Inova Fairfax Builds Physician Alignment, Standardization for Cost-Effective Care

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Patrick-Christiansen-thumbPatrick Christiansen, PhD, Chief Executive Officer, Inova Fairfax Medical Campus, and Executive Vice President, Inova Health System

by Patricia Chaney

Healthcare organizations employ various strategies to promote physician alignment and create a collaborative working environment. Often, the primary element needed is trust, not just between physicians and hospital administrators, but also between physician groups and among the clinical staff.

In 2007, Patrick Christiansen, PhD, joined the Inova Health System as vice president of the Inova Heart and Vascular Institute. His primary goal then was to redefine the relationship physicians had with the organization. As chief executive officer of the hospital, he is now working to “reinvent hospital-based care.”

Building physician alignment through trust

Inova Fairfax Medical Campus is the flagship facility of a regional healthcare system located in Northern Virginia that serves the Washington, D.C., metro region and surrounding areas. Inova Health System features multiple hospitals, primary and specialty care centers, a children’s hospital, and other care sites, as well as the 204-bed heart hospital.

Seven years ago, heart and vascular physicians did not have a trusting relationship with the hospital administration and little trust across subspecialties. Dr. Christiansen wanted to create an integrated physician leadership model that aligned physicians with the organization’s vision.

“The methodology of leadership at that time in 2007 was that decisions were made often without fully consulting the community-based physician groups,” he said. “Although they were often good decisions, they had a perceived negative impact on physician groups, which created a lack of trust. Once we got the physicians into a room and focused on the patient rather than our collective individual needs, we were able to move forward with care paths and decisions that supported patient care.”

Cardiac services are offered within Inova Health System’s five hospitals, but are anchored by the institute located on the Inova Fairfax Medical Campus. Through the collaborative spirit created under Dr. Christiansen’s leadership, the physicians began working together to build the service line across all subspecialties and locations.

Standardizing care across the organization

As CEO, Dr. Christiansen has applied the same lessons he and his team learned from heart and vascular services to service lines across the entire medical campus. In addition to alignment, standardizing service-line methodologies was key to creating a high-functioning, high-quality, cost-effective cardiac service line.

Standardization based on the organization’s value proposition of quality, safety, and patient experience helps keep Inova Fairfax as cost effective as possible. The organization is currently performing a critical analysis to reduce waste and manage resources, as well as applying standardization to workflows in order to reduce clinical variation.

In addition, purchase strategies for supplies and technology are being developed that will support cost targets. With nursing, Inova Fairfax has developed a model to “flatten” the organization and support its nurses who are working at the top of their license.

For example, Dr. Christiansen said, in the nursing units, each nurse should only have one or two people between her or him and the chief nursing executive to ensure accurate, timely communication among all care-team members.

In surgery, physicians complained about having a different procedural team every time they entered an operating room. With team-based trainings in ORs and procedural areas, physicians will now see the same people, which increases trust among physicians and staff.

Adapting to changing patient care needs

With its focus on quality, safety, and patient experience, Inova Fairfax is looking to redefine hospital-based care by understanding what patients want from their care experience.

“We need to be the best or in the top quartile, in some cases the top decile, in quality metrics that are important to the public,” Dr. Christiansen said. “But we also have to provide this quality at the lowest cost. Consumers are researching healthcare as they do any other major purchase. We want the healthcare consumer to choose Inova as their provider of choice.”

The hospital is in the midst of a physical plant redesign and $1.2 million campus overhaul with a new women’s and children’s hospital and an adult medical/surgical hospital with all-private rooms. Despite declining inpatient utilization, Dr. Christiansen said the investment is necessary because consumers are much more involved in their care and have high expectations for their care environment.

Inova Fairfax is also growing its “premium services,” including oncology, heart and vascular, and neuroscience, with centers of excellence in each service line. These services promote the latest in clinical and translational research, such as using the most recent genomic and molecular research to develop personalized approaches to cancer treatment.

“We offer high-end physicians, providing superior care, grounded in research to develop personalized approaches,” he said.

Along with expanding hospital services, Dr. Christiansen said hospital-based care can no longer be defined only as time of admission to discharge, but should be broadened to prior to admission through 90 days post-discharge. Inova Fairfax has developed corporate health services and a community-based coordinated-care division to promote population health.

“Our care-management division works with inpatient providers to identify upon admission those patients who will need comprehensive services to keep them healthy in and out of the hospital,” he said. “We place people with chronic conditions under our transitional care model and offer outpatient services, in-home visits, telemonitoring, everything we can to keep them healthy and improve outcomes.”

Inova Fairfax continues to grow and change to meet the needs of its community and thrive in a competitive environment, working together with physicians and developing strategic partnerships. To grow services and maintain alignment, Dr. Christiansen stresses the need to recognize the contributions of physicians and the added stressors they have that weren’t present 10 years ago.

“As organizational leaders, we don’t admit patients,” he said. “We have to create an environment that meets the community and patient needs in a way that facilitates the success of our physician colleagues along with the Institute for Healthcare Improvement Triple Aim.”

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