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E Pluribus Unum for Health Care (09:14)

Emme Deland, Senior Vice President and Chief Strategy Officer at NewYork-Presbyterian Hospital, says the new era of health care delivery is all about relationships. She likened today’s health care delivery challenges to the productivity study of chickens conducted by William Muir. In the study, Muir found that the average flock of chickens flourished, while the “super flock” was aggressive, wasteful, and unproductive.

“NewYork-Presbyterian,” Deland says, “is probably a flock of super chickens. We have the privilege of being affiliated with two med schools, we just added four hospitals to our regional network, we’ve employed 800 primary and specialty physicians. We have the wealthiest of patients, and 30% of our patients are on Medicaid. There’s great diversity in what we’re trying to do. We provide care in 100 languages. It’s a complicated community.”

Health care in general, she adds, is very complicated. There’s a complicated web of stakeholders, payers, hospitals, physicians, regulators, patients, and consumers. Relationships, therefore, are key to building social capital, bonds, loyalty, and trust.

To find out one of their goals for addressing this, look no further than the coins in your wallet. E pluribus unum — printed on nearly all of our coins, means “out of many, one.” In other words, Deland says: How can we leverage the many to provide wonderful one standard of care?

NY–Presbyterian is taking many steps to answer that question, including:

  • Developing a framework around an initiative of respect. “We’re framing it around the principle of accountability, so we are implementing a credo that everyone will sign,” Deland says.
  • Looking at performance evaluations. “Respect is one of the ways we’ll reward people,” Deland adds.
  • Listening to what their employees have to say. Says Deland, “We are going around to listen to our employees and what they are telling us — what works, what doesn’t work, how can we support the way they do their work.”
  • Developing collaborative councils at various levels of the organization to create opportunities for the physicians, nurses, and various support services to work together — “which we have not been successful at doing in the past,” Deland adds.
  • Making sure the people providing the care have what they need. “We’re developing a service standard for all patients in the care model, in patient or outpatient, and making sure we have the right leadership, 7 days a week, 24 hours a day, so we can get the right services done that we need to for the patients.”
  • Developing a new communication strategy: coordinated huddles, enabling people all around the organization to hear up and down what is happening.

“Change isn’t easy for any academic medical center, but it’s absurd for us to have any judgments on the kind of changes, the expectations, based on the last 5 years. This is a journey. We need a little more time before we can be judgmental about what works and what doesn’t work,” says Deland.

“As all of us contemplate the future, I think e pluribus unum, which is probably more important today than any time in my lifetime, may bring us more sanity and success than just flocks of super chickens.”

From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.

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