I am not aware of co-management agreements, but we have always tried to align the interest of physicians in the cardiology department as they are major producers and the profitability of this department is very critical to the overall performance. We have defined employment agreements that have a fixed and a variable component, with fixed being relatively small percentage of the total compensation. The variable is tight to both productivity (volume, revenue etc.) as well as to quality indicators. each component has a share in the overall variable components.
You can never communicate enough. From my personal experience, I have always tried to communicate with people in face-to-face meetings such as town hall meetings, presentations, large discussions groups. What is very important though is that there is always that is closer to their hearts and something that is important to you. You can send e-mails in advance to ask the people about what they would like to include in the agenda and then select the topics according to their responses.
We have gone through a process of integrating several hospitals into our system. I think the biggest instrument that we used was communication and transparency. We made the performance transparent. We also tried to be fair to everyone, especially vis-a-vis compensation. Alignment of incentives starts with alignment of monetary incentives. Additionally, we focused on the small things as well, such as creating uniform badges, of nurses wearing same color scrubs, everyone having same parking privileges etc.
We have done some work to transform our cardiac care into an IPU. I think the first thin g is to have large enough volume. We had about 2,000 open heart surgeries in three locations and close to 10,000 cath procedures. First thing was to get people to talk to each other. Everyone wanted to make TAVI or AFIB ablations. We are experts at fragmenting care rather than aggregating care. We put everything together – Cardiac surgery, interventional cardiology, clinical cardiology, cardiac surgery ICU, telemetry unit etc. We also had full time related specialties such as pulmonary physicians. Important was to have the customer service people and scheduling as part of the IPU as opposed being part of the hospital administration. We also had the housekeeping and cleaning personnel be inhouse in order to follow certain specific guidelines. We left functions outside of the IPU such as finance, accounting.
Medication management was one of the most difficult areas when our first hospital went through the Joint Commission International accreditation. nevertheless, the process of setting up systems that address the medication administration and medication management was very helpful for the entire organization. Technology solutions can help with preventing errors, but they reflect actual underlying processes. In my opinion the processes should first be formulated and then technology can help in implementation. Adding secondary labels on high-risk drugs, having double verification (signature) on dispensing narcotics, writing down the various times of actual administration of a drug in a paper log, do not require technology and could be as effective as a high-tech solution.
Given the scarcity of medical professionals and the severe demographic problems all around the world, increasingly providers will rely on technology to deal with these issues. Examples of applicable technologies will be RFID identification and tracking of people, Virtual desktops allowing providers to use technology from home and remote locations; cloud computing, clinical decision support tools.
Medication reconciliation has been a big challenge in Bulgaria. It also was one of the major aspects during the Joint Commission accreditation. The way we addressed it was from several aspects. First, we maintained at all times an up-to-date formulary with all the medications that were used in the hospital and have been used in the past. The medications were included with both their generic names and the brand names. At any visit in the clinics, the patient was given a med reconciliation sheet that he was asked to fill in and then this was transferred to the electronic record with drop down menu of the actual formulary.