Accountability generates improved care.
Authors: G. Austin
Year: 2010

AS CHIEF EXECUTIVE OFFICER of Brown & Toland Physicians, a clinically integrated independent practice association in San Francisco, I am often asked to comment on strategies to reduce costs while improving quality. Certain concepts often rise to the top, only to be overtaken by a new grand idea that's going to revolutionize the industry, improve quality, and save dollars. Lately, accountability has been the buzzword, and that's a good thing. As the feature article by Caldwell, Butler, and Poston accurately points out, a healthcare organization's senior team usually includes different leadership competencies, and leadership alone is not the deciding factor that determines an organization's ability to reach its goals. As the authors correctly detail, a combination of factors, including prioritization, use of data, and organizational culture, helps determine success. And a culture of accountability should help ensure that goals and objectives are met. Brown & Toland Physicians consists of more than 850 physicians in San Francisco and southern Marin and northern San Mateo counties. More than 330,000 HMO and PPO patients are members of Brown & Toland, and our 260 employees provide a number of key services for our doctors and patients, including information technology; eligibility and benefits coordination; referral services; claims payment; a full slate of care management services, such as quality, disease management, and clinical inpatient and ambulatory case management programs; electronic health records and billing; and a host of other services. We are a driven and action-oriented company, with a number of key initiatives that will help ensure that the independent practice of medicine remains a viable option - both for patients and for physicians. To meet our goals and objectives, we use excellent planning processes that include metrics and milestones for each major strategic objective. Milestones allow us to gauge progress of the steps we need to complete to achieve the ultimate goal. Metrics vary depending on the project; testing environments are created to ensure that when a specific product or change in process is rolled out, it will have as little impact as possible on physician offices. We have many avemies for communication across the organization and up through the project manager, senior leadership team, and the chief executive officer, and we have the right culture to make it happen. Accountability is a key part of the equation. As Clark, Savitz, and Pingree note in their feature article, each month the leaders of Intermountain hospitals, physician clinics, and insurance companies hold accountability meetings with management team members to review actual performance and compare this performance against board-approved goals. At Brown & Toland, we have worked hard to create a culture that values accountability, teamwork, and communication. With fewer than 300 employees, we are a relatively small organization, yet we have accomplished much because we follow a recipe for success. This recipe includes: * making a detailed project plan for each major objective, with specific measureable deliverables and key dates - project participants are held accountable and communication is vital so as a team we can work through any obstacles or impediments to success; * using project management processes and systems, so everyone on the project team, including senior management and anyone else with a vested interest, has electronic access to project plans, key milestones, and a list of deliverables; * creating a culture where project participants are held accountable, and where innovation is encouraged; and * celebrating successes and acknowledging and rewarding individual and team contributions. Yes, it is okay to fail, as long as we are able to learn from our mistakes, regroup, and move forward. Success is defined as completing our objective, not total perfection throughout the process. …