Intermounatin Case

9-603-066

REV: JUNE 29. 2006

RICHARD M. J. BOHMER AMY C. EDMONDSON

Intermountain Health Care

Dr. Brent James, executive director of Intermountain Health Care's (IHC’s) Institute for Health Care Delivery Research, explained to a group of IHC's clinical leaders gathered around the conference room table that the more often physicians and nurses complied with IHC’s Clinical Integration care delivery protocols, the more patient-care quality improved. He summarized his thoughts: “Anytime I get physicians to use them, I’m basically tracking them into an evidence-based, standardized line of clinical thought.” One nurse appeared reluctant and—perhaps overstating her case to emphasize that each patient was unique and could not be treated in an assembly line manner—exclaimed, “We're not making widgets here!” Unexpectedly, James countered, “Oh yes we are!” Clinical Integration referred to an organizational structure and network of tools, including paper and electronic protocols and a centralized patient database that organized the delivery of clinical care at IHC Health Services. Clinical Integration was presented as a set of care- and productivityenhancing tools that would “Make it easy to do it right.” For example, diabetes management was most effective among patients whose physicians had full electronic clinical-decision support; not inconsequentially, those physicians were directly employed by IHC. Even though no one—neither practitioners employed by IHC nor non-employee physicians who admitted patients to IHC facilities—was required to adhere strictly to the Clinical Integration caredelivery protocols, critics saw an insidious element to them, calling them a Taylorist1 system that stripped away the autonomy of those who practiced the craft of medicine. James acknowledged that following the protocols increased the interdependence between the physician and the health care team, but believed that Clinical Integration was a crucial component of IHC’s affordable and...