Improving Health Care Outcomes

Scheinman Institute team helping measure results of restructuring
Scheinman Institute team helping measure results of healthcare restructuring
Wednesday, August 1, 2018

An ILR study is at the heart of a health care transformation project on Staten Island that is improving treatment services for Medicaid patients and may be a successful model for other regions in New York state.

A team from the Scheinman Institute on Conflict Resolution, led by Professor Harry Katz, has been surveying hundreds of nursing home, hospital, and private clinic employees on Staten Island from more than 70 health care facilities for the past year.

The goal of the study is to measure the effectiveness of a five-year statewide Medicaid restructuring program in Staten Island health care facilities. The state program was launched in 2015 with the primary goals of reducing hospital re-entries and emergency room use, establishing greater coordination of clinical and behavioral care, ensuring consistent training standards across all facilities in a region, reducing employee turnover and overtime, and saving money.

Katz, working with Associate Professors Ariel Avgar and Adam Litwin, and John August, expects to report the study’s preliminary statistical findings to Staten Island administrators within two months.

In a 2017 report of preliminary findings by the ILR team, after one year of work, researchers said they were seeing many benefits associated with the program. “We are confident that our future research will confirm that this restructuring is leading to significant improvements in the quality of health care on Staten Island and to substantial cost savings,” the report said.

The state created 25 Performing Provider Systems to manage the Medicaid restructuring program. After one year of operation, the Staten Island system was ranked as the best-performing system in the state. It started its fourth year in the program in July.

“When we saw the first-year results, we thought it would be interesting to study why they are performing so well and how they could perform even better,” Katz said. Cornell researchers and undergraduates have surveyed about 600 employees, mostly in 10 nursing homes and two hospitals, about changes in their workplaces.

“The employees report that their work has changed in meaningful ways,” Katz said. “Many of those changes have been perceived as positive, but there have been some changes that are not as positive because, in some cases, they require more intensity and harder work. We are looking more closely at how employees are being affected and will have some interesting lessons to convey to the provider system.”

The Cornell team is also working with United Healthcare Workers SEIU 1199. “They asked us for advice on how they could improve the labor-management relationship,” Katz said. “They have a pretty good relationship, but it’s not perfect, and we are experts in improving that.”

The researchers have been impressed by the role of Performing Provider Systems management in establishing organizational infrastructure and leadership. Standardized training programs and the sharing of best practices are improving communication horizontally among providers and vertically in the facilities, Katz said. “The key to the restructuring efforts is a profound change in how front-line employees like nurses are working, supported by extensive training and broader roles for the employees.”

Among the positive signs, Katz highlights better coordination between the hospitals and nursing homes, which has led to shorter hospital stays and less frequent transfers to the hospitals. Better coordination between hospitals and their emergency departments and community-based organizations has improved addiction counseling.

Bill Myhre, senior director of Workforce Transformation/HR with the Performing Provider Systems, said Staten Island is fortunate to be working with ILR because the school is highly respected for its workforce research. “We think the study will validate what we are doing and it will serve as an educational tool beyond Staten Island.”