Integrated Delivery Networks:
Homeward Bound
The emergence of integrated delivery networks (IDNs) has increased attention on home healthcare, particularly its potential to contribute to an IDN's success by delivering patient care at lower costs while generating greater patient satisfaction and superior outcomes.
The key to tapping this potential lies in integrating home healthcare with IDNs on many levels.
- Integrate physicians. Home healthcare agencies can work in partnership with physicians to develop protocols and reduce readmission rates.
- Integrate nurses and other clinical disciplines. Through training nurses and physical therapists in home care, hospitals can increase continuity of care for patients and boost staff members' skills.
- Integrate patients. Coordination between the hospital and the home healthcare agency ensures that patients are moved to the appropriate care setting in a timely manner.
- Integrate management. When home healthcare agencies and hospitals share management of home care, they lower costs and increase their available resources.
- Integrate data. Shared information systems can help caregivers set goals and distribute patient information.
- Integrate technology. Home caregivers can advance the quality of care by taking advantage of information technology: laptop computers, home fax machines, modems, beepers.
- Integrate compensation. Productivity increases when caregivers' compensation is linked to the agency's reimbursement plan, whether pay-per-visit or capitation.
- Integrate hospital operations. When a home healthcare agency is hospital based, costs are lower and management more efficient. In addition, managers can more easily identify healthcare needs beyond inpatient care—an important consideration for long-term success.
From Connie Curran, "Eight Key Components to Integrating Home Care and IDNs," The Remington Report, May-June 1997, pp. 44-47.
Spreading News About Innovations
Although healthcare organizations are increasingly skillful at developing new systemprocesses that improve care and serve communities better, they continue to have trouble getting their own employees to understand and accept them.
This need not be so. Beginning in 1943 with a pioneering study that involved Iowa farmers, researchers have learned a good deal about the way society diffuses its innovations. Healthcare organizations could profit from this research. Leaders of such organizations should, for example:
- Regularly monitor professional journals, which are full of articles by and about inventive people.
- Recruit "innovators," people who, according to the 1943 study, are fascinated by novelty and will instinctively be on the lookout for new ideas. In fact, innovators are so important that organizations might want to employ scouts to seek them out.
- Have innovators pass on new ideas to "early adopters," employees with a natural inclination to transmit news.
- Ensure the frequent interaction of early adopters with members of the "early majority," those who, though slow to listen to strangers, are quite willing to learn from people they trust.
- Encourage all employees to "reinvent" ideas—that is, adapt concepts from outside the system to fit local circumstances.
- Make sure that, since spreading innovation consumes the energy of all involved, employees have sufficient time to learn about, discuss, and test innovations.
- Lead by example. Leaders who want to diffuse innovation must begin by changing themselves.
From Donald Berwick, MD, "Spreading Innovation," Quality Connection, Winter 1997, pp. 1-3.
Copyright © 1997 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.