Optimizing care delivery in expanding health systems: Views from clinical leaders

Adrian Diaz; Karan R Chhabra; Mary E Byrnes; Abishek Rajkumar; Phillip Yang; Andrew Ibrahim; Justin B Dimick; Hari Nathan

doi:10.1016/j.hjdsi.2023.100722

Optimizing care delivery in expanding health systems: Views from clinical leaders

Healthc (Amst). 2023 Dec;11(4):100722. doi: 10.1016/j.hjdsi.2023.100722. Epub 2023 Nov 23.

Authors

Adrian Diaz¹, Karan R Chhabra², Mary E Byrnes³, Abishek Rajkumar⁴, Phillip Yang⁴, Andrew Ibrahim⁵, Justin B Dimick³, Hari Nathan³

Affiliations

¹ National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, Ohio State University, Columbus, OH, USA. Electronic address: Adridndi@med.umich.edu.
² National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
³ Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁴ University of Michigan Medical School, Ann Arbor, MI, USA.
⁵ Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Taubman College of Architecture & Urban Planning, USA.

PMID: 38000229
DOI: 10.1016/j.hjdsi.2023.100722

Abstract

Introduction: In response to intense market pressures, many hospitals have consolidated into systems. However, evidence suggests that consolidation has not led to the improvements in clinical quality promised by proponents of mergers. The challenges to delivering care within expanding health systems and the opportunities posed to surgical leaders remains largely unexplored.

Methods: Semistructured interviews with 30 surgical leaders at teaching hospitals affiliated with health systems from August-December 2019. Interviews were transcribed verbatim and coded in an iterative process using MaxQDA software. Attitudes and strategies toward redesigning health care delivery across expanding systems were analyzed using thematic analysis.

Results: Leaders reported challenges to redesigning care delivery across the system ranging from resource constraints (e.g. hospital beds and operating rooms) to evolving market demands (e.g., patient preferences to receive care close to home). However, participants also highlighted that system expansion provided multiple opportunities to increase access (e.g. decant low-complexity care to affiliated centers) and improve quality of care (e.g. standardize best practices) for diverse populations including the potential to leverage their health system to expand access and improve quality.

Conclusions: Though evidence suggests that hospital consolidation has not led to redesigned care delivery or improved clinical quality at a national level, leaders are pursuing varying sets of strategies aimed at leveraging system expansion in order to improve access and quality of care.

Keywords: Expanding Networks; Quality; health systems.

MeSH terms

Delivery of Health Care*
Government Programs
Hospitals*
Humans
Medical Assistance