Integration has been well underway since even before the combined entity’s official closing. Clinical and operational leaders from across the Mount Sinai Health System have been assembling since last fall into integration workgroups to coordinate the myriad functions that were previously based at the individual facilities into an interoperable network of such functions. At the highest level of the organization, we have established the Quality Leadership Council (QLC) and the System Management Council (SMC).
If we are to make the most of the combination of four separate hospitals spread across seven campuses, effective integration is fundamental and highlights two key concepts:
Typically, it can take a decade to integrate an organization as large and complex as the Mount Sinai Health System, but we do not have a decade. We have three years. Health care finance is changing too rapidly under forces beyond our control. Therefore, we must be able to respond and adapt just as rapidly, making operational integration essential. Furthermore, organizationally we will need to function simultaneously as individual hospitals and practices, as well as a coordinated health system. To do so, we must embrace the notion of matrix management.
Quality Leadership Council
Composed of the Presidents, Chief Medical Officers, Nurse Executives, and Quality Vice Presidents from each of the seven hospital campuses, the QLC formed last October, meeting every two weeks. It determines the overarching quality agenda for the Health System. Thus far, the QLC has developed and adopted a system-wide dashboard of critical quality indicators addressing our performance on health care-acquired infections, hospital-acquired conditions such as pressure injury, risk-adjusted mortality and readmission rates, process-of-care measures, and patient satisfaction.
It has set the goal of achieving best-in-region and national top-decile performance on all these measures within five years. To achieve these aims and others, the QLC is directing system-wide integration of infection control, nursing quality, pharmacy and therapeutics, critical care, patient relations, accreditation and regulatory affairs, and emergency management.
System Management Council (SMC)
Paralleling the work of the QLC, the SMC was established to oversee and accelerate the integration of key operational functions such as peri-operative services, emergency services, hospitalist services, transfer services, communications, post-acute care, hospital throughput, and case management.
While operational and quality integration progresses, personnel integration is proceeding, as well. Clinical leaders from across the Health System are assembling under the direction of the Dean of the Icahn School of Medicine at Mount Sinai, Ambulatory Care leadership, and the Health System clinical department chairs to establish inter-hospital departmental structures. Clinical programs across the Health System, such as primary care, behavioral health, cardiology and cardiac surgery, HIV, kidney transplantation, diabetes, neonatal critical care, and neurosurgery are evaluating strategies to optimize care delivery across the Health System, considering factors such as community need, facility capabilities, and staffing resources.
In some cases programs are coalescing into a primary location, such as kidney transplantation and ophthalmologic surgery. In other cases, programs are being more widely deployed, such as neurosurgery. Additionally, programs such as neonatal critical care, diabetes, primary care, and respiratory care, are sharing best practices and evaluating their local standards to raise their performance across the Health System.
The other significant work that is underway is the melding of the Mount Sinai Beth Israel, Mount Sinai Hospital, Mount Sinai St. Luke's Roosevelt, and New York Eye and Ear Infirmary faculty practices. Coordinating the care provided by more than a thousand physicians and allied health professionals requires a single electronic medical record, a uniform set of practice principles, standardized treatment protocols, and widely accessible single source laboratory and imaging resources. It also necessitates alignment, which requires leadership and an effective organizational structure.
Physicians at Mount Sinai Beth Israel, Mount Sinai St. Luke’s Roosevelt, and New York Eye and Ear Infirmary will join into the Mount Sinai Doctors Faculty Practice on a department by department basis. These physicians will receive faculty and medical staff appointments at Icahn School of Medicine at Mount Sinai and will become members of Mount Sinai’s Independent Physician Association. Approximately 300 physicians from the departments of Obstetrics and Gynecology, Primary Care, Emergency Medicine, Anesthesiology, Orthopedics and Radiology at MSBI and MSSLR will be brought into the Faculty Practice on a rolling basis by early 2015.