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Hospitals and health systems face common challenges in making the transition to a delivery system characterized by value-based payments. Hospital and system trustees are faced with the daunting task of transforming business and health care delivery models to balance quality, cost, patient preferences and health status to achieve real value and outcomes. Balanced hospitals must have a thorough understanding of where they stand on this journey. Trustees need robust data as hospitals balance the drive to transform existing market forces.

Second-Curve Strategies

In 2011, the American Hospital Association Committee on Performance Improvement identified 10 must-do strategies for hospitals to survive and thrive in the changing environment. These strategies are described in a new report, "Hospitals and Care Systems of the Future." Additionally, four are high-priority strategies required to be successful in the transformation from the volume-based first curve to the value-based second curve:

  1. Aligning hospitals, physicians and other clinical providers across the continuum of care
  2. Utilizing evidence-based practices to improve quality and patient safety
  3. Improving efficiency through productivity and financial management
  4. Developing integrated information systems

To steer their organizations to the second curve, leaders must create and measure organized processes to transform their care delivery system. Health care organizations should base their care approach on value, integration and patient needs. Tools and resources that help to identify gaps and opportunities in an organization's transformation allow leaders to provide visionary and strategic thinking in the ever-changing health care landscape.

Second-Curve Metrics

A new AHA Hospitals in Pursuit of Excellence report, "Metrics for the Second Curve of Health Care," expands on the four must-do strategies and creates specific metrics to evaluate progress. "As hospital leaders, we need to ask ourselves if we are identifying and measuring health care delivery operations such as physician alignment and population health impact, which take us to the second curve," says James Diegel, chairman of the Committee on Performance Improvement and president and CEO of St. Charles Health System, Bend, Ore.

For example, the report identifies a metric for Strategy 2 as "active patient engagement in design and improvement." Activities that a hospital or health care system should undertake to meet this metric are:

  • Regularly using patient engagement strategies such as shared decision-making aids, shift-change reports at the bedside, patient and family advisory councils, and health and wellness programs;
  • Regularly measuring and reporting on patient and family engagement, and experiencing positive results.

To complement the report, trustees and senior leaders can use the "Second Curve Road Map for Health Care" to assess and score their organization's progress in meeting the second curve. The road map provides a comprehensive assessment of each of the four high-priority strategies with additional questions related to the other six strategies. Additionally, through its Hospitals in Pursuit of Excellence strategic platform to accelerate performance improvement, the AHA develops educational resources, including best practices, to help hospitals and health care systems bridge any gaps and successfully navigate the transformation to the second curve.

To view the report, go to To complete the online road map, go to

Thomas Duffy, M.P.H., ( is a program manager at the Health Research & Educational Trust, Chicago.