One Is NOT the Loneliest Number

Background and purpose: In a world of rising healthcare costs, mergers and acquisitions create large organizations that leverage economies of scale to reduced costs. One of the largest accountable care organizations in the Southwest acquired an academic medical group and an urgent care medical group, bringing the total to three disparate medical groups. The need to align clinical practice across these three medical groups became evident; influencing quality of care and optimizing clinical outcomes becomes possible when we function as one.

Methods: A nurse-led policy development and approval committee structure was designed that included a clinical policy committee (CPC) and a provider clinical policy committee (PCPC). The CPC membership included education, risk, regulatory, operations, pharmacy, and clinic managers. The PCPC membership included nurse executives and physician leadership from all three medical groups. The structure includes five distinct phases, define, approve, design, implement, and monitor. The define phase is where collaboration between all three groups begins. The approve phase is where each medical group reviews/approves the policy with their individual group. The design phase brings the groups back together to design the toolkit. The implement phase is where members from each group become part of a team that presents the toolkit to managers and staff.

Results: While this structure continues to be fine-tuned, it has provided a solid foundation with which to join these three disparate medical groups together as one. In 2018, we decided to standardize the medication management process since it had the most variation and posed the highest risk to our patients and the environment. The medication management policy was the first policy to require all five phases of the policy structure. Once the define and approve phase was complete, we entered the design phase. In this phase, we sought approval to purchase appropriate pharmaceutical waste containers and for additional costs related to pharmaceutical waste pick up to meet state and federal regulations and developed a toolkit to address all elements of the policy. The design work group then transitioned to the Implementation phase where a presentation was created. Pharmacy leadership and nursing leadership joined together to present this information to all three medical groups over a period of two months. We are now in the monitoring phase.

Conclusion: The medication management policy was used as the test of design to determine if the policy development structure was the appropriate structure to align clinical practice across three medical groups. This structure does supports standardization of clinical care and quality outcomes through policy development.