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Written by: Mediware on Wednesday, January 16, 2013 Posted in: Inpatient Rehab

Accountability for patient care value is more than a buzzword or marketing hyperbole. Accountability for delivering patient care value is entering the mindset of clinicians in all practice settings. Being personally accountable for outcome extends altruism to professional identity and self-scrutiny of effectiveness. Care providers are recognizing the need to maximize their contribution to patient outcome within the broader spectrum of care, requiring coordination with multiple disciplines within the delivery system. A clinician’s effectiveness is now dependent upon others. Nowhere is this more apparent than current initiatives to reduce hospital readmission rates. Transforming healthcare will require knowledge and influence upon multiple parts of the delivery system to improve value.

A bulldozer is a massive and complex construction vehicle capable of transforming the earth. Controlling this behemoth takes knowledge and skill, only the well prepared need apply. Getting from one place to another without a steering wheel, gas or brake pedal is accomplished with effective precision by pulling or pushing a series of levers each with a specific function, which in turn accomplish the most complicated tasks.  No single lever will accomplish the objective, but the coordinated synchrony of pushes and pulls at the right time will produce the desired outcome.


Care management is the systematic coordination and execution of all elements of the patient care system.  The move to bundle and pay-for-care outcomes instead of services will place greater emphasis upon the factors that contribute to care value. With the recognition that healthcare professionals accomplish better outcomes working in teams, individual contributions are amplified at the system level where coordinated efforts create greater value.  IT and data fuel the vehicle to produce care value in delivery systems.  Providers will need to become familiar with and take control of these value levers to optimize effectiveness and reduce costs through meaningful use of electronic data sources. W. Edwards Demming said it well, “It is not enough to do your best; you must know what to do, and then do your best.”

The bulldozer of healthcare has many levers that move the delivery system and create value.  Becoming familiar with and controlling these is expected for successful patient outcome.

In her recent book, “Rethinking Return on Investment: The Challenge of Accountable Meaningful Use,” Pam Arlotto puts forth the arguments for steering hospital operations with meaningful use of operational data to accomplish the organization’s strategic objectives with the metrics or value levers to influence successful outcomes.

The process of identifying performance improvement objectives, developing the strategy to accomplish them, linking the metrics and value levers to management’s control and reporting the results are presented with today’s examples of transforming delivery systems from fee for service compliance models to value based performance. We should explore and become skilled with how the value levers of rehabilitation influence outcome and improve management’s ability to pull the right lever at the right time for optimal value.

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