NEJM: Successful integrated networks share same habits

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Although it’s difficult to determine if a high-value healthcare organization’s specific tactics will work elsewhere, Harvard Business School’s Richard M.J. Bohmer believes that by emulating the shared habits of successful integrated networks, others can learn how to reliably deliver higher value.

“Organizations considered to be among the nation’s highest performers, such as the members of the new High Value Healthcare Collaborative, often have unique personalities, structures, resources and local environments,” Bohmer wrote in a Dec. 1 commentary in the New England Journal of Medicine. “Given the healthcare sector’s mixed record of disseminating clinical innovations and system improvements, how do we learn from leading organizations?”

According to Bohmer, healthcare organizations seeking to learn from their high-value peers need to look beyond specific practices, which often can’t be imported due to environmental differences. Instead, they need to look at habits, the “repeated behaviors and activities and the ways of thinking that they reflect and engender.”

Bohmer defined four habits he’s recognized in high-value healthcare organizations.

Specification and Planning:

Bohmer wrote that high-value organizations carefully plan and clearly define decisions regarding future activities, basing both operational and clinical decisions on explicit criteria. Additionally, Bohmer believes that specification applies to separating large patient populations into meaningful subgroups.

Infrastructure Design:

High-value organizations develop microsystems based on the needs of patient subgroups and “make thoughtful use of assistive personnel and alternative providers, and they ensure that each has the necessary resources by carefully designing the supply chain of equipment and information, simplifying workflow and reducing work stress,” he wrote.

Measurement and Oversight:

While all healthcare organizations are required to collect and report certain data, Bohmer stated that high-value organizations go beyond standard reporting requirements, collecting additional information to measure process control and performance management. According to Bohmer, high-value organizations also “integrate measurement activities with other priorities such as pay for performance, annual target setting and improvement activities.”


“Most healthcare organizations treat clinical knowledge as a property of the individual clinician,” Bohmer wrote, but he believes such knowledge should be used as an organizational tool to examine deviances in outcomes and to ultimately improve the value of healthcare delivery.