Health Care Transformation in the Context of Caring

Aug 7, 2013, 9:00 AM, Posted by Ann O’Brien

Ann O’Brien, MSN, RN, is national director of clinical informatics for Kaiser Permanente - National Patient Care Services & KP Information Technology. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2011-2014).


I had the honor of hearing Donald Berwick, MD, present last week at the American Hospital Association Leadership Forum in San Diego. In fact, I registered for the conference to hear his keynote address. He brings the unique perspective of both of his previous roles: president and CEO of the Institute of Healthcare Improvement (IHI) and, most recently, director of the Centers for Medicare and Medicaid Services. 

But more importantly he knows the secret of how to transform care. In fact, we can go back to the 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New Health System for the 21st Century for the six aims of health care improvement:  safe, effective, patient centered, timely, efficient and equitable. Berwick was on that IOM committee and expressed concern last week with the progress we have made in meeting those goals over 12 years.

Health information technology (IT) has been touted as a way to promote safety, efficiency, quality and patient-centered care. But these benefits have yet to be realized because there has not been large scale adoption of electronic medical records (EMR) and enabling technology to achieve these goals.

According to HIMSS Analytics U.S. EMR Adoption Model, as of the second quarter of 2013, only 2.1% of the country’s 5,439 hospitals have achieved Stage 7, which is having a complete EMR. Most hospitals, 34.5%, have reached Stage 3, which is having implemented nursing/clinical documentation and some clinical decision support.

It’s challenging to expect care transformation when the majority of U.S. hospitals are in the implementation phase of EMRs with fully closed loop medication processes and intelligent clinical decision support.

What can hospitals learn from leaders like Kaiser Permanente and Cincinnati Children’s Hospital about improving quality, safety, efficiency and patient-centeredness?  First, in order to utilize clinical data to improve care, the EMR is a foundational requirement—but it is only one step in the journey, and not the destination.

Much of health care relies on systems that are dysfunctional, with many workarounds creating inefficiencies and ineffective communication among clinicians. The result is a clinical environment characterized by interruptions, cognitive overload, and a lack of “systemness,” which leaves patients feeling dissatisfied and disconnected. Health care organizations must re-invent their leadership teams and care processes to focus on continuous performance improvement, team care, and putting the patient at the center.  

A new IOM report, Health IT and Patient Safety: Building Safer Systems for Better Care, utilizes the notion of a “socio-technical system” to provide support for health care organizations on this journey. This perspective takes the approach that the immensely complex health care environment is a collection of many components that interact with each other in ways that account for the system’s behavior.  Health care organizations need to recognize the socio-technical system as a cornerstone upon which the foundation of clinical transformation is built.  

Health care transformation isn’t easy. It’s a journey that will require new leadership and governance structures, and continuous performance improvement to achieve highly reliable care that’s not only evidenced-based but also personalized. That will require a new culture of caring; one that recognizes that attaining those now famous six aims of health care improvement will require the best integration of people, process and technology.

Read more about RWJF grantees who are harnessing the power of technology to advance a culture of health.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.