Building a 'capable' healthcare system

3 levers to drive organizational change

  | October 18, 2018

Every healthcare organization is trying to crack the code on physician wellbeing, financial performance, and patient outcomes. Ongoing research by athenahealth indicates leaders should consider the concept of “capability" as they strive to build sustainable healthcare organizations.

The core principle of capability is simple: Investing in people on the frontline of service improves the overall profitability of an organization. Health systems that succeed in giving physicians the tools, resources, and latitude to care for patients can be considered capable organizations.

“Capability is a powerful concept that goes a long way towards explaining why some practices perform better,” says Josh Gray, vice president of research at athenahealth. “It’s a useful framework for guiding leaders as they design physicians’ work environments.”

The most recent phase of this project drills down on why capability is so important and, for the first time, identifies the exact levers healthcare leaders should pull to build successful, productive organizations and effective care delivery. (More information on the methodology of the study is available here.)

Focus on leadership and communication

Capable organizations address leadership at many levels – from the executive team, which sets long-term strategy, to the immediate supervisors, who oversee and support physicians. The payoff is significant: Physicians with high capability scores are twice as likely to report high levels of satisfaction with their leadership and organization.

The research also revealed that trust in leadership impacts performance. Physicians who rate their leadership as strong are more than two and a half times as likely to have high capability ratings, at 61 percent, than those who do not feel their leadership supports them (23 percent).

Collegiality matters, too: Physicians with the highest capability ratings are twice as likely to report working in practices where they have close relationships and open communication with their clinical colleagues. These practices use regular huddles and management meetings to keep channels open, and cross-team social events to build relationships that can support honest feedback.

Physicians feel most empowered when they know their input and feedback actually influence how the practice is run. Brian Titesworth, M.D., of Clarkston Medical Group in Michigan, says the most important element for him and his colleagues is that “we are part of decisions that affect us directly."

Reduce administrative burden, improve EHR effectiveness

Interviews with medical group leaders reveal that organizations are more likely to have physicians with high capability scores when they set up workflows, data, and team responsibilities to help physicians deliver care with ease and efficiency.

By a wide margin, satisfaction with an organization's electronic health record correlates with capability. Some 78 percent of physicians with high capability scores also had a positive impression of their organization's EHR — meaning they found the EHR easy to use, were comfortable with the administrative burden and felt they'd received clear training on how to use it. And they were more likely to agree with statements saying the EHR was a tool that helped them provide high-quality care.

According to the data, EHRs at organizations that promote capability give physicians easy access, from anywhere, to all the information they need to treat patients at the time of their appointment. Where possible, pre-loading charts with care plans, notes, and lab results give physicians an idea of what needs to be done even before the patient walks into the office.

Interoperability is important too. A lack of access to EHR data from other facilities is one of physicians' biggest headaches, making it harder for them to do their jobs; organizations that overcome these hurdles are more likely to have physicians with high capability scores.

Clayton Foster, M.D., of Colorado Infectious Disease Associates, says, “I can do my job faster and more effectively if I have the information in front of me and know I'm not going to have to log in to three different systems."

Finally, physicians with the highest capability scores work in practices that minimize their administrative burden. In follow-up interviews, physicians overwhelmingly agreed that the most effective model is team-based care with nurses, medical assistants, and other providers working at the tops of their licenses.

Medical scribes are often critical to these teams. Edward Fasolino, M.D., of Baylor Scott & White Clinic – Belton South in Texas, says his scribe has "shortened my day by probably an hour and been a tremendous stress-reliever. And my patients are happy because I am not sitting in the exam room staring at the computer."

Moderate the pace of practice

A capable healthcare organization focused on the physician's needs creates more time with patients. This matters, because according to athenahealth data, 54 percent of physicians feel rushed more than once a week —and feeling rushed diminishes physician capability.

On the flip side, team-based care and reduced administrative burden promote a manageable pace, improving provider-patient relationships, healthcare outcomes, and profitability. “Leaders of high capability organizations limit administrative burden, empower clinical teams, and set up systems that conserve precious physician time,” athenahealth’s Gray sums up. “The payoff is more productive teams, lower burnout levels, and better retention.”

Lia Novotny is a contributing writer to athenaInsight. Additional reporting by Payal Patnaik.

3 levers to drive organizational change