A Culture of Accountability: The Way of the Future

By Brenda Mullan, MSN, RN, CDP, NE-BC

Brenda Mullan, MSN, RN, CDP, NE-BC

The shifting landscape from volume to value has placed pressure on healthcare systems, like Cleveland Clinic, to dramatically change the way care is delivered both inside and outside the acute care setting.

Care redesign begins with an intentional ambulatory strategy that alters the focus from effectively managing patients during a hospital stay to a culture of teamwork, ownership and accountability across the entire continuum of care.

To establish a culture of accountability, healthcare leaders need to seek new ways to develop innovative processes to improve the quality of care from the traditional fragmented system to one of integrated, coordinated care. The successful model of the future promotes health, prevents disease and embraces ownership of the transition as the patient moves across the entire healthcare spectrum.

Integrated, coordinated care delivers numerous benefits

Patients enter the hospital today for stabilization, not to get completely well, and then are transitioned into a post-acute setting that functions like the hospital of old. With an integrated healthcare delivery system, this picture looks completely different.

It creates a culture of accountability in which the patient is never discharged – and, it brings the medical home into the hospital. For example, integrated care delivery:

• Links multiple levels of care and care providers
• Promotes patient advocacy
• Coordinates services and provides patient navigation
• Encourages professional collaboration across the continuum and the community
• Leverages technology to bring care to the patient

An integrated healthcare structure is not focused on common ownership, but instead, embraces relationships, networks and connections, often between separate organizations. It is both clinical and financial accountability that unites the healthcare continuum.

And, at the very core of this integrated structure lies care coordination.

The foundation is built on care coordination

Care coordination is not a tactile intervention, a series of tasks or a set of defined initiatives. It isn’t just a role or a function. It is a carefully planned, enterprise-wide transformation that aligns directly with an organization’s mission, vision and values. It is a culture with a greater sense of purpose and it represents a significant paradigm shift for the current health delivery system.

According to the Agency for Healthcare Research and Quality, care coordination involves deliberately organizing patient care activities and sharing information among all participants to achieve safer and more effective care. In other words, the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people to provide safe, high-quality care.

The care coordination model is how health systems can deliver holistic care and keep patients and entire populations at the center of care delivery.

Care coordination is essential to meeting the needs of diverse, complex, at-risk, very ill and underserved populations. And, fully connected healthcare through care coordination must be part of a clear vision of improved quality, patient engagement and holistic care.

Without effective care coordination in place, the healthcare industry will continue to see higher medication errors, unnecessary or repetitive diagnostic tests, and avoidable emergency department visits. It’s a known fact that many patient readmissions result from preventable complications and mismanagement.

In summary, to establish a culture of accountability, healthcare organizations must focus on integrated delivery and care coordination. Care coordination is the launch pad for fully integrated care, which will reshape clinician-patient relationships, transform the patient experience, and shift healthcare spending from expensive, episodic interventions to preventive, outcome-based approaches.

Brenda Mullan is the Associate Chief Nursing Officer of Ambulatory Care for the Cleveland Clinic Health System.