Abstract
Background: As part of our Regional Hospital System's multi-year systemic transformation aimed at accelerating continuous and coordinated integrated care across the entire Hospital System, the redesign of clinical governance was identified as key to ensuring integrated care outcomes and value; a better accountability framework for physicians was needed to drive outcomes and value improvement and foster a culture of excellence.
Approach: We developed the physician accountability framework guided by the iterative three-step process from the Health System Transformation Playbook, involving storytelling, model building, and pathfinding. We first analysed 2023 hospital data on patients' care trajectories, healthcare costs, and lengths of stay to identify patterns and areas where physician accountability could be clearly defined.
Building on these insights, we collaborated with departmental leaders, senior physicians, and subspecialists to conduct iterative storytelling sessions, where physicians shared their experiences on care coordination and patient outcomes. Through these discussions, we identified key inflection points where physicians' decisions directly influenced patient outcomes. This enabled us to design the accountability framework for ""episodic care"", where accountability is assigned based on care initiation, transitions between subspecialties, and discharge management.
Results:
The accountability framework provides clear rules to define each physician's scope of accountability and contributing responsibility in patient outcomes. Key principles include:
•The period of accountability for “episodic care” begins with an inpatient admission and concludes 90 days after discharge or on the day before a readmission.
•The consultant in-charge of the patient’s care at the point of discharge is held accountable for outcomes of the entire “episodic care” period.
•Specialists, from other departments, who contributed to patient’s care share responsibility based on their seniority.
This framework is incorporated into our Systemic Integrated Care Dashboard that provides actionable insights on patient outcomes, including clinical outcomes, patient experiences, and healthcare costs. These insights enable physicians to track the impact of their care decisions, while departmental leaders monitor performance and guide improvements. By structuring accountability across the care process, we have introduced transparency and fostered a shared responsibility model, enhancing care coordination and patient outcomes.
Implications: Understanding the mapping of systemic performance measures to different physicians involved in the interdisciplinary delivery of integrated care throughout a patient’s journey will delineate accountability more coherently. This governance transformation signals a shift in how responsibility for patient integrated care outcomes is structured, focusing initially on physicians, but with future plans towards a broader inclusion of the range of healthcare providers potentially involved in integrated care into the accountability framework. In the long term, this framework aims to foster a mental model of shared accountability, ensuring a holistic and collaborative approach to continuous and coordinated patient care, where all members of the healthcare team are aligned in delivering high-quality outcomes.
Additionally, the framework highlights the importance of mentorship within subspecialty departments to ensure junior physicians are consistently supported in delivering high standards of care. This emphasis on mentorship not only improves clinical outcomes but also foster a culture of continuous learning and professional development within a Regional Hospital System delivering integrated care.