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Doylestown, PA - Health Quality Partners today announced that Eric Heil has been named senior vice president of Global Growth and Opportunity. Founded in 2001, Health Quality Partners (HQP) is a leading not-for-profit healthcare service provider and quality improvement research and development organization. HQP has created a highly effective and innovative care model called Advanced Preventive Care for chronically ill, older adults. Advanced Preventive Care represents a combination of care coordination, disease management, and personalized preventive interventions. Created using 6 design principles which are implemented through 5 operational domains, Advanced Preventive Care uses specially trained nurses to deliver robust, reliable, and long-term preventive care interventions in close collaboration with primary care providers.
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Dear Friends and Colleagues,
Reflection on recent tragic aviation events offers us an important insight;
though immediate and practical gains in system performance and capabilities can often be achieved through incremental improvements (the crudest iteration of which is the “bolt on” solution) – this is not always so.
There are conditions under which complete redesign is required. Failure to heed indications of that being the case, can lead to tragic outcomes … far worse than forgoing an incremental improvement incompatible with the system within which it operates.
We are most certainly surrounded by equivalent situations in health care delivery every day. Do we see them? Do we know when not to force incremental improvements, but rather to champion fundamental redesign? Do we even know when the equivalent of the plane crashing occurs on a community population health basis?
The investigation into the root cause of these aviation disasters is still unfolding and more facts and insights will likely enter the public domain in the weeks and months ahead. But the story garnered so far … has a profound ring of truth to it. Let’s use it as an insight to inform our design thinking and energize us to take the appropriate actions required to improve our health care system.
Effective models of preventive care for high-need patients do exist but require new organizational capabilities to implement. This is one reason the use of such models has not yet become widespread. But if effective models of preventive care were more broadly available to high-need patients, the health of millions of Americans could be improved and the cost of health care better controlled - especially for the growing population of chronically ill older adults. A new partnership is committed to determining whether an innovative approach to designing systems for replication can help achieve this goal by making it easier for adopting organizations to learn how to implement such models.
This unique opportunity is made possible through the support and leadership of the Peterson Center on Healthcare that is enabling a partnership between the Center, Health Quality Partners (HQP), and the Camden Coalition of Healthcare Providers’ National Center for Complex Health and Social Needs (Camden Coalition) to engage an innovation design firm and a group of experts with diverse backgrounds, including implementation science, quality improvement, organizational leadership, health services research and evaluation, nursing, and community-based care models. The project will use HQP’s system of Advanced Preventive Care (APC) as a well-tested exemplar of a preventive intervention for a high-need population. The goal will be to design more efficient implementation methodologies and infrastructures to accelerate the adoption of APC for better patient care. The Camden Coalition and HQP, in collaboration with an interdisciplinary team from the University of Pennsylvania’s NewCourtland Center for Transitions and Health within the School of Nursing, will also develop an evaluation framework to test the newly designed systems for replication and share key learnings with the field that may help to scale other efforts underway.
This project represents an essential starting point and a key area of R&D for pursuing the long-term goal of achieving large-scale adoption and implementation of effective models of care for high-need patients.
What’s most important? Replicating a proven care model with high fidelity in order to get reproducible results? Or adapting (i.e., changing) a proven care model to fit and work effectively within a specific context or environment? At first blush these two choices seem at odds, diametrically opposed to one another – increase one and you inevitably decrease the other. The cognitively uncomfortable truth is that, in most real-world settings of health care delivery, both high-fidelity replication and local adaptation are critical to the success of spreading even a “proven” model of care delivery to other sites. The scaling of a model that worked at original site #1 can fail by holding too fast to either concept at the expense of the other as one attempts to implement in sites #2, 3, etc.
It may be better to think of combining the two concepts (replication, adaptation) within a single optimization function through which one seeks to find a balance point that maximizes the probability that a new implementation of a proven model will be effective in achieving the desired health outcomes for a given setting and population. This may be especially relevant for models of care serving complex populations that require a broad set of dimensions to be effective; protocols, standards, and specifications, along with a compatible organizational or team culture, and principle-driven decision-making.
To innovate systems of replication that more effectively and efficiently spread and scale models of care, we must simultaneously innovate systems of adaptation and have the two work in synchrony. These must occur together since, in practice, they proceed very nearly at the same time and in the same place. Two systems? Or one? Some might argue that a new generation of “replication” systems could simply incorporate the concept of adaptation within them – replication now needing to address not only fidelity, but also adaptation. Perhaps. But this would likely lead to a linguistic and cognitive bias in which the classical meanings associated with replication are automatically assigned more importance than the newly engrafted concept of adaptation.
Instead, we could conceive of a single system of replidaption that facilitates both replication and adaptation simultaneously in a manner that sees both as critical variables in an optimization function – not in opposition to one another – but interrelated, with each contributing to the success of sites adopting and implementing a new model of care.
If there is utility in the term replidaption, it is not in the cleverness of its word play. A portmanteau of “replication” and “adaptation”, the power of the term is in changing the way we think and innovate – to one that is more integrated, holistic, and effective. To be useful, this way of thinking must ultimately offer some advantage to those deciding to design systems of replidaption rather than systems of spread that continue to struggle to reconcile the duality of replication and adaptation as separate and competing processes.
I think replidaption could prove to be a very useful term and mental construct because it is more likely to compel model innovators to think about how to apply their knowledge to optimize adaptation at each unit of spread; not simply whether or how much adaption to allow, but specifically how to adapt in ways most likely to preserve model effectiveness. At the same time, the construct calls upon adopters to play a more active role in providing an understanding of site context and the necessary inputs for adaptation while simultaneously stretching to achieve fidelity. I and the team at HQP are excited to collaborate with others, to further develop the concept and methods of replidaption and to design systems of replidaption that can be put to the test.
I had the privilege of sharing Health Quality Partners’ unique approach to designing systems of care in a workshop yesterday, 11/17/2017, at the Putting Care at the Center conference of the National Center for Complex Health and Social Needs in Los Angeles. The workshop was full of engaged and committed attendees seeking to create better health care systems through design. The feedback from both highly experienced designers and those new to the field was extremely positive and helpful. I'm grateful for everyone's thoughts and insights.
The HQP approach follows in the tradition of design thinking, but adds elements of applied systems thinking and organizational culture that are crucial to achieving effective team-based models of care in the community capable of managing the complexity of vulnerable populations. The “no compromise” design approach is anchored in the need to develop longitudinal, trusting relationships with participants and prioritize effectiveness. This approach yielded HQP’s model of Advanced Preventive Care, which has been rigorously tested over 17 years and shown to reduce mortality and health care costs with a positive ROI among chronically ill older adults. The same design approach is now being used by HQP to innovate dissemination of Advanced Preventive Care to other organizations through HQP's Replication Consultancy service.
There are many more variations of systems of care to be designed and tested using the HQP approach that hold great promise for improving health and reducing cost among a diverse array of complex, higher-risk populations and environmental and organizational settings. If we can imagine the future health care system we desire, we can design it. If we design it, we can implement it. If we implement it, we can change everything.
Note - The phrase The Art of Possibility came to me from the title of a book, "The Art of Possibility: Transforming Professional and Personal Life" by Rosamund Stone Zander and Benjamin Zander that I highly recommend.
More about Health Quality Partners (HQP) here - https://www.hqp.org/
More about the National Center for Complex Health and Social Needs here - https://www.nationalcomplex.care/ @NatlComplexCare #CenteringCare17
Ken Coburn, MD, DrPH, FACP is CEO and Medical Director at HQP