury Health was led by Nathan Rudd, MHA, FACHE. Mr. Rudd had been a service line administrator and then hospital administrator in another state prior to coming to Highbury Health four years previously. The leadership team at Highbury Health consisted of Paul Thomas, MBA as Chief Financial Officer and Sr. VP for Finance, Devin Gonzalez, RN, MBA in a combined role as Chief Nursing Office and Sr. VP for Clinical Operations, Salvatore DiPisciligia, MD as Chief Clinical Officer for the system, and Calum Earle, MBA, M.Sc. as Chief Strategy Officer and VP for Strategic Planning.
HighburyPhysicians
Highbury Physicians consisted of 353 employed physicians and 576 affiliated physicians who practiced at various Highbury sites. The group was led by Johnna Francona, MD, FACP, FACC. Dr. Francona reported to Dr. Pisciligia. Dr. Francona was a non-invasive cardiologist who was promoted to President of the practice by Mr. Rudd. Dr. Francona had been part of Highbury Health for seven years and practiced at the main Highbury hospital. Brian Rodderidge, MBA as chief administrative officer along with sixty-two staff addressed revenue cycle, contracting, information technology, human resources, and other practice management functions.
Highbury Physicians had a 27-member governing board. Each specialty was assigned to one of seven districts with three representatives elected from each district and six community representatives named to the board. The board committees included Personnel and Compensation, Quality, Operations, Finance, Compliance, and Communications. The Highbury Physicians board determined that there was a need to better manage chronic care to position Highbury Physicians for value-based contracting. The Quality committee was given a set of tasks that included disseminating innovations in healthcare throughout the entire Highbury delivery system.
Dr. Francona communicated this new charge to the practice via an all-practice memo that described how the Quality committee would be leading this work.
August 1, 2022
To: Members of the Quality Committee, Highbury Health Physicians
From: Dr. Johnna Francone
Re: New charge
Your committee has done exceptional work for Highbury Health over the last two years. Given the changes happening throughout Highbury and the external environment, we have had multiple discussions around the best focus for your committee in support of our organization. The board of Highbury Health has been looking to a committee in our organiz