Collaborative Discourse

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Dr. Cohn addressing annual medical staff dinner on collaborative discourse: a physician’s impact on quality and safety

I entitled this post “Collaborative Discourse” because I found the question and discussion session energizing following my talk at this system’s annual medical staff meeting. Here are some of the questions we discussed:

One of the losses we are dealing with is collegiality. What can we do to improve it?
Service lines can bring physicians together in caring for patients. So can physicians who are tech-savvy, giving colleagues at-the-elbow support regarding the electronic health record system. Finally, many activities can bring out the fun in annual medical staff meetings, such as golf outings, softball competition, and chili or other cooking contests. At Memorial Hospital, physicians and administrators bonded, putting together a prototype of their new vascular hospital with cardboard and duct tape.

Collaborative Discourse: Dealing with Change

What have you learned as you travel throughout the US about how to move from volume- to value-based care, so that we don’t leave money on the table or get caught by surprise?
Start with your employees. Their decreased hospitalization resulting from increased attention to wellness and health maintenance is a win-win, in that employees who have a lower rate of hospitalization can be more productive on the job as well as costing employers less in terms of healthcare expenses.

How should we deal with change, especially what to keep and what to let go?
To paraphrase Harvard Business School Professor Rosabeth Moss Kanter, change done by us is preferable to change done to us. We can begin by seeking changes that help make us more efficient and effective. The way to deal with complexity is through face-face dialogue. The ultimate arbiter of what to preserve and what to discard lies in what is best for patients.

Managed care did not work in the 80’s. What makes you feel that it will work better now?
This is one question from a fellow general surgeon that I could have answered better. I pointed out that we have access to better data now than we had several decades ago, when payers leveraged data to create favorable contracts for them. Now, many organizations are taking on risk and being paid for it by managing the clinical behavior especially of their heavy users with guidance from nurses, navigators, and healthcare coaches. Healthcare expense is unsustainable. The best way to have current reforms succeed is for physicians to lead them.
What I wished that I had pointed out to him was that baby-boomer general surgeons have seen many changes for the better, such as enteral and parenteral nutrition, minimally invasive surgery, and improved imaging that have benefited patient care. Let us embrace change rather than fight it.

What do you think? As always, I welcome your input to improve healthcare collaboration where you work.  Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2015, all rights reserved

Disclosure: I have not received any compensation for writing this content.  I have no material connection to the brands, topics and/or products that are mentioned herein.

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