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Business schools could aid health system problem solving

As foreign systems nurture relationships with academia, U.S. providers cling to consultants

Tammy Worth, Contributor

"We research and educate around issues like getting evidence into practice.""We research and educate around issues like getting evidence into practice."

Nottingham University Hospitals had serious problems. The system, a member of the England-based NHS trust public health unit, was seeing nearly 10 patient falls per day, despite a 15-year effort to reduce overall fall numbers. In fact, NHS trust was spending more than 2 billion British pounds a year on fall-related care.

It took partnering with a business school to turn things around, an outside relationship that U.S. healthcare organizations are hesitant to forge, favoring traditional consultants instead.

For Nottingham, it was the advice of the Warwick Business School, which helped the system create 10 reports a month, highlighting info on serious falls that helped raise internal awareness of the issue. The campaign worked, and by 2013 falls dropped by 8 percent and the percentage of those that caused fractures plummeted 35 percent.

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“What you have to do is get clinical and managerial practitioners working together,” said Graeme Currie, professor of public management at Warwick. “We research and educate around issues like getting evidence into practice.”

[See also: Preventing falls curbs costs and risk.]

Working with business schools brings a new perspective to healthcare problems, said Scott Wallace, visiting professor of family and community medicine with the Audrey and Theodor Geisel School of Medicine at Dartmouth College.

“In every other sector of the economy, services are organized around creating value for customers,” Wallace said. “In healthcare, the problems we have come from not structuring services in ways that create value for customers.”

One way to create better value is through “deepening expertise,” he said. For instance, a clinic in Hamburg, Germany has nine surgeons that focus exclusively on radical prostatectomies. One of the biggest problems after surgery for prostate cancer is incontinence and impotence, but patients at this hospital are five times less likely to have either complication after surgery there than anywhere else.

Working with business schools costs a fraction of what an organization might pay for major consulting firms.

Wallace worked for 18 months with Bon Secours Saint Francis Health System in Greenville, South Carolina. The provider is located near manufacturing giants like Michelin and BMW. It was during this time that Michelin realized, along with Bon Secours, there was a huge problem with diabetes among their employees.

Instead of having labs, physicians, nutritionists and other providers spread out across the community, Bon Secours utilized a business strategy and designed an integrated practice specializing in patients with Type 2 diabetes. They now treat diabetic patients in one place, beginning with a four-hour intake appointment that includes diabetes education and pharmacy consultations. They have visits with specialists in psychiatry, exercise and wellness. Wallace said the practice has had excellent results, including reversing the condition in some patients.

“The need for expertise is critical,” Wallace said. “We don’t need to talk about narrowing our focus … but we should organize around the places we are really great.”

Opportunities for collaboration

There is a lot of room for collaboration with academia, said Dereesa Reid, CEO at Hoag Orthopedic Institute, particularly if a hospital is interested in trying to introduce new thinking into the system. Reid said it works best when a project has a defined and narrow scope. Providers can work with professors or collaborate with interns, working together for a three- or four-month semester.

Reid said working with business schools costs a fraction of what an organization might pay for major consulting firms. Universities also have expertise in teaching. Reid previously worked on projects in the Institute for Healthcare Improvement’s Joint Replacement Community Project in which a team from the university came to the providers and ran the project like a class.

Business professionals were deployed throughout the facility and taught basic business tools and process improvements that could be disseminated to other staff throughout the system. Assignments were given to the staff to complete by certain dates. Then, the groups would meet to look over results and determine the next goals and deadlines.

“In a traditional consulting world, the group comes in, asks questions and gives analysis and then they are gone,” Reid said.

[See also: Recession, reform disrupt hospital strategic planning efforts.]

There are, however, times when it is better to work with consultants, she said, like when issues are compliance-related. Not all organizations can take 18 months to work on projects like those at Bon Secours.

“We won’t be able to deliver something in a month to you,” Currie said. “We often separate into 12-month chunks with six-month meetings. There are no quick fixes.”

Working with business schools isn’t something that all healthcare providers might consider, but Deane Waldman, an author and retired pediatric cardiologist, said the relationship could be a real boon.

At the University of New Mexico Hospitals, where Waldman previously worked, the average wait time in the emergency room was 11 hours. He proposed a solution based on a business-focused queuing theory that could have reduced waits to less than 60 minutes, but when he offered it to his superiors, “You would have thought I was talking German,” he said.

“And 20 years later, they still have terrible wait times.”