Harvard- Myths about Creativity

Six Myths About Physician Creativity (Richard Reese, MD, http://medinnovationblog.blogspot.com/)
From the March 2008 Harvard Business School Alumni Bulletin- an article, “Innovation, Inc.” that lists six myths about creativity in organizations. These myths apply to physician groups.

• Creativity Comes from Creative Types – Not necessarily. Creativity depends on experience, knowledge, technical skills, talent, and the ability to think in new ways. To encourage creativity in physician groups, appointing a Chief Innovation Officer (a nurse, doctor, practice manager) and holding periodic brain storming sessions may help foster creativity.

• Money is a Creativity Motivator - Money isn’t everything. Most doctors don’t think about money on a day-to-day basis, and it doesn’t drive new ideas.

• Time Pressure Forces Creativity - Actually creativity goes down under pressure. Creativity requires time to think, concentrate on a problem, and let the ideas bubble up.

• Fear Forces Breakthroughs – Not so. Creativity comes when people are excited about their work. Often creativity strikes overnight after an exciting day at the office. One day’s excitement predicts the next day’s creativity.

• Competition Beats Collaboration - Nonsense. The most creative groups are those that share ideas and don’t compete for recognition.

• A Streamlined Organization is a Creative Organization - Not in the opinion of HBS. They say a stable work environment in a group that is doing well fosters a sense of freedom and autonomy and lets ideas flourish.

Mayo on health reform

The Mayo consensus on health reform, reached after a year of meetings at Mayo and elsewhere:

• We already spend enough money on health care.

• Everybody should be required to buy insurance.

• Employers should contribute.

• Government should support those who can’t afford to pay.

• Electronic records will be required to coordinate care.

• Medicare should give more money for good outcomes and less money for bad outcomes.

http://www.mayoclinic.org/healthpolicycenter/summary-session6.html

Private sector action steps:

• Payment Reform
Make the case for payment reform with properly aligned incentives (outcomes, prevention, wellness, "virtual" appointments, etc.).
• Universal Clinical IT
Universal use of interoperable electronic clinical information technology systems (systems that can share information).
• High-Cost Service Program
Develop care programs for high-impact/high-cost services (end-of-life care, chronic diseases, etc.)
• Coordinating Care Team
Incent delivery model which provides defined care coordinator for chronic and acute conditions (i.e. medical home).
• Benefits to Improve Health
Define a minimum standard benefit package that realigns the health system toward improving health in addition to treating disease.
Government sector action steps:
• Insurance For All
Ensure/mandate insurance coverage for all.
• Interoperable EMR
Require all providers to have interoperable electronic medical records within a certain time (4-5 years) with patient accessibility.
• Pay For Value
Direct Medicare to pay for value/outcomes/prevention using innovative payment models.
• Federal Health Reserve
Implement an independent "Federal Health Reserve Board" to set rules/standards to promote value in health care.
• Care Coordination
Reward care coordination (whether provided by primary care, specialist or other caregiver).

Coordinating Care - Bodenheimer, NEJM (3/08)

Short Take on Coordinating Care (Blog post by Richard Reese, MD at http://medinnovationblog.blogspot.com/)

* What – Article by Thomas Bodenheimer, MD, West Coast managed care expert – “Coordinating Care – A Perilous Journey through the Health Care System, “ New England Journal of Medicine, March 6, 2008

* Why - Because more and more Americans are falling through the cracks, shuttling back and forth between specialists. Bodenheim says barriers to “seamless coordination” are – overstressed primary care physicians, shortage of primary care doctors, lack of interoperable computer systems, low primary care pay, no payment for coordination, and paucity of integrated systems.

* When – Poor coordination has been a problem for at least 20 years, and has grown more intense over the last decade with physician shortages, widening income gaps between primary care doctors and specialists, and lack of incentives to coordinate care.

* How – To correct coordination deficiencies, Bodenheimer suggests electronic referrals by primary care doctors to specialists, referral agreements between the two, hospitalist-initiated agreements with practitioners, advanced practice nursing, care transition programs, and assisting primary care clinicians through: 1) transforming solo practices into “teamlets” – two person teams with a physician and non-physician coordinator in each practice; 2) payments for coordination; 3) creating “medical homes,” 4) adopting and subsidizing EMRs and interoperable records; 5) moving primary care into larger integrated systems.

* Where - Wherever different health care entities choose to work together or to integrate into organizations.

*Who – As a practical matter, coordinating care is most talked about and acted up by leaders of large integrated systems, which involve about 12% of American physicians, some of which are physician-led and others hospital-led. American Academy of Family Practice, American College of Physicians, and American Academy of Pediatrics support the concept of medical homes, which visualize primary care physicians as coordinating quarterbacks for care.