HCI3 Update from the Field – Newtown, CT
Positive deviants can be defined as organizations whose results are significantly and positively better than others – and a study published in the Annals of Internal Medicine a few months ago by Leslie Curry and colleagues at Yale, identifies some key characteristics of these positive deviants. The study focused on hospitals that had shown to be in the top 5% of performance in AMI survival rates for at least two consecutive years, and contrasted them with hospitals in the bottom 5%. They conducted a series of on-site interviews to gauge what made these folks tick. The conclusion is that it's all about leadership, commitment, a sense of urgency from all involved, teamwork in a learning environment, and a willingness to do the right thing even if it hurts a bit financially. This list matches up exactly with the attributes of successful organizations in our pilots. Another finding by Curry and colleagues is that the top and bottom organizations all had care protocols and processes and systems….stuff. But having stuff on shelves and in computers doesn't change behaviors and doesn't make organizations focus on being at the top. Money does, especially for all those who aren't positive deviants.
What this means to you – If all we needed to get hospitals and physicians to chase the top performers – to aspire to become positive deviants – was to share best practices and show them how to improve, the job would be done. So for those of you who have drunk too much of the "Triple Aim" Kool-Aid, stop reading. For all others, we have to wake up to the realization that there should only be one aim at this point: To fix the environment of financial incentives. It's delusional (at best) to think that a $500 million investment to create "learning networks" of best practices will be enough to counter a $2,500 billion steady stream of counter incentives. The top 5% in Curry's study are at the top despite the odds, and only because the C-suite is completely committed to a culture of continuous improvement. The other 95% will stay where they are until it hurts. And it won't hurt until CMS and other payers shift away from FFS. Have you ever noticed that the Kool-Aid drinkers only mention controlling costs as the third aim? As a result, and with barely six weeks left in the government's fiscal year, the amount of money paid by CMS for value hasn't changed from last year's level. An entire year has been wasted again, frolicking around about sharing best practices, instead of focusing on the one thing that will force best practices to be adopted and create a chase to the top, a chase to positive deviancy, instead of the current chase to mediocrity: Payment. It's not too late, but the clock is ticking and the cliff is getting closer.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.