Accountable Care Units
Published on Jul 27, 2016
Re-imagine how care is provided on a hospital unit. Picture patient-and-family centered care where both take part in creating the care plan and discussing needs for post acute services. Picture teamwork and transparency where all members of the care team work together to synchronize care and are accountable to each other and to shared outcomes.
Regionalization of hospitalist patients is becoming more prevalent in the hospital community because medical and hospital leaders recognize that it will promote better teamwork essential to improve care coordination, facilitate care team communication, reduce readmissions, reduce excessive costs and boost patient satisfaction. And most of all it significantly reduces the inefficiencies hospitalists experience by providing medical care to patients in so many units across the hospital.
But its not an easy plan to execute.
There are many challenges to creating an equitable regionalization program: There are hospitalist concerns about uneven work loads; lack of diagnostic diversity; decisions about admitters versus rounders; and whether to have flex teams in addition to static assignments. On the operations side the challenges may include triaging patients and bed management, nursing cooperation; assigning ancillary personnel to specific care teams; and the competing priorities of the ED medical staff.
A successful regionalization plan is a win win for everyone but the most valuable outcome is the sense of ownership and autonomy that the hospitalists and the care team experience. It offers a real opportunity for multidisciplinary teamwork, and shared accountability for the outcomes of a population of patients. And it leads to a cutting edge innovation in hospital care: The accountable care unit.
An Accountable Care Unit (ACU) is a practical interpretation of Michael Porter's Integrated Practice Unit. Porter and his Harvard associates proposed the integrated practice unit as a organized structure targeted at specific disease conditions which provides care throughout the full continuum. The ACU first appeared at Emory University Hospital but similar models have popped up in hospitals across the country to improve care efficiency. Among the organizations that have gone through the complexities of developing a regionalization model, including St Mary's Health in Missouri, Northwestern Memorial in Chicago, and Baystate in Springfield, hospitalists report greater satisfaction and less turnover and clinical outcomes, including mortality rates and HAC plummet.
An ACU generally has four key features: Unit-based Hospitalist teams; structured interdisciplinary bedside rounds (SIBR); unit-level performance reports with rewards for achieving pre-determined outcomes; and unit co-management by the medical director and the nurse manager. In larger hospitals, an ACU care manager may be part of the management team since they bring a critical business perspective to managing progression-of-care.
Yes, there are many challenges associated with regionalizing hospitalist assignments and transforming to an ACU but one thing is for certain: While no single hospitalist regionalizationh model has emerged, when the dust settles, the outcomes are measurably better for every stakeholder and feedback is always positive.