(This continues our blog series on our recent papers on health care quality published by the Commonwealth Fund.  Last week we focused on the Hill Physicians Medical Group. This week we look at Baylor Health Care System, a nonprofit integrated delivery system based in the Dallas/Fort Worth area.)

Yesterday we looked at Baylor's Best Care Committee's role in quality. Today we'll turn to physician leadership.  

Physician Champions

After what was evidently an inspiring site visit to Intermountain Health Care in Utah earlier this decade, the HealthTexas Provider Network (the 450-member physician group owned by the Baylor Health Care System) appointed five ambulatory care "Physician Champions" to join the initial set of Baylor's hospital clinical champions who had been appointed in 2000. Physician Champions contractually agree to commit between four and 16 hours per week to support Best Care initiatives. They are paid by the hour and have specific expectations and duties. Some are HealthTexas physicians and some are other affiliated physicians who have patients at Baylor. They are paid below their standard market rate, but well enough to demonstrate that respect for their time (via compensation), combined with commitment to purpose, results in strong engagement. The Baylor system now has dozens of Physician Champions.

Physician Champions' duties include graduating from ABC Baylor (to be discussed tomorrow); influencing peers to adopt Best Care Committee initiatives; developing standardized order sets for a specific diagnosis or condition; helping define measurable clinical, financial, and patient satisfaction outcomes; being responsible for their improvement on a local level; and serving as needed on the Best Care Committee.

HealthTexas has a formula for success (literally). To inspire change among a certain number of physicians (numerically represented as N) requires a number of leaders equal to the square root of the total (√N). That means that 58 physician champions were needed to effect change among the 450 HealthTexas members, plus 3,000 additional physicians practicing at Baylor hospitals. Baylor budgets three million dollars annually to recruit, train, and pay these champions to implement Best Care measures and EHRs.

HealthTexas Quality Committee

As Dr. Carl Couch writes in a recent Physician Champion Annual Report, "Alignment with physicians is nationally recognized by hospitals as a critical success factor in health care delivery and quality improvement."  The Baylor system achieves this coordination with its employed physician group, HealthTexas Provider Network, as well as through a broad range of other physician relationships. Specifically, Baylor's facilities work closely with the HealthTexas quality committee to improve physician performance in the delivery of clinical preventative services.

Working with Dr. David Ballard, who had been recently hired as the Baylor system's first Chief Quality Officer, the HealthTexas quality committee first focused on a practice area that had been vastly under-delivered: Adult Preventive Health Services, also known as Clinical Preventive Services. In 2007, Dr. Ballard and colleagues published the results of Baylor's focus on preventive services. By increasing productivity through 11 interventions—ordered sequentially to further enable the provision of these services at each step—the delivery or recommendation of clinical preventive services rose from 68 to 92 percent from 1999 to 2006.  

Shortly after this study began, Baylor began measuring the actual delivery of those preventive services. HealthTexas physician reports and quality initiatives focus now only on delivered preventive services because the network's leadership believes physicians should be held accountable for care that is delivered, not simply care that is "recommended or delivered."  From 2001 to 2008, the delivery of these services rose from 68 to 82 percent, reaching as high as 84 percent. Baylor physicians, however, have thus far not been able to break through that 84 percent ceiling, which has been ascribed to the limits of its paper-based processes. Leaders are considering how to deploy decision support tools, which are components of the ambulatory electronic health record software, for improved delivery of clinical preventive services.

(Source: BHCS)