Thought leadership

Dyads, Compacts and Experience Maps: Essential Structures for the Success of Integrated Health Systems

Dyads, Compacts and Experience Maps: Essential Structures for the Success of Integrated Health Systems

Physician leaders at an increasing number of our clients recognize the value of weaving together three strands of strategy to make a rope that successfully pulls an integrated health system into the domain of value-based payments:

  • Patient Centered Care Experience Mapping
  • Physician Hospital Compacts
  • Dyad Leadership Models

The effective implementation of these three initiatives requires open conversations and creative planning among administrative, board, and physician leaders. Perhaps this article can catalyze and support these conversations.

Patient Experience Mapping: Energizing Care Models

To achieve the Triple Aim, strong health systems are redesigning their care delivery models by borrowing ideas and lessons from three other industries: hotels, rental care agencies, and community banks. The common theme of this new design process is creative listening to the needs and concerns of “customers,” and then mapping a journey into an ideal situation where service users are not just satisfied, but delighted with the experience from all facets and angles.1 Mapping the experience for our health systems, however, must be a journey to a desired destination, the “Care Model.” While many models exist, you might start your conversations with the Mayo Clinic Model.2

A leading practitioner in the hotel industry, the Ritz Carlton Institute,3 provides a valued model for consumer delight that embraces such building blocks as: defining how to excel in “moments of truth” where clients interact with your service model; daily huddles among staff to remain focused on mission, vision, and values of service excellence, and reminders that every person on the team from receptionist, to phone operator, to surgeon can make or break the experience. Car rental agency ideas may be found here:

As banks parallel the regulated operations of hospitals, and require multiple levels of consumer interactions over long periods of time, their mapping techniques are also valuable to consider here.

Our journeys into population health will be more successful when physician leaders champion the mapping of high priority chronic diseases, like diabetes. Experience maps are also being used in the National Health Service in England.4

Physician Hospital Compacts: Explicit Guiding Principles

Having a map to guide the journey into an ideal care experience is only part of the challenge. Implementation success demands that all members of the care team have performed their work guided by a culture that is patient-centered, mission driven, and value-based. Such a culture needs explicit and balanced roles among physicians and advanced practice providers, with administrative and board leaders. Like an orchestral score, real music is more likely when these leaders define their expected roles within “compacts” or a set of clear responsibilities and behavior guiding principles. The Virginia Mason Medical Center provides a powerful set of these shared expectations in a set of responsibilities for three pairs of collaboration: physicians and the organization; administrative leaders and the organization; and board members and the organization.

Insert three tables here with balanced roles

Dyad Leadership Models: Positive Partnering

While the care model and experience maps are necessary for a journey into population health and accountable care, they are not sufficient for sustainable success. Many integrated health systems are relying on unique “Dyad Partnerships” between clinical and administrative leaders.5

These co-managed models have at least these three key characteristics:

1.    Each member of the Dyad has a clear position description with measureable performance results that are assessed and celebrated quarterly for refined behaviors and intentional professional development;

2.    Each member needs to like and respect the capabilities of the other as they provide visible behavior modeling for high quality and safe, patient-centered, service excellence and cost-effective processes; and

3.    The Dyad pair creates the conditions within which a team of care providers guides patients and their families through disciplined experience maps and that balance accountabilities of the care team and the patient for optimal health status improvement.

How is your organization investing at the intersection of these three elements for success: (1) A Clear Care Model, (2) Explicit Patient Experience Maps by type of patient and medical condition, and (3) Talented Dyad Leadership?

Contact us to assess your current situation and explore with you the practical ways to enhance the success of your journey into value-based payment and population health.


James A. Rice

Jim Rice, PhD, FACHE is the Managing Director & Practice Leader with the Governance & Leadership service line of Gallagher’s Human Resources & Compensation Consulting practice. He focuses his consulting work on strategic governance structures and systems for high performing, tax-exempt nonprofit, credit union and health sector organizations and integrated care systems; visioning for large and small not-for-profit organizations; and leadership development for Boards and C-Suite Senior Leaders. 

Dr. Rice holds masters and doctoral degrees in ...

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