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From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More then Technology

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The big first step toward building an outcomes improvement program is installing the analytics platform. But it’s certainly not the only step. Sustaining healthcare outcomes improvement is a triathlon, and the three legs are:

Installing an analytics platform
Gaining adoption
Implementing best practices

The program requires buy-in, enthusiasm, even evangelizing of analytics and its tools throughout the organization. It also requires that learnings from analysis translate into best practices, otherwise the program fails to produce results and will eventually fade away. Equally important is that top-level leadership across the organization, not just IT, supports and promotes the program ongoing. We explore each of the elements and how they come together to create successful and sustainable outcomes improvement that defines leading healthcare organizations.

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From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More then Technology

  1. 1. From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More than Technology ̶ Drew Cardon
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Sustainable Change in a Healthcare System Igniting change and outcomes improve- ment within a healthcare system requires three unique elements. It’s well accepted that an analytics platform, with its enterprise data warehouse (EDW) and advanced analytics applications plays a pivotal role. Two other elements—adoption of analytics across the enterprise and converting data-driven discoveries to best practices—are essential for sustaining healthcare outcomes improvement.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices The analytics platform is crucial for driving any outcomes improvement initiative, especially over time. Let’s look at three scenarios that show why it must be supported by an adoption methodology and best practices implementation: • Without adoption • Without best practices • Without analytics
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without adoption Focusing on best practices and analytics is insufficient. Without adoption, the organization ends up with solutions that never quite create a lasting impact across the organization as a whole. While research-focused organizations have good intentions to use research to feed the creation of best practices, they are often prone to academically appealing ideas with little regard for practical application.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without adoption Sometimes organizations focus squarely on the technical and analytical aspects of improving outcomes. These tend to manifest symptoms of large report queues and dashboards. It’s the mentality that says, “if we build it, they will come!” But without input and buy-in of the right stakeholders, the organization creates many technical solutions that end up on the shelf.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without adoption Finally, there are organizations that are able to adequately merge the two other systems of analytics with best practices, but don’t have the expertise to get widespread adoption. They create successful “science projects,” limited pockets of excellence, then find themselves unable to rollout improvements across the organization.
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without best practices If the organization implements an adoption system and analytics, but doesn’t include best practices, it may end up with consistent practices. But not the right practices, i.e., a standardized status quo rather than continuous improvement. We affectionately call this the “paved cow paths” approach because processes are automated and adopted, but not truly improved.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without best practices To avoid these symptoms, we advocate permanent teams consisting of frontline individuals with deep subject matter expertise. Another symptom could be clinician’s disengagement of management’s “flavor of the month,” where there is missing evidence in the data and missing proof of best practice. To outperform competitors you must be dedicated to delivering the best care.
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Requires Adoption and Best Practices Without analytics If best practices and a system to spread adoption are implemented, but ignore analytics, it has no way to measure effectiveness. Improvement projects chosen will tend to be based on who shouts the loudest rather than focusing its resources on areas with the most variability in quality and cost. Organizations without a robust analytics system experience unsustainable improvements after only a couple of projects because they don’t have the automated capabilities to scale.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Most organizations understand the need for an analytics system, but many fail to implement an adoption and best practice system to feed and nurture the technical aspects of an improvement project. Let’s touch on the challenges of implementing these two critical systems and then I’ll reveal the characteristics of organizations that implement them successfully.
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption Without adoption, even the best data- driven improvement projects can stall. Health Catalyst is working with Piedmont Healthcare, an integrated delivery system with six hospitals and close to 100 clinics in Georgia. It is a perfect example of how adoption is so important to process improvement, and is a great success story of sepsis care improvement.
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption Piedmont organized a cross-functional team consisting of innovative clinicians and frontline staff, supported by analytical and process improvement personnel. As the workgroup built out the solution, they were constantly feeding the improvements up the chain so those improvements could be vetted and implemented across each hospital in the Piedmont system.
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption Piedmont brought in Health Catalyst’s Sepsis Improvement application and then went through a data validation process to gain comfort with the data being presented. Data validation can literally paralyze a project when there is too much focus on getting things exactly correct, so the workgroup was careful to do just enough validation to garner a high level of ownership and engagement, aka adoption.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption Based on the data and their own knowledge of clinical workflow, the Piedmont team made initial decisions about where to focus improvement efforts. This group was also tasked with determining how to implement best practices that would drive the desired improvement. To gain buy-in and receive valuable feedback, the workgroup presented its recommendations to peers.
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption This physician-led process ensured the perspectives of all key stakeholders informed any changes to a clinical or operational process. It gave clinicians an opportunity to “fingerprint” new processes—to give their feedback and make the process their own. This is more than just coming up with goals and metrics. It is about using the team’s knowledge and expertise to drive out waste and improve processes.
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption For example, Piedmont wanted to do more than simply track how well they were responding to system alerts. We put the data to work by establishing a baseline, identifying parameters for improving alert sensitivity, and implementing triage and system alert training. Piedmont also wanted to improve its 3-hour and 6-hour bundle compliance, so we used the EDW to track order set utilization and standard notes and assessments.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Gaining Adoption Over the years, we have seen these physician-led workgroups achieve incredible, sustainable quality improvements. On the other hand, we see quality improve- ment projects flounder when driven by IT. Clinicians tend to view such projects as imposed from the outside by people who don’t understand clinical workflow. Physician leadership and enthusiasm are absolutely essential to driving adoption system-wide.
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices In U.S. healthcare, spending waste is estimated at $1 trillion a year. Best practices are a key to transform- ing healthcare and reducing waste. So why is it so hard to implement best practices throughout an organization? Why does it take an average of 17 years for a newly discovered best practice to become standard practice in healthcare?
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices One of the biggest reasons is simply a matter of human nature: most of us are comfortable with the status quo. Physicians like to do things the way they’ve always done them and don’t like to change. Comfort with the status quo isn’t limited to physicians. Fewer than 20 percent of people tend to be innovators or early adopters. The rest of us are slower to adopt new practices.
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices It’s hard for us to overcome personal habit and preference. From the organizational perspective, it’s even harder to overcome institutionalized inertia. For this reason, it is essential to identify influential physician innovators and early adopters who can help spread information about, and enthusiasm for, a new best practice.
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices The Piedmont sepsis improvement project stands as a success story of best practices implementation. The improvement team used the Sepsis Improvement application to show all stakeholders precisely how well Piedmont was adhering to the best practice 3-hour bundle, responses to early sepsis alerts, and how this performance directly impacted length-of-stay, mortality, cost, and patient outcomes.
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices When clinicians were informed by this accurate, near real-time individual feedback, they were motivated to make adjustments to their practice. But a lack of resources has historically been a challenge to implementing best practices in healthcare organizations. Some organizations are able to dedicate resources to discovering best practices. Others simply don’t have those kinds of resources.
  23. 23. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges of Implementing the Two Elements Implementing Best Practices The best analytics vendors help organizations overcome that barrier. They come equipped with best- practice order sets and other analytic intellectual property for use by healthcare organizations. Physician-led workgroups that form into permanent teams can then take these standard best practices and adapt them for the particular needs of their organization.
  24. 24. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Connecting All the Pieces of the Outcomes Improvement Puzzle Organizations that successfully and sustainably improve outcomes understand that the analytics system is not an end in and of itself, but a means to an end. They understand that adoption and best practice systems are also essential. These organizations’ improvement projects are not driven by IT. Executives (and especially the chief medical officer) are engaged and involved in the project.
  25. 25. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Connecting All the Pieces of the Outcomes Improvement Puzzle At the same time, these organizations have grassroots champions and clinician leaders on the frontlines of care who help elicit enthusiasm and drive adoption. Engaged clinicians keep patient needs in their sights at all times and don’t get distracted by the bells and whistles of new technology.
  26. 26. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Connecting All the Pieces of the Outcomes Improvement Puzzle Finally, successful organizations do not have an “if you build it, they will come” mentality. They know that gaining adoption requires concerted effort and establishing new organizational structures. They’re not afraid to break from the status quo or try a new intervention to improve care processes. Instead, they’re willing to break down barriers and disrupt inertia.
  27. 27. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  28. 28. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More than Technology Outcomes Improvement: What You Get When You Mix Good Data with Physician Engagement Paul Horstmeier, Senior Vice President Moving Healthcare Outcomes Improvement Projects to the Finish Line Dr. Bill Knowles, Senior Director of Client Engagement 7 Features of Highly Effective Outcomes Improvement Projects Brant Avondet, Vice President of Client Operations The Top 7 Outcome Measures and 3 Measurement Essentials Ann Tinker, Engagement Executive, VP Delivering Excellence: How Stanford Health Care Uses Analytics to Improve Outcomes Paul Horstmeier, Senior Vice President
  29. 29. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Drew Cardon joined Health Catalyst in November 2011 as a data architect. Prior to this, he worked for nine years in the state tax and revenue industry as a project manager and implementation consultant with Accenture, and later with Fast Enterprises. He was involved in the installation of large information technology systems for the State Tax Commissions in Arizona, Utah, and Oklahoma. He holds a Bachelor’s degree in business from Brigham Young University and an MBA from the University of Notre Dame. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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