The Collaborative Experience from a Nationwide Perspective
On November 4 and 5, I had the pleasure of attending and presenting at a conference in Baltimore. The conference, titled Healthcare Learning Collaboratives: Lessons Learned and Future Opportunities, gave attendees the opportunity to reflect on the various ways collaborative learning has been conducted, the results of those collaborative learning experiences, and what collaborative learning may look like in the future.
The conference was organized and facilitated by Bruce Spurlock, MD, executive director, Cynosure Health in Roseville, California. Cynosure Health is a not-for-profit organization dedicated to improving health care at the local, regional, and national level by working collaboratively with hospitals, hospital associations, and others seeking expertise and support in improving quality and reducing patient harm.
Approximately 150 people representing both the private and public sectors attended the conference. Some of the organizations that were represented included national organizations such as the Institute for Healthcare Improvement, the Network for Regional Healthcare Improvement, CMS, CMMI, the High Value Healthcare Collaborative, as well as a number of regional collaboratives, including Minnesota Community Measurement, the Iowa Healthcare Collaborative, and the Pittsburgh Regional Health Initiative along with WCHQ. There were also a number of Quality Improvement Organizations in attendance, including MetaStar, Telegen, and HealthInsight, as well as leaders from Hospital Engagement Networks such as the Wisconsin and Ohio Hospital Associations.
The two-day conference was structured around the major themes of a new book released at the conference -- All In: Using Healthcare Collaboratives to Save Lives and Improve Care -- which includes topics such as elements of effective collaboration design, how to recruit participants and optimize effectiveness, how to turn knowledge into action, the use of communication as a tool for success, budgeting and funding, and the use of technology to advance collaborative learning. Numerous national, state and regional collaboratives and their experiences were showcased, clearly illustrating the growing recognition and acceptance of the collaborative model as a vehicle for health care transformation.
While every collaborative reflects the unique market and environmental context in which it operates, it is also true that all collaboratives experience similar opportunities and challenges. It seems that everyone has had to deal with recruiting and sustaining engagement of the right mix of leaders and doers; acquiring the resources to accomplish the work; establishing effective governance models; and evaluating impact and results.
As mentioned at the outset, I was one of the presenters at the conference during a breakout session focused on the elements of effective design. Here are a few key points from my presentation:
Voluntary model: I spoke at length about WCHQ’s origins and the prevailing theory in Wisconsin that experimentation and innovation are better than mandates. I stressed that we have chosen to embrace this approach, based on the idea "that you can mandate participation, but not commitment” - the classic definition of intrinsic motivation.
Values/guiding principles: These evolved from almost a year of conversation between health system leaders and the business community, a process of building social capital and trust. This a step not to be ignored or minimized in its importance, as they capture the spirit of learning and sharing that pervade our work to this day.
Value proposition: Given that participation is voluntary and that our business model is based on membership, we place extraordinary emphasis on articulating and delivering a clear value proposition with a customer service orientation. While our orientation must, therefore, be toward serving our provider members, we operate with a multi-stakeholder governance model to ensure we also have a multi-constituent perspective.
Intrinsic versus extrinsic motivators: Our voluntary model, coupled with a medical market characterized by integrated health systems/multi-specialty groups and highly-motivated, improvement-oriented hospitals, has brought us to 40 member organizations and approximately 60 percent of the state's physicians. That said, we might be reaching the limits of reliance solely on intrinsic motivation as the basis for engagement; put another way, we will need to couple this with extrinsic motivators to strive to achieve 100 percent participation. These could include the new requirements within MACRA as well as payment incentives/sanctions created by public (Medicaid/ETF) and private (The Alliance, BHCG, employers) sector purchasers and payers in Wisconsin.
Participating in the conference and hearing from a variety of organizations about their experiences with collaboratives once again reinforced for me that WCHQ and its members have been and will continue to be leaders in collaborative learning and quality improvement. I was proud to be able to share the collective experiences of this organization with a national audience and to realize we have learned a great deal over the past 15 years, but have many new and exciting opportunities still to come. We look forward to collaborating with our members and stakeholders on each of those opportunities.