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St. Luke's Strategy, Part Two: Exceptional Expectations

By Dr. David C. Pate, News and Community
October 7, 2013

Last week, in the first part of a two-part report, I started to explore St. Luke’s strategy. Following you will find more detail.

Strategic Initiatives

Our strategy document discusses seven strategic initiatives St. Luke’s is undertaking in order to transform health care to provide accountable care to all those we serve through the Triple Aim of better health, better care, and lower cost. 

Those seven strategic initiatives are to:

  • Align St. Luke’s Health System
Historically, St. Luke’s Health System has been aligned around its member hospitals – a very hospital-centric approach. 

In the first part of this strategy report, I explained the importance of us being patient-centered and managing the health of populations. A more logical alignment for the future is around those populations and where they receive the continuum of care. 

For St. Luke’s, patients tend to receive their care in two geographic regions, and so we are embarking on an effort to realign our management and governance structures around these service areas. We hope to conclude this work by the spring of 2014.

I also said in Part 1 that we cannot continue to do the same old things in health care and expect to have better results. I stressed the importance of innovation. If we are to be successful, we must incorporate innovation and creativity into our culture and not be afraid to experiment. We must try things and succeed, or fail fast, and learn from all of our efforts, whether successful or not. 

We must have a culture of continuous learning, both from our own experimentation and from the work of others. We must adopt best practices quickly, and execute swiftly and well. We have embraced this approach and will continue these efforts.

In Part 1, I mentioned the importance of physician leadership. St. Luke’s has a commitment to develop leaders throughout our organization. We are increasingly developing a structure in which we pair a physician leader with a non-physician leader, and this has been very effective.

Finally, the most game-changing alignment will occur when all the providers involved in a patient’s care are clinically and financially aligned. We must continue our work to transform provider compensation from pay for procedures, the volume approach, to pay for performance, the value approach.

  • Connect Ourselves and Our Communities
We know that we cannot transform health care by ourselves. We don’t have the size, resources, or expertise to do it all. 

Fortunately, relationships are one of St. Luke’s strengths. We are especially glad for partners that will help us achieve the aim of Better Health. 

Our work with the YMCA, Bogus Basin, Walmart, and others will be critical to our efforts around childhood obesity. We have many sponsors contributing to our new FitOne 5k and 9k walk/run as we continue the reach of this program out into our communities. We also will continue our work to partner with state and local government to leverage our collective efforts. 

Assessing community health needs will continue to be critical to targeting our efforts and resources.  The involvement of community members will be vital to ensuring we have accurate information and that our efforts are best tailored to community needs. 

And we have to continue to tell our story, so that our communities can understand the need to support our efforts philanthropically. Many of these programs and efforts will not pay for themselves, and we must partner with our communities to make these needed health improvements.

  • Eliminate Waste
We must take unnecessary cost out of the system and maximize the use of the assets we have. 

As I mentioned in Part 1, irrational variation must be eliminated. Lean is our process methodology to accomplish this, and our St. Luke’s branded version of lean principles is TEAMwork.

I have written about TEAMwork previously, and we have seen early success in bending the cost curve through applying these practices. 

  • Create a Clinically Integrated Network
Our efforts require the transformation of the clinical model and the business model. St. Luke’s Clinic of employed and contracted physicians is not large enough to take the clinical and financial responsibility for an entire population. We must also engage independent physicians who are philosophically aligned and aligned with our vision. 

That is precisely what we are doing with the SELECT Medical Network, and recent blog posts have been outlining key clinical integration initiatives the network is undertaking. We are beginning to see data analytics that support the clinically integrated network and we are making great progress, so much so that we are on schedule to achieve clinical integration by year’s end. 

As we transition from fee for service to pay for value, this network will be critical to our success. We will be able to measure and document the added value that such a network brings to insurers and employers.

  • Become a National Quality Leader
While we have plenty to be proud of, there are still areas where we fall short. To me, being a national quality leader means that we are consistently turning up as a top performer on all the various national awards. It means driving harm to patients to as close to zero as we can. 

I previously wrote about our efforts on Project Zero, where while we had very good performance nationally on our infection rates, it was not good enough when we think about those few patients that do acquire a serious infection. Instead of just patting ourselves on the back about how good our postoperative infection rates were, we were determined not to be complacent, and started looking outside of health care for ways to further improve our rates. The result is that we have already cut those very good rates in half. Now that is national quality leadership!

Traditionally, most measures of quality are for hospital inpatients, but more than half of our work takes place in outpatient settings. We must develop new models that promote our quality results for this large group of patients as well, measuring our performance and comparing to benchmarks where those benchmarks are available and where they are not available, benchmarking to our own performance and continuing to improve. 

Our continued improvements in care coordination and our new team-based approaches to patient care are sure to contribute to us being a national leader in both inpatient and outpatient quality and safety.

  • Expand Patient-Centeredness
We must place the patient at the center of all we do. We must continue to engage patients in their own care and involve their support structures. We must also look to use activation strategies to help people with risk factors undertake lifestyle modifications. 

It is all part of being patient-centered  – we must involve patients in their care, understand their motivators and goals, provide them with education tailored to their needs and learning style, set out expectations based on their goals, equip them with the tools to be successful, and employ systems of accountability.

  • Establish Information-Driven Decision-Making
St. Luke’s is investing heavily in a single, integrated electronic health record that is very patient-centered, allowing patients to view their records online, email their providers, and request appointments online. 

We are also working to embed evidence-based protocols into the medical record so that physicians are aided in making the best possible decisions for their patients, and making significant investments in data and predictive analytics so that we can measure the impact of our initiatives, identify other areas of opportunity, and provide physicians with data about their performance that can drive improvement. 

Having actionable data will allow us to identify our opportunities, prioritize our efforts and resources, and measure our efforts to ensure that our performance is improved.

Assets and Bottom Lines

Our most valuable assets are our employees. They are the most incredible and caring employees any health system could hope to have. Empowering them is what contributes to our success in delivering on our values of iCARE: Integrity, Compassion, Accountability, Respect, and Excellence.

When most organizations speak of their bottom line, they are referring to their financial performance. Financial performance, of course, is critical to sustaining our investments in people, technology, and facilities so that we can meet the needs of our communities.

But we have two other bottom lines as well: exceptional experiences and exceptional outcomes. While the financial bottom line permits us to continue our work and our investments, these other two bottom lines indicate the value that we provide to our communities.

After all, that is why we exist.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.