tages. The disconnect Hamlin saw between the workshop discussions and where the discussions needed to be to capture the attention of leadership was the business model. In defining a business model, a business case is usually made, followed by case examples supporting it. In health care, the opposite seems to happen. Case studies are often used as proof of a business case, but are rarely presented in the context of the entity’s articulated business model or business strategy. Hamlin provided the following business model as an example: Cincinnati Children’s Hospital Medical Center is located in a small metropolitan area and relies on a substantial portion of its inpatient revenues to come from patients traveling from outside its primary service area; many patients must bypass multiple other options along the way. To justify patients’ efforts, or the trust of a referring physician, the Cincinnati Children’s Hospital Medical Center must have a demonstrable outcome advantage or provide a cost advantage for a comparable outcome. This is the business model and shows the importance of quality. Improved quality carries the ammunition to attack both sides of the “value equation”: product differentiation from better outcomes and/or lower costs.

As an academically affiliated organization, Cincinnati Children’s Hospital Medical Center’s care is suboptimal because no patient stays in a division or department throughout an entire inpatient stay. This is one of the biggest challenges to optimizing value, Hamlin said, noting that although academic structures can inhibit quality improvement, the highly successful pieces must be built up. The CEO’s and CFO’s roles are to help each line be as successful as possible. If parts of the system are suboptimal, they must work together to find a solution, not just focus on the specialties in which they are competitive. The problem is not the reimbursement system, Hamlin said, because people will always find ways to maximize profits in reimbursement systems. The real key is to improve the quality, and thereby the value, of health care.


Research partnerships with clinical care are imperative. The research and development arm of a health care institution cannot be a separate group and must be engaged in the decision-making process, Hamlin said. Examples of success, such as those described during the first panel, can influence others to improve the quality of care they provide, Boat said. Although successful spread can occur in this manner, it will not be entirely successful without an evidence

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