During a 2012 interview I asked Joel Allison, CEO of Baylor Scott and White Health, to describe his organization’s system-wide process of communication and decision making. Allison began by explaining that over the last several years Baylor has moved from a holding company concept to an operating company:
“We first started this back in 1993, when we said we wanted to become an integrated delivery system. Back then we had several hospitals, but we were not an integrated delivery system, so that became our goal. We created the Strategic Integration Action Team (SIAT) and set up a process where we pulled leaders together to start working on the question: ‘How do we really take this journey and move from where we are today into an integrated delivery system?’”
SIAT started by standardizing systems around marketing, managed care, finance, and information. Allison explained that the biggest challenge for standardization was of course clinical integration, especially since the health system continued to grow during that time. “We’d have new hospitals coming on, and the question was, ‘how do we get those aligned?’ So we created a road map of what was going to be required, how such and such should be done, etc.” Also, like everyone else in the industry, Baylor has been implementing the electronic health record, which is overseen by a clinical transformation advisory council.
After that, the next step toward becoming an integrated delivery system was figuring out how to get the hospital boards to become an integrated system board:
“Over time we took all of our community boards and moved them from any type of fiduciary responsibility to instead be an advisory board. And we put all of the fiduciary responsibility for budgets, capital plans, and operating plans at the system level. Then the integrated system board created an operating board that oversees the environment of care for each of those facilities, including quality and safety.”
The operating board, which is always chaired by a system board member, also functions as the quality committee for the system board, and this new board meets the requirements for Joint Commission accreditation and licensure.
“That’s how we’re beginning the process of clinical integration,” Allison explained, “and it’s really about bringing people together communicating specific initiatives and working toward a common set of goals.” He went on to give the example of Baylor’s leadership councils, which have proven to be very effective:
“We have a physician leadership council. We have a chief nursing officer council. We have an emergency department council. We have an imaging council. Even though there may be some variation by different groups and different facilities, these departments can come together and the leaders work as a council to identify and implement best practices.”
To further move toward a model of standardization and best practices, Baylor has created a system-wide best care committee, co-chaired by the system’s chief medical officer and the chief nursing officer. In turn, each facility has its own best care committee. These committees identify and report on strategies and best practices for the benefit of the system as a whole. “For example, through the findings of the best care committees we know that for the past few years [as of 2012] the Baylor Jack and Jane Hamilton Heart and Vascular Hospital has had the lowest re-admission rate in the country.” After these best practices are identified, the question then is, “how can we spread that across the system?”
Baylor has created special communication mechanisms to communicate as a system, including the Senior Leadership Council (SLC) and the Leadership Development Institute (LDI), which are designed to bring Baylor leaders together several times a year to collaborate.
“Also, each year when we develop our system goals, we then cascade those goals down through our performance management program to every member of our team—every employee, not just executive management. That way everyone is connected and involved; they have responsibility for some part of the overall goals for the system that relates to what they’re doing each and every day to care for our patients. Obviously the goals get more specific as they cascade throughout the organization, but every employee can see and understand the line of sight back to the system goals, mission and vision.”
While the system is continuously growing, developing, and improving, it’s obvious that Baylor Scott and White Health has already become a highly successful integrated delivery system under the leadership of Joel Allison.