The Journey to Value-Based Care: Lessons Learned from Aviation
By David Nace, MD
The Affordable Care Act (ACA) and healthcare reform have impacted providers in all aspects, from the way they are and will be paid to how they engage patients. To meet the deadlines and demands of an industry shifting to value-based care (VBC), physicians must change their thinking from independent to team-oriented in order to succeed in this new world.
VBC is empowering an evolution within the overall healthcare community, especially amongst physicians. This is enabling a focus on delivering high-quality of care to patients. The Meaningful Use and EHR certification programs have helped all provider organizations get closer to the more meaningful use of information technology, but the requirements also pose many challenges for providers.
These challenges should not be met with resistance. The physician community should embrace the call for change. Similar to the revolution of the aviation industry, reform required them to adapt to new methods of communication and technology to ensure safer flights.
Traditionally, physicians are independent and competitive in nature. They didn’t go through rigorous selection and testing over nearly eight years of higher education to merely coast by – they have an innate drive to be successful and help people. Value-based care, in theory, plays to their personality traits and gives them the motivation to achieve even higher goals.
However, physicians have a hard time trusting data or measures that they do not understand, especially when their evaluation is out of their control and input. For example, a 2014 survey of 4,000 physicians found 78 percent reported patient satisfaction ratings moderately or severely affected their job satisfaction and 28 percent considered quitting their job or leaving the medical profession.
To add to this statistic, most organizations do not have the appropriate communication, technologies, and data collection sources and processes put in place to understand the measurements being imposed on them. To tackle this challenge, hospital executives and physicians need to improve physician communications and transparency in regards to measurement.
Pilots faced a similar disconnect during the 1980s. Training a pilot occurred in an apprenticeship model — you learn from a “master” and through them learn their personal techniques and strategies. It really was a “master craftsman” mentality of mentorship.
This method of training and learning lead to a variations in practice and high accident and death rates associated with aviation. The practice was not based on teamwork or leveraging technology for standard operating procedure. There were no Global Positioning System (GPS) and Cockpit Resource Managements (CRM) utilized – it was all based on the techniques and approach of pilots. To understand the technologies imposed on them and to improve quality of flight, the way pilots were taught changed to a team-based approach that focused heavily on communication and transparency, data, and standard operating procedures.
There is a similar revolution coming to the world of medicine. Many of the physicians of tomorrow are beginning to prepare through team-based, information driven training. Young physicians in training are being proactive in understanding the methodologies and technologies of today and starting grass root movements — for instance, Primary Care Progress — to inform and inspire newcomers to the industry. Medical students are increasingly being trained in groups (versus one-on-one) to leverage the concept of teamwork and to better understand the evolving healthcare industry and their role in the transformation.
Change is inevitable in any organization. New rules, methods, and technologies will always cause a shift. These transformations should not and cannot be met with resistance, but with an open mind, as everyone needs to work together toward the end goal.
Pilots needed to adapt and alter their training and methodologies during flight to fly in a safer, more efficient manner. Similarly, providers must do the same with value-based care. The more collaboration, the smoother the ride will be.
David Nace, MD is vice president and medical director of McKesson Technology Solutions.