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Partnering to build a regional network

We explore how you best build partnerships with fiercely independent regional hospitals with Tad Morley, Executive Director of Outreach & Network Development at the University of Utah Health. That involves a lot of trust, telemedicine and the discipline of KPIs.

Being based in the sparsely populated Mountain West leaves University of Utah Health, the only academic medical centre in the region, with a big challenge. “Our core catchment area has just over two million people, so we have to draw a very wide circle to ensure that we get in enough patients with the rare and complex conditions we need for research and medical education. Effectively, we have to address about 10% of the geography of the USA to get to 10 million people!’

Today, Utah, which has a unitary structure in which both hospital and research are owned by the university, gets a third of its inpatients from beyond its core catchment area, the Salt Lake conurbation. They come mainly from a network of 23 entities.

That means getting out and forming partnerships with a host of “fiercely independent” community-owned hospitals who are also on the call list of competitors such as Intermountain Healthcare, Mayo and Cleveland. The local hospitals ranged in size from smaller entities designed to handle emergencies up to facilities which could handle cancer care and strokes.

Apart from taking in complex patients, Utah provides medical expertise often through telemedicine, some staff and a lot of training.

Utah had many links before Morley started in the job nine years ago but most were fairly ad hoc: ”So I got out there and spent a lot of time meeting people and understanding them. There was a fair amount of suspicion.” Would Utah simply seek to cream off their patients? What quality of care would it deliver? Would Utah seek to take them over? These questions were often uppermost in their minds.

It helped that Morley had done spells as CEO and COO at rural hospitals – he understood them. “I did a lot of listening. There was no playbook, things developed organically.”

It also helped that Utah really didn’t want to take their patients. “We don’t have the capacity. We wanted to see the ones with rare and complex conditions, but I understood early on that the patients and our partners wanted care delivered locally.”

Morley built trust and bridges. Both were important. Bridges are arrangements which enable Utah to share patient care with the local partner and often involve some form of telemedicine. Trust came initially from demonstrating that Morley got their perspective. “We built the tools and relationships around the needs of their communities. It was an outside in approach, we didn’t weigh in saying ‘this is how we do things at Utah’.”

Being able to offer training helped, particularly for nurses. “They need to know how to put in fixed lines and in a week at Utah they can do that more than they might do in a year at their local hospital.”

For Morley trust also comes down to having a very clear shared idea of what will be delivered. “You need to be able to define what success looks like for them and for us. How are you going to measure it? And then you need to keep measuring it with regular quarterly meetings.”

He adds: “It is about weaving a tapestry one strand at a time but with every strand we seek to understand the measure of success. What constitutes winning for you and for us and how do we measure it? “

This often involves a degree of confrontation. “You have to be clear about what you are delivering and what you are not delivering. You don’t want drift. Like “that training 18 months worked well but since then we’ve not had quite as much training as we would have liked and we kind of get the feeling that you are not really delivering…” – that is a real danger and really doesn’t work.” In other words building and maintaining trust calls for the discipline of real KPIs, regularly measured. “You can’t pay basketball without the baskets and without keeping score. We’ve learnt that lesson over the years, sometimes the hard way.”

It is also important to be sure that the other side shares your values. Morley says: “You have to be super careful in choosing a partner so that your philosophies and values align. They won’t be perfectly matched.”

Utah has created a checklist of what it thinks is important. “What is the reputation and performance of this hospital? There is publicly available data that we can look at and there is the reputation in the community and among providers who have received patients from these community hospitals.”

So does it sometimes reject a potential partner? “Absolutely yes!” And there are pain points. “These are independent entities and we don’t govern them. There can be challenges when leadership teams change. And there are resource issues. We have to be very clear and careful especially when we build deeper relationships. We don’t want to short change our partners or our home base.”

Money is always an issue and here he says Utah tries to charge market rates.

So what services is Utah offering? Telemedicine is a big offer, around services labelled Telestroke, Teleburn and Teleicu. “We have limited specialists and we have to be super prudent how we use them,” says Morley.

He says often it is not clear whether someone is having a stroke. “A doctor may be unclear as to whether to administer the blood clotting drug TPA or not. The service enables the doctor to contact our neurology team and consult live.” If it is administered the patient will often then be shipped to Utah for monitoring.

Teleburn enables doctors to consult and assess the severity of the burn. With Teleacute the doctor can be given coaching on how to best manage a ventilator, for instance.

Utah also provides a lot of training. “We have been able to organise training for nurses and ancillary personnel so as to elevate their skills so that the hospitals can retain patients particularly in areas like obs and gynae, and oncology.”

Utah can also supply part time or full time specialists. “Some hospitals would not have enough work for a full time urologist or a sub-specialist in cardiology. So we take our physicians out on a rotation which makes sense – weekly or quarterly. We have our plane which flies out daily.”

Utah can even supply staff full-time. “We have a couple of examples where our faculty staff an emergency dept.”

Deeper relationships see Utah sharing its Epic electronic patient record system with another hospital. “That calls for a really deep and connected partnership because when we make changes it affects them and vice versa.”

Some affiliates are over 500 miles distance. “If you look at the patients who come that far they have very high case mix scores. The further you go the sicker the patients are when they come to us.”

Affiliates are tiered by strategic importance and Morley says Utah is also looking at co-branding. “We’ve waited to be asked and we have been asked. So there are now six sites where we allow co-branding with our Huntsman Cancer Institute. But we are very strict on quality. They get access to our case conferences and to top physicians so we do have a very close connection there.”

How far this will go is hard to say. There are those who say that only five health care systems will eventually be left in the USA. That has led to a lot of M&A and the commercialisation of some big brand names. Mayo, for instance, is known to sell its brand and to extract a high price for its use.

But one senses that, at least as far as Morley is concerned, that won’t be the way at Utah, despite, as Morley points out, being, along with Mayo, the only other hospital brand to be in the top 10 consistently for the last 12 years.

For Morley it is all about the relationship and ensuring it is right for both parties.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.