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LETTER FROM THE CHAIR
Dear Colleagues:
The Department of Neurology
at Case Western Reserve University is a national
pacesetter in a major revolution underway in how we
deliver care to our patients with neurological
conditions. The mission of the Department of Neurology
through the Neurological Institute (NI) is to provide
our patients with neurological conditions with the
highest value healthcare through a systems approach to
care.
There is a long and honored
history of neurological excellence within the Department
of Neurology at University Hospitals of Cleveland. The
Neurological Institute now provides University Hospitals
Case Medical Center, the University Hospitals healthcare
system and Case Western Reserve University with a
tremendous opportunity to provide neurological
leadership both locally, nationally, and
internationally. The challenge for the Neurological
Institute, including the Department of Neurology, is to
integrate a system of patient care ("to heal"),
education ("to teach") and research ("to discover") that
delivers the highest value care within both the academic
culture of the University and the increasingly
competitive healthcare environment. The goal of the new
medical condition model (the "Institute") is to
integrate patient care, education, and research into a
highest value system of neurological healthcare. This is
the philosophy underlying the creation of the
Neurological Institute at University Hospitals Case
Medical Center.
Michael Porter and
Elizabeth Olmstead Teisberg, in their book Redefining
Health Care, offer three guiding principles that
they believe will define high value healthcare in the
21st century.
1. Healthcare value
will be defined in terms of improved outcomes per
healthcare dollar spent. While the healthcare dollar
may be spent entirely across the spectrum of direct
patient care, at academic medical centers a
significant portion must go towards education and
research. The challenge for the academic healthcare
organization is to demonstrate the value of
education and research by linking them to patient
outcomes.
2. Healthcare delivery
should be organized around medical conditions rather
than strict departmental lines. The goal of the new
medical condition model (the "Institute") is to
integrate all components of patient care, education,
and research related to a particular neurological
condition into a system of care. This represents a
patient centric departure from the traditional
departmental structure and an evolution of the
multidisciplinary group practice model.
3. Outcomes must be
actually measured to determine healthcare value.
Although many healthcare organizations profess a
belief in outcomes assessment, few have committed
the necessary resources to actually do it. Most
either do not report outcomes at all or report only
on process, which may reflect the delivery of
quality care but not necessarily the outcome of
care. Many physicians also feel threatened by
outcomes assessment. Regardless, outcomes assessment
will be a hallmark of the successful healthcare
organization in the 21st century.
The challenge for the
academic healthcare organization is to demonstrate the
value of education and research by linking them to
patient outcomes. Direct linkage of education and
research to patient outcomes requires a departure from
the healthcare organizational past. Historically,
healthcare organizations have been dichotomized into
those oriented toward education and research or those
oriented toward patient care. In the new healthcare
model high value patient care is contingent upon
education and research. Conversely, while education and
research are necessary components of high value
healthcare, they are by themselves insufficient to
deliver such care. The successful organization must
blend all three elements to provide the highest value
healthcare. In my role as Chairman of the Department of
Neurology and Co-Director of the Neurological Institute,
I am constantly striving to achieve this goal. I welcome
you to learn more about us.
Anthony J Furlan, MD
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