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Healthcare Business Solutions
November 17th, 2016

From Dave’s Desk: Multi-stakeholder engagement – a look at clinical alignment and integration

dave reed littleThere is a lot of variation in healthcare. When examining how clinicians deliver care, the ideas of clinical variation, clinical integration, and clinical alignment are frequently reviewed.

Clinical alignment is getting stakeholders, like doctors, nurses and administrators, all on the same page. Clinical integration builds on clinical alignment and refers to how these stakeholders are working together to deliver the best care for patients across the entire patient care pathway. In order to ultimately achieve comprehensive patient-centered care, departments and various stakeholders need to be engaging collaboratively. This holistic engagement is achieved in part through clinical integration and clinical alignment.

Care pathways

When examining clinical alignment, it is important that all individuals in the care delivery system are in sync. Administrators, supply chain groups, value analysis teams, physicians, advanced practice providers, nurses, technicians, and others all have to be on the same page in order to carry out their mission: to comprehensively deliver cost-effective and high-quality patient outcomes.

Typically, clinical alignment is achieved first, and then clinical integration follows. First, stakeholders need to align with each other to decide how patient care will be delivered. Second, integration happens through coordination of care and care pathways that promote efficiency and streamline patient support.

As healthcare funding continues to decline, systems will need to rethink their care pathways in order to provide cost-efficient care. Fee-for-service institutions—where hospitals are paid based on the number of visits, tests, and procedures—are declining, and value-based systems—where the goal is to keep patients healthy and out of the hospital—are on the rise.


An example of a value-based clinical alignment and integration system is the Virtual Care Center at Mercy in St. Louis. This unique approach highlights a bedless facility that staffs physicians, nurses, specialists, and support staff who talk to their patients about health issues virtually, using mediums like Skype, Facetime, email, and phone. These care pathways have been established to ensure that patients can stay at home and away from a hospital while still receiving quality care.

How is clinical alignment achieved?

Throughout the years, EMRs and other technology have helped to clinically align and connect processes and reduce gaps in patient care. However, there is a lot of clinical variation and plenty of preferred ways of practicing medicine. Many health systems are attaining clinical alignment by reducing clinical variation by standardizing processes and procedures when possible.

Clinical variation can be reduced through the use of evidence-based medicine. Evidence-based medicine can drive quality experiences and good patient outcomes. For example, a hypothetical health system has ten physicians; eight of those physicians perform a procedure one way, and the other two physicians perform the same procedure in a different way. Through data, one may discover that those two physicians also have higher costs due to additional instruments used or time spent performing the procedure. Evidence-based medicine allows us to drill down into the variation and use that information to move towards aligned and integrated clinical excellence, good patient outcomes, quality experiences, and cost-efficient care.

Physician engagement

It is vital to involve physicians as key stakeholders in the clinical alignment and integration discussion. It is important for those involved to understand the value in balancing clinical care and operational efficiencies. 

Just like many things in life, it takes a village to ensure patients are healthy and away from the hospital. This village of healthcare professionals is assembled to help advance clinical alignment and integration. Start now; you may find that clinical alignment touches many aspects of the healthcare continuum including, but not limited to: clinical variation, consumerism in healthcare, and preventive care.

Your thoughts

How is your system clinically aligned? What are your tips on how healthcare organizations can better clinically integrate? Share your thoughts with me on Twitter and LinkedIn.