From the Archive

Healthcare As Harbinger

Mario Morino, Chairman of the Morino Institute, highlights his lessons from healthcare

Healthcare in America is a mess in many respects. The unsustainable rise in costs. The substandard care for so many Americans. The continuing “Animal House” food fight over Obamacare. But one of the very best places to look for insights on how to nurture a data-informed performance culture is, you guessed it, healthcare.

Health is a decade or more ahead of human services, education, the environment, and many other social-sector fields.

Why? For one thing, there’s a lot of money in healthcare. Well-funded institutions like research hospitals can afford to invest in collecting data and using it to improve their performance.

But more important than the dollars are the major shifts in mindset I’m seeing within the best in healthcare — as  a result of both external and internal motivators.

In terms of external motivators, almost every healthcare institution in America now operates in a financial environment that is increasingly linking dollars to performance—that is, to patient outcomes. The reporting of health outcomes has been required for years, but we’re now seeing the dawn of an age in which those outcomes have a direct impact on healthcare providers’ bottom line. For example, hospitals now have a strong incentive to reduce the number of patients who unexpectedly return to the hospital after being released. Hospitals that have excessive “readmission rates” are now seeing their Medicaid and Medicare payments reduced.

I serve as a director of the Cleveland Clinic. Not a meeting goes by without a detailed presentation of our performance. I’m also on the Clinic’s Safety, Quality, and Patient Experience Committee, in which board directors and physicians alike delve into the institution’s performance and learn of the numerous efforts to change culture, create safer settings, and continually improve. All of this has been brought into very clear focus as a result of new federal rules tying payments to outcomes.

But even in similar institutions operating under the same incentives and rules, there are very wide differences in performance. What’s the differentiator? Usually it is whether the institution’s executives have an intrinsic desire to figure out how they can keep improving care for those who are, quite literally, putting their lives in their hands.

I want to highlight two medical doctors in diverse settings who in different ways exemplify this type of leader. Dr. Jeffrey Brenner is the founder of the innovative Camden Coalition of Healthcare Providers. The light is already shining very brightly on Dr. Brenner; he is a recent recipient of the MacArthur Fellowship (aka “genius grant”). If you want to understand the data-driven performance mentality in less than three minutes, take a look at this short video.

And you can hear more from Dr Brenner here, in which he explains his work to improve care and cut costs in a part of the healthcare world that is anything but flush with resources.

The second high-performance pioneer is Dr. Delos “Toby” Cosgrove, the acclaimed heart surgeon and visionary CEO of the Cleveland Clinic, and someone I hold in high regard. Under Dr. Cosgrove’s leadership, the Clinic has become world renowned for achieving outstanding patient outcomes while caring for a high proportion of people with incredibly complex medical conditions. Dr. Cosgrove is the very definition of a “passionate, courageous, adaptive leader.” He and his whole leadership team are relentless in finding new ways to improve access, quality, and safety of healthcare—while reducing costs and fostering even greater empathy for the patients the Clinic serves.

Those of us who care deeply about education, human services, the environment, the arts, and other critical parts of the social sector have much to learn from these leaders. We know that external mandates can drive improvements and also negative unintended consequences. So why not seek health leaders’ insights into what kind of public policies could help encourage a constructive focus on outcomes and performance in other parts of the social sector?  And, perhaps most important, why can’t we learn from health leaders how to tap internal incentives — including every leader’s innate desire to be the best he or she can be—to inspire leaders to use data combined with keen judgment to produce high performance and true impact.

Ultimately, the vast majority of the social sector will come under the kind of external pressures we see today in healthcare. Government and private funders will increasingly come to see that we simply don’t have a dollar to waste on efforts based primarily on noble intentions and wishful thinking. They will see that we need efforts built on a sound analysis of the problem or need, evidence-driven insights about how their activities can lead to the desired change, assessments to determine whether hard work is paying off, and a desire to keep getting better over time.

There’s no reason for social-sector leaders to wait. We see the handwriting on the wall. And we have good models — especially innovative, ahead-of-the-curve healthcare institutions — that can help us all learn and improve.


 

Mario Morino is Chairman of the Morino Institute, Co-Founder and Founding Chair of Venture Philanthropy Partners, and primary author of Leap of Reason: Managing to Outcomes in an Era of Scarcity (2011)