FORESEEING THE FUTURE
The senior staff of NICHQ thought hard about the kinds of lessons they had learned from their first attempts to cultivate a "culture of improvement" in children's health. Midway on their path to independence many possibilities lay before them. Which would prove most fruitful for the kinds of change they envisioned was difficult to gauge. It was clear that their organization was beginning to attract broader recognition as a source of expertise. NICHQ leaders were well respected within the American Academy of Pediatrics and senior staff had been involved in such high profile gatherings as the US Preventative Services Task Force. Bisognano was impressed with how far they had come in heightening their organization's profile in such a short time. She remarks, "They've achieved a level of national recognition quickly that took us 10 years to achieve."

However, in terms of fostering the "culture of improvement" on the ground, Homer along with others believed they had yet to confront their biggest obstacle figuring out who their "customers" were and what they wanted.

Among the senior staff, several views emerged as answers to the questions around customer and product. Donald Berwick and Maureen Bisognano of IHI were sanguine about NICHQ's principal focus on marketing the learning collaborative model. Bisognano continued to believe that learning collaboratives offered the best route to "dramatic" improvements. She emphasizes, "My advice to them is just make results." Berwick echoed Bisognano's belief but acknowledged the difficulty NICHQ faced in finding the right connections with practices. He says, "They've been unable to find the aggregators, the people who will get 20 practices in the room." Berwick viewed this as a process that simply required more time getting to know the leaders of those aggregates and making the case for how NICHQ "could help them in the long run".

Others appeared less optimistic about finding "aggregators" willing to pay, much less identifying the right kind of product to pitch. Bergman comments, "I thin we need to have a well-defined product. We've got four demonstration projects; we may be doing four different things. What we are accomplishing in these demonstration projects needs to drive our product line." Bergman, in particular, mused about what information technology might bring to bear in creating a new model of collaboration, one based around the advantages of making connections online. "It's unbelievably expensive to bring people together for collaboratives, " he says, "You need to be experimenting alternatives to the face-to-face meeting."

Bergman also saw the advantages a focus on information technology might bring to bear in another market entirely. "We have to ask who has the money and who is really going to pay for it?" His answer: "I think we may need to go to the consumer." As health plans increasingly shifted from serving a set plate of benefits to defining a "prix fixe" menu of possibilities, consumers of health care were the ones who were most likely to define health care alternatives through the choices they made according to Bergman. Heviewed an appeal to consumers as a way to develop a mandate for quality care that was currently far overshadowed by considerations of cost. Bergman brainstormed about the possibilities, based on the groundswell of public interest in reliable, web-based health information. One way of fostering connections with consumers, he believed, was to provide high-quality health information about children or online health care services for children with needs for particular kinds of care to which health plans could subscribe for their customers. Part of such a package might also be providing tools for use within the health plan to ensure that the kinds of information parents were getting on the web matched what the health plan was providing through its affiliated practices. This, he believed, was a way to build momentum for quality improvement from a completely different direction.

Homer, too, worried about putting too many of the new organization's eggs in the basket of one approach, such as the learning collaboratives. He expressed concern about "building this whole organizational infrastructure around producing one particular product." Homer wondered whether they had been right to spurn more conventional approaches. He muses, "We're so aware of the failure of traditional written materials to have much impact. I think that inhibits us a little bit from being innovative." This might mean putting more emphasis on marketing their educational material as stand-alone products. In this arena, they might face stiff competition from commercial firms that also marketed evidence-based guidelines and "state of the art" materials to practices, but they would be doing so with the cachet of NICHQ and the backing of the American Academy of Pediatrics. Margolis acknowledged the difficulties of moving beyond the path already taken. He says, "Do we want to go down the IHI road? It's hard if you're at the IHI to come up with some independent approach."

Harvard University > John F. Kennedy School of Government > Case Program

COPYRIGHT/CREDITS INFORMATION

This file was last updated on 24-May-2001 .

Email the Case Program.