Rady Children's Hospital Takes a Team-Based Approach to Care Innovation

Matthew Brigger, the hospital's chief of otolaryngology, says collaboration is the key to better clinical outcomes and more involved providers.

Innovation in healthcare doesn’t always have to involve technology. It can focus on new ideas or strategies that shake up the status quo and create different—and better—pathways to delivering or managing care.

At Rady Children's Hospital in San Diego, Matthew Brigger, MD, MPH, is working to change how the hospital treats its young patients, many of whom come to the hospital for complex care or a variety of care concerns. As a result, they see several clinicians, usually separately and sometimes in several locations, a process that can be stressful to both the patients and their families.

Brigger, the hospital's chief of the division of otolaryngology, figures these young patients, their family members—and, just as importantly, their care providers—could benefit from a connected care platform that focuses on collaboration.

"There's just so much overlap," he says. "But how can you operationalize when that overlap occurs?"

Matthew Brigger, MD, MPH, chief of the division of otolaryngology at Rady Children's Hospital. Photo courtesy Rady Children's Hospital.

Brigger notes that each member of the care team has specific responsibilities and care concerns, yet everyone is focused on care for the patient. A specialist focused on just the heart or kidneys or bones will affect and will see the effects of care delivered by other specialists, sometimes without even realizing the influences. So it stands to reason that all the providers caring for a specific patient should get together and collaborate.

"We specifically get together in a room," he says.

That's not as easy as it sounds. Specialists are specialists for a reason, and their focus is often laser-trained on that particular area of expertise. The idea of working with others and participating in group discussions over whole-person care might not sit too well with them.

"There is a little convincing that has to go on," Brigger admits. "But this is how we're going to re-think collaborative care. We're all really doing a lot of the same things, but in different ways. If we can sit down and have that discussion, we'll see these ideas develop."

"It's really about presenting a vision," he adds, describing how he approached hospital leadership with his ideas. "We're showing how we can streamline and improve care for medically complex children … by working together and looking at the whole child."

Brigger says technology does play a part in this care management routine, by allowing providers in other locations to join conversations and meetings virtually and share data. They can also share advice on using new technologies such as AR and VR glasses and wearables.

"We're all learning and trying to understand how to do things," he says. "Having a C-Suite that recognizes the value of innovation is great. And by working together, I might see something that another specialist doesn't see. Everyone learns from everyone."

"We also challenge each other," Brigger adds. "We'll start with a presentation. This is the box. It's our job to think outside the box."

Patients and their families also play an important role in this process. New care plans won’t work out if the patient isn't on board. And with children, there's an added emphasis to creating care plans that meet the needs of the entire family.

"The parents are often easiest to convince and the most receptive to new ideas and innovation," Brigger says. "They're frustrated [by what their child has gone through] and motivated to look for ways to make healthcare better. They are a driving force. They've helped us to design so many programs."

That's especially important in pediatric care, he says, as many new and intriguing technologies and ideas aren't designed with children in mind. Many a children's hospital executive has had to take technology designed for an adult patient and modify it for pediatric care.

"It's often incumbent upon us to build these things out," he says. "And that’s where having parents and other [care team members] is really valuable."

That strategy also pertains to gaining payer support for what is often very expensive healthcare. Brigger says that while most revenue cycle strategies are left to management, care providers and parents do help that process by developing anecdotal information on how innovation is changing outcomes for children.

"Even if it is one child at a time, it's important to see what we can do with the technology," he says. "That's a heartstring we definitely feel."

Brigger's team-based approach to care has turned Rady Children's Hospital into a resource for other health systems across the country. Aside from sending their most complex patients to Rady, they also ask for advice on how to improve care coordination and management. With that in mind, hospital leadership is putting together the infrastructure needed to develop Rady as a center of excellence.

"There's a lot more to do," he says. For example, he'd like to breach the invisible walls that so often separate in-patient and out-patient care, creating care pathways that use technology and new ideas to connect patients and providers before, during, and after hospital stays.

"There are a lot of opportunities that we should be exploring," he says. And many of them are coming out of collaboration.