Intermountain Health Care

In the article Intermountain Health Care, written by Richard Bohmer and Amy Edmondson, they discuss the pressures of strategic positioning at the Intermountain Health Care's Institute for Health Care Delivery Research. Throughout this paper my group members and I will describe the pressures, challenges and decisions that were made at the Intermountain Health Care's Institute for Health Care Delivery and Research.

Dr. Brent James, executive director of the Intermountain Health Care's Institute for Health Care Delivery Research, held a meeting with several staff members which included physicians, nurses, and clinical leaders. Dr. James discussed the institute's policies regarding delivery to the patients and how these policies could improve the quality of patient care. "Anytime I get physicians to use them, I'm basically tracking them into an evidenced-based, standardized line of clinical thought." (Bohmer and Edmondson, 2003). One nurse that was involved in the meeting, wanted to make a point that each patient's case is treated uniquely and to expect that each patient's care was managed the same manner was inappropriate. This nurse referred to patients not being treated as if they were an assembly line. The nurse stated that "we're not making widgets here!" (Bohmer and Edmondosn, 2003). Dr. James disagreed and felt that the comparison could be done.

Health care staff from different levels within the organization had access to patient records that were stored in a centralized database. The staff utilizing this database is employed by Intermountain Health Care's Institute for Health Care Delivery Research. As this EMR held pertinent information, non-employed physicians from other locations of the Institute did not want to follow the policies regarding the use of the EMR. One of the challenges Dr. James faced was how to get the non-employees "on-board" and utilize the system.

In 1975, Intermountain Health Care consisted of fifteen hospitals in Utah. "In 1983, Intermountain Health Care transitioned from being exclusively a hospital company and became an insurer. The provider arm was known as IHC Health Services. By 2002, IHC Health Services comprised more than 150 facilities, including 22 hospitals, 25 health centers and over 70 outpatient clinics, counseling centers, and group practice offices." (Bohmer and Edmondosn, 2003). As you can see, many different businesses make up the foundation in which the Research Institute is able to view health care quality and cost. Like any organization or company, outcomes are important and need to be viewed by all of the providers within their network of services.

Dr. James stated "We just started to add cost outcomes to our traditional clinical trials and proved it true within a few months." (Bohmer and Edmondosn, 2003). This is proof that higher quality can lead to lower cost. "James was able to attach costs to individual clinical activities and then build a cost profile of different strategies for managing a particular clinical condition." (Bohmer and Edmondosn, 2003). A challenge Dr. James faces is how to get all of the physicians, managers and staff engaged with this strategy.

Dr. James worked directly with the IHC CEO, Scott Parker. Parker sent out a "memo with the subject line "Is quality improvement important for IHC?"" (Bohmer and Edmondosn, 2003). Two Hundred managers responded as yes. James held many workshops with managers and "presented a concept (e.g., the use of protocols to control care delivery, how service quality affected the business, and models of leadership and participation) and then opened the floor for discussion." (Bohmer and Edmondosn, 2003). A shared vision was reached by the end of the workshops.

Dr. James proceeded to hold clinical workshops titled Advanced Training Program in Health Care Delivery Improvement (ATP) in regards to clinical quality improvement. Staff attending the clinical workshops consisted of senior physician leadership. Each was assigned an evidenced-based project which involved improving clinical outcomes. The outcome of the projects led both physicians and nurses to implement protocols, solve many problems and as a result, lower the cost of care. "In 1995, James identified 65 clinical protocols that had been developed and implemented, producing about $20 million in net annual savings in a clinical operating budget of about $1.5 billion, as well as significant gains in clinical quality." (Bohmer and Edmondosn, 2003).

A strategic plan was developed that consisted of four areas: clinical conditions, clinical support services, service quality, and administrative support processes. In developing the strategic plan and including each of the four areas listed, the plan would include every area and staff person, therefore, changing the culture of the many providers that make up the IHC Health Services. Dr. James realized that in order to bring everyone on board, he had to do it in ways that each of the service departments would understand. He realized that mistakes were made before because things were not introduced in ways for all of the departments to understand. "You manage what you measure....Doctors manage patients, not money. The data [that we provided them] didn't have anything to do with those tasks, as physicians and nurses saw them. The key to engaging physicians in clinical management was to make it meaningful by aligning date collection to work processes. This represented a pivotal shift in mental model and in practice. James explained: Managers think in terms of cost-per-facility, which, in health care translates to cost-per-unit [e.g., ICU, phlebotomy, or surgery]. By contrast, doctors think in terms of resources, or tests and treatments required for a specific condition." (Bohmer and Edmondosn, 2003).

Dr. James identified key work processes based upon criteria such as high volume, high cost, and variability of the provision of care; as a result, eight clinical programs were developed. Dr. James also used methods to identify processes in the other three