Taking Steps Toward Integration

Abstract

If patients are to be at the center of health care, then providers should work diligently to better organize the delivery system. In this Perspective, two Mayo Clinic leaders provide their views on why it is necessary for physicians and hospitals to set aside their differences and work together for the good of their patients. They cite successful enterprises nationwide that combine hospital and physician control. T h e s e v e n t e e n t h -c e n t u ry poet John Donne points out a simple truth that can guide our country as it undertakes the difficult task of reforming the health care system: No one is self-sufficient. Physicians need hospitals; hospitals need physicians. And, most of all, patients need their providers to work together. A 2006 Commonwealth Fund survey found that more than 40 percent of Americans have experienced "poorly coordinated, inefficient or unsafe care" at some point during the past two years. The survey also found that, across the board, adults endorse the importance of wellcoordinated care. 1 Integration will also help us reach a common vision articulated by the Institute of Medicine: health care that is safe, effective, efficient, timely, equitable, and patient centered. 2 Some have proposed that health care be offered in a "focused factory" setting-a carveout facility where physicians focus on providing heart care, for example. 3 We believe that this approach is inadequate for patients with complex, multisystem health problems. In Remaking Health Care in America, Stephen Shortell, a leading health services researcher who has dedicated his career to studying organized delivery systems, and his colleagues ask, "How are the needs of a mother with breast cancer who cares for a mother-in-law with chronic obstructive pulmonary disease and has a child at home with attention deficit disorder served by a focused factory?" 4 At medicine's best, health professionals create teams of experts that deliver appropriate care to patients throughout their lifetimes. They share a common electronic record; they consult with one another; they provide the care that is appropriate and no more. When providers aren't working together, they provide uncoordinated, expensive, unsafe, and substandard care. Unfortunately, this is common in the United States. Studies show that w 6 8 5 D e c e m b e r 2 0 0 6 P e r s p e c t i v e s

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

“…Considering the confluence of these forces, it is not surprising that Hospital-Physician Relationships (HPRs) are an important area of academic research and a key concern of hospital managers and health policy makers. Moreover, given the central important role of physicians in hospital care delivery, it has been shown that HPRs have an impact on quality of provided care [ 8 ], hospitals’ financial performance [ 9 ] and cost-effectiveness of health care delivery [ 10 ].…”

Infrastructural mechanisms leading toward pro-accountable care organisation orientation: a survey of hospital managers

“…Clinical integration will require more than meaningful use of health information technology (HIT) and information exchange (Robert Wood Johnson Foundation, 2012; Tello-Leal et al 2012). To improve the delivery system, health informatics integration is needed (Wan, 2006; Cortese and Smoldt, 2007). Furthermore, the current view on integration in ACOs is that the integration is not only a structural change, but also a cultural change (Kreindler et al 2012).…”

Health Care Integration In the Russian Federation: Conceptual Framework, Evaluation, and New Instruments

“…Halvorson (2009) places the emphasis on shared information as an instrument for the coordination of providers. Cortese and Smoldt (2007) add to this more coordinated hospital-physician relationships within various forms of integrated delivery systems (physician or hospital-led), as well as new business environments and payment policies.…”