Overview of Professionalism Competence

Lately, the term ‘high-value care' has become a popular mantra among healthcare leaders and policymakers. These people claim that changes are necessary in healthcare to reduce costs, minimize overuse, and optimize outcomes. While few can argue that changes are needed in these areas, there is disagreement as to how to make the largest impact. The authors agree with those who believe that the greatest potential for success is found in professionalism improvements, not through payment or policy reforms. While medical education prides itself on producing highly competent and technically proficient physicians, it has generally neglected professionalism development considering these skills something to be acquired outside of formal medical education. The authors consider recent efforts to define professionalism competency and offer a useful model that brings parity to physician training. If professionalism is the bedrock of high-value care, the time has come to provide physicians with the skills to excel.

Telemedicine Adoption Opportunities and Challenges in the Developing World

Mapping opportunities and challenges of telemedicine adoption in an emerging economy has always been presumptive due to the scarcity of empirical evidence. Only recently the potential influencing factors of both issues in the rural context of emerging economies (using Bangladesh as a cases study) were investigated. Analysis of existing literature identified seven broad categories of challenges (e.g., deficient organisational commitment, inadequate technological infrastructure, insufficient resource allocations, deficient service quality, clinicians demotivation, patients' dissatisfaction, and patients' distrust) and six broad categories of opportunities (e.g., service usefulness, service assurance, secured patient privacy, adequacy of services, peer influence on use of services, and environmental conditions) concerning telemedicine adoption. Their significance is outlined. These findings contribute to the literature by distinguishing significant factors, which can positively favour or deter telemedicine implementation in developing countries and similar settings.

Maturing an Information Technology Privacy Program

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was initially enacted as an administrative simplification to standardize electronic transmission of common administrative and financial transactions. The program also calls for implementation specifications regarding privacy and security standards to protect the confidentiality and integrity of individually identifiable health information or protected health information. The Affordable Care Act further expanded many of the protective provisions set forth by HIPAA. Since its implementation, healthcare organizations around the nation have invested billions of dollars and have cycled through numerous program attempts aimed at meeting these standards. This chapter reviews the process taken by one organization to review the privacy policy in place utilizing a maturity model, identify deficiencies, and lead change in order to heighten the maturity of the system. The authors conclude with reflection related to effectiveness of the process as well as implications for practice.

Exploring Innovative, Alternative Healthcare Models in the US

This chapter explores, discusses, analyzes, and presents some recommendations for new, innovative alternative healthcare models to the traditional insurance and healthcare models that currently exist. These include a revised and enhanced hybrid model of healthcare; healthcare cost-sharing faith-based model; healthcare cost-reduction corporate partnership model (for example, Amazon, Berkshire Hathaway, and JPMorgan Chase partnership); direct primary care model; and wellness program model including subscription type payment services, concierge medicine services, networks of primary care physicians providing patient retention, personalized medicine, and preventive care (MD VIP for example). Significant outcomes such as lowering healthcare costs, enhancing the quality and delivery of healthcare services, improving patient satisfaction, and promoting overall sustainability are addressed, including their implications for various stakeholders.

Healthcare Reform

The healthcare system in the U.S. is very fragmented in its structure. It is generally agreed that it needs to be reformed. This chapter addresses this issue from an organizational point of view with specific reference to cancer, a disease termed “The Emperor of All Maladies.” The basic tenet of this chapter is that any healthcare system should be designed so as to maximize the benefit to all the stakeholders involved, while incorporating the newer advances in technologies, but above all, must be patient-centered. Solving a complex adaptive problem requires different approaches compared to solving a simple technical challenge. Especially, when it comes to dealing with cancer—a very intelligent, continually adapting, rule breaking, self-sustaining disease—simple technical solutions are insufficient without an understanding of how to change the system. After discussing the current healthcare system in the U.S., a proposal is made as to how to reform the system.

The Economics of Health

The American healthcare system is vast and complex. An overview of the United States' healthcare system provides a view into the interrelated dynamics between three categories of factors: consumers, intermediaries, and providers. Consumers demand health inputs in order to produce health status that allows them to live productive lives. Intermediaries, such as insurance companies and government programs, reduce the direct cost of healthcare for consumers. Providers, such as hospitals and physicians, amongst others, have historically exhibited a degree of monopolistic power in the healthcare market. The modern trend towards managed care organizations, firms that vertically integrate multiple aspects of the healthcare market, aims to reduce costs imposed by such providers.

Effective Teamwork and Healthcare Delivery Outcomes

The chapter focuses on high-performing people and effective teamwork in healthcare at accountable care organizations (ACOs). Studies have found that patients are more satisfied when they engage with providers who understand and express their 'soft-skill' competencies. The model presented will illustrate how teamwork training and innovative care, Leader-less Group Discussions, interprofessional education and communication, and leadership/top management support have been found to positively impact effective teamwork, which in turn would synergistically impact the quadruple aim of patient experience, quality of patient care, lower cost, and provider satisfaction. Patient satisfaction is closely linked to provider related outcomes such as employee performance, job satisfaction, and reducing costs.

An Enhanced Healthcare Delivery System Model for the US

This chapter focuses on developing an enhanced US healthcare delivery system model by learning from the “best” healthcare systems in the world and adapting some of their best working principles to the existing US healthcare system. These global systems include the Swiss healthcare system, which is considered one of the best in the world, and some of the other leading healthcare systems such as the German, the UK, French, Italian, and Singaporean. It would also explore, among a few alternatives, the state innovation-based approach to healthcare reform. Major concerns such as cost containment, affordability, flexibility, accessibility, feasibility, and implementation-related issues have been addressed.

Professionalism Competence

The existing medical education paradigm is not structured in a way that prepares future physicians with knowledge or the skill set to excel in professionalism. The authors provide information in the form of a case study of a professionalism competency development program that was undertaken in the Duke University Medical School Division of Head and Neck Surgery and Communications Sciences, barriers found that impede development, and offer five reforms that are necessary in order to bring about the movement toward high-value care. The authors propose to 1) prioritize professionalism competency training in medical education, 2) make curricular revisions to promote professionalism competency training across the continuum, 3) revise selection criteria for entrance to the profession that deals with basic professionalism skills, 4) institute new prerequisite requirements for entrance to the profession centered on professionalism competency, and 5) require professionalism competency training as part of certification and re-certification processes.

Shifting Toward Consumer-Centricity

In the face of government reform and competitive disruption, healthcare organizations are in need of consumer-centric transformation: transformation that will help them win when consumers shop for a doctor, plan, or medicine and engage them in their care to form a partnership that will improve outcomes and lower costs. The authors interviewed 70 senior executives at leading provider systems, health plans, and pharmaceutical manufacturers to understand their transformation agenda. Interviews asked such question as What initiatives and changes are underway? Where have they had success? What will come next? Where have they struggled?” And, most importantly, What can others learn from them? Davis and Gourdji uncovered five shifts and share practical advice and examples of what these leaders are doing to set them in motion.