Los cuatro hábitos de importantes organizaciones de la salud – NEJM

The Four Habits of High-Value Health Care Organizations

Recent attention to the question of value in health care — the ratio of outcomes to long-term costs — has focused on problems of definition and measurement: what outcomes and which costs? Less attention has been given to an equally difficult but important issue: how do health care delivery organizations reliably deliver higher value?

It would certainly simplify health care reform if we could show the superiority of a dominant delivery model (e.g., the accountable care organization or the medical home) and roll it out nationwide, developing and proving new approaches to creating value only once. However, experience suggests that not only do new delivery models — for example, integrated networks — not necessarily live up to their promise, but they are surprisingly difficult to transfer, even when successful; those that succeed in one U.S. region haven’t always done well in another. Organizations considered to be among the nation’s highest performers, such as the members of the new High Value Healthcare Collaborative, often have unique personalities, structures, resources, and local environments. Given the health care sector’s mixed record of disseminating clinical innovations and system improvements, how do we learn from leading organizations?

Although high-value health care organizations vary in structure, resources, and culture, they often have remarkably similar approaches to care management. Specific tactics vary, but their “habits” — repeated behaviors and activities and the ways of thinking that they reflect and engender — are shared. This is important because experience suggests that such habits may be portable.

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2010 © Foro Latinoamericano Colaborativo en Calidad y Seguridad en Salud

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