Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Quality Improvement In Healthcare: Where Is The Best Place To Start?

191,146 views

Published on

One of the biggest challenges providers face in their quality improvement efforts is knowing where to get started. In my experience, one of the best ways to overcome that “where do we begin?” factor is by using data from an enterprise data warehouse to look for high-cost areas where there are large variations in how health care is delivered. Variation found through the KPA is an indicator of opportunity. The more avoidable variation that is reflected in a particular care process, the more opportunity there is to reduce that variation and standardize the process. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. You will also want to take into consideration the readiness/openness to change in each of those areas.

Published in: Healthcare

Quality Improvement In Healthcare: Where Is The Best Place To Start?

  1. 1. Quality Improvement in Healthcare: Where is the Best Place to Start? -Eric Just VP of Technology
  2. 2. Quality Improvement Challenges © 2014 Health Catalyst www.healthcatalyst.com Where to start is the biggest challenge providers face when setting out on a quality improvement initiative. With so many processes across healthcare systems, determining where to get the most benefit can be difficult. Consider the following analogy: Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  3. 3. Quality Improvement Challenges Eric Just and brother on commercial expedition in Long Island Sound. © 2014 Health Catalyst www.healthcatalyst.com Fisherman rely on, and relish, intuition. Finding the best spot is part of the sport. Charter Skippers must leverage their experience and data to find the most productive fishing spots for their paying customers. Most skippers use the best fishing tool available to them—the fish finder. So what’s the “Fish Finder” for healthcare providers? Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  4. 4. Quality Improvement Challenges © 2014 Health Catalyst www.healthcatalyst.com Many providers overcome that “where do we begin?” factor by using an enterprise data warehouse to look for high-cost areas where large variations in health care is being experienced. Using a Key Process Analysis (KPA) allows you to quickly zero in on the biggest opportunities for improve-ment and waste elimination. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  5. 5. Why Variations Are Great Indicators Variation found through the KPA is an indicator of opportunity. The more avoidable variation is reflected in a particular care process, the more opportunity exists to reduce that variation and standardize the process. Generally, standardization is an indicator of efficiency. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  6. 6. Why Variations Are Great Indicators Efficiency hinges on scale and repeatability. That’s why it’s more efficient to build complex products such as cars and appliances on an assembly line. The more you have everyone following the same evidence-based procedures and processes, the more control you have – which translates into higher-quality outcomes. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  7. 7. The chart below shows a fictional analysis of the cost per case of vascular procedures. As you can see, the bulk of the bubbles in the chart fall right around the $20,000 range. That is the established norm in this hospital. With Dr. J’s surgical costs three times the $20,000 average, a substantial opportunity for improvement exists. At 15 surgeries a year the cost savings would be $600,000. © 2014 Health Catalyst www.healthcatalyst.com Practical Example Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Impacts of Cost Variation Wide variations in cost are usually associated with wide variations in health care quality. Reducing variations in cost will bring corresponding increases in quality. Using KPA methodology, look at data from many different areas, such as heart failure, diabetes, obstetrics, and orthopedic surgery, to determine where first steps should be taken. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Adjusting for Severity While a KPA provides a valuable top-line view, you’ll want to avoid the temptation to use it as an excuse to punish individual providers. There may be a good reason those outliers are showing up where they are. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  10. 10. Looking back at Dr. J from our example: Even though the cost for procedures was 3X the norm there may be valid reasons. He might be drawing the toughest and most complex cases from all over the world. He may be a world renowned surgeon and his international reputation brings much prestige to the hospital. © 2014 Health Catalyst www.healthcatalyst.com Adjusting for Severity Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  11. 11. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. Variation analysis is the voice of the data, but it must be balanced with the voice of the institution. © 2014 Health Catalyst www.healthcatalyst.com Determining Where to Start Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  12. 12. You wouldn’t think of starting a commercial fishing company without a fish finder. The same thinking should apply to a process improvement initiative. A KPA designed to uncover significant variations can help you identify your greatest opportunities for improvement and serve as the map to help you get started. © 2014 Health Catalyst www.healthcatalyst.com Let Variation Be Your Map Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Link to original article for a more in-depth discussion. Quality Improvement in Healthcare: Where is the Best Place to Start? More about this topic Driving Out Waste: A Framework to Enhance Value in Clinical Care (HFMA) Dr. David Burton, Senior VP and Former CEO How Clinical Analytics Will Improve the Cost and Quality of Healthcare Delivery Dan Burton, CEO How Analytics Will Lower Waste and Reduce Costs for the Healthcare Industry Bobbi Brown, VP of Financial Engagement 3 Steps to Prioritize Clinical Quality Improvement in Healthcare Bobbi Brown, VP of Financial Engagement Key Steps that help Clinical Improvement Projects Reduce Waste Ann Tinker, VP for Customer Engagement Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com For more information: Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  15. 15. Other Clinical Quality Improvement Resources Eric Just joined the Health Catalyst family in August of 2011 as Vice President of Technology, bringing over 10 years of biomedical informatics experience. Prior to Catalyst, he managed the research arm of the Northwestern Medical Data Warehouse at Northwestern University's Feinberg School of Medicine. In this role, he led the development of technology, processes, and teams to leverage the clinical data warehouse. Previously, as a senior data architect, he helped create the data warehouse technical foundation and innovated new ways to extract and load medical data. In addition, he led the development effort for a genome database. Eric holds a Master of Science in Chemistry from Northwestern University and a Bachelors of Science in Chemistry from the College of William and Mary. © 2014 Health Catalyst www.healthcatalyst.com Click to read additional information at www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

×