Approach: Culture

Each local community and each set of participants in the formation of Accountable Care Organizations (ACOs) has different cultural attributes, and no one set of attributes can be considered “correct”. However, it is our view that the following set of cultural attributes is likely to enhance the success of ACOs.

Cultural AttributesKey Elements
  • Conceptualize patient and family as the “customer”
  • Focus on exceeding the customers’ expectations
  • Involve the patient in informed medical decision-making
  • Burden of proof is on those who think cutting corners on quality makes business sense
Lean Thinking
  • Think of work as a process and the ACO as a system
  • Engage front-line staff in identifying and eliminating wasteful process steps
  • Use objective data rather than subjective intuition
  • Consider uncertainty explicitly and quantitatively
Medical Professionalism
  • Adhere to the principles of the Hippocratic Oath
  • Commit to truthfulness and transparency regarding clinical performance, medical errors and treatment effectiveness to patients, payers, employers, regulators, accreditors, professional associations, and public health officials
Balance between collaborativeness and competitiveness
  • Be sufficiently collaborative to create processes that cut across traditional organizational and professional boundaries
  • Be sufficiently competitive to leverage benefits of a free market in terms of justifying capital investment and motivating difficult change

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