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A New Kind of Great Save: Value Improvement Leadership
We all love the “great save” stories. But heroism in the context of health care improvement isn’t always so exciting. When you’re pursuing more reliable, more patient-centered, and more affordable health care, providers have to rely on a different kind of gratification.
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or physicians, much of the work improving value in health care does not feel particularly glamorous. For one thing, improving value requires a team, so the image of physician as lone hero isn’t realistic. The team is often comprised of multidisciplinary members, outside the direct chain of command. Instead of relying on authority, one must influence peers, gain consensus in a process that could take months or years, be willing to fail, and then take incremental success as a win.

Dr. Kencee Graves illustrated this hard work in a short but evocative comment. Reflecting on her work to prevent death from sepsis, Graves observed,

“It’s hard. You’ll never know who you save. The thing about preventing something bad is that nothing happens. If you don’t know that going in, it can be hard to feel fulfilled.”

Surprisingly, when we talk with those who are leading value improvement, the rewards are actually many and meaningful. They find it to be some of the most exciting work of their career.

The following are three ways University of Utah Health physicians describe how value improvement feels fulfilling.

Value Improvement: The New Heroism

1. Improving Care For Patients

Chief Medical Quality Officer Bob Pendleton leads our system’s value improvement efforts, and focuses our organization on the significance of quality measures. Instead of looking at the external pressure negatively, he works to link value improvement to his personal vision of medicine. 

“Tying (value improvement) back to the patient makes it easier. We are always saying transformation in health care is SO HARD. We should be saying that it is SO EASY. There is not a better true north than making it possible for someone to live a better life with better health.”

Here’s an example of this principle in action. Orthopaedics Chief Value Officer Chris Pelt leads University of Utah’s first alternative payment model mandated by CMS. The new payment model forced the team to look beyond the surgery to 90 days. Did the patient develop an infection? Did the patient return to the hospital?

Pelt and his colleagues had little access to these measures before CMS changed the payment model. The team decided to change what a patient experienced before and after their joint replacement surgery to include more education, better inclusion of caregiver, and more information about post-surgical care. Quality outcomes improved. Today’s U of U Health joint replacement patients develop fewer infections and visit the emergency department less frequently. Pelt reflects,

“Improving value is not just about saving money or the financial return to the organization. It’s about my ability to tell a patient...your outcomes are likely to be better and we know that because of the data we have.”

2. Improving Practice For Colleagues

One of the most significant sources of satisfaction for those leading improvement is the ability to improve daily practice for other physicians. Mark Eliason, Chief Value Officer for Dermatology explains, “I’ve reached a point where some of my efforts are paying off and I can see my colleagues having an easier time with their careers, meaning that their clinics are running more efficiently. I see myself as helping other clinicians to get through the mess of complicated regulations more easily. This gives a great deal of satisfaction. Eliason shares,

"I’m making a difference for my peers and for the people that I know need help.”

Surgery’s Chief Value Officer Rob Glasgow shares the same drive. “People are very disillusioned, disengaged, upset, feeling lost. It doesn’t have to be that way. Glasgow reflects,

"Creating high value health care is not only for the patient but also for our colleagues. My hope is that we can get it [the healthcare delivery system] right. That the next generation of doctors can wake up every day and say that [medicine] is the coolest job that can be. Yes, the rewards will be there, and they might be different." 

3. A New Team Brings Expanded Resources

What many perceive to be a challenge of leading value—working across departments—can turn into one of the biggest satisfiers. Collaborating with diverse skill sets and competencies can bring new levels of support and effectiveness. Hospitalists Devin Horton and Kencee Graves discuss the benefits of cross-departmental teams. “At the U, we had a lot more support than we would have had in in other systems. The support of the team was even more important than salary support. We had the support of our quality office and value engineers. We were given IT support to develop in EPIC." They continue,

"We’ve had a lot of support, a lot of mentoring, and a lot of great ideas that didn't come from physicians. Having those people on our team has been worth so much.”

Contributors

Mari Ransco

Director of Patient Experience and Accelerate, University of Utah Health

Chrissy Daniels

Former Director of Strategic Initiatives, University of Utah Health

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