Three Steps to Prioritize Clinical Quality Improvement in Healthcare

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© Health Catalyst. Confidential and Proprietary.
Three Steps to Prioritize
Clinical Quality
Improvement in Healthcare
© Health Catalyst. Confidential and Proprietary.
Bobbi Brown, MBA
Senior Vice President
Article
Summary
Healthcare organizations today have access to so much data from
across their systems that they may struggle to know where to focus
quality improvement efforts. An analytic framework and a stepwise
process ensures organizations have broad data access and can
identify the most significant opportunities for impact. With a
strategic, data-informed approach to clinical quality improvement,
health systems can consume fewer resources, discover cost
savings, and improve ROI and the quality of care.
Three steps comprise an effective quality improvement process:
1 2 3
Adopt a
healthcare-
specific, open,
scalable data
platform.
Identify
improvement
priorities using
the 80-20 rule.
Gain consensus
from clinical
teams on
specific projects
and goals.
© Health Catalyst. Confidential and Proprietary.
Three Steps to Prioritize Clinical Quality Improvement in Healthcare
There’s a lot of discussion in today’s marketplace about clinical quality
improvement in healthcare. But with so much data from various systems,
such as administrative, research, clinical, human resources, etc., how do
healthcare leaders begin to identify where to focus their quality
improvement efforts?
Before launching quality improvement, organizations can eliminate the
guesswork with an analytic framework, such as the Healthcare Analytics
Adoption Model, and use quality data to drive any improvement
decisions. By systematically advancing through the nine levels of the
adoption model, any health system can use its data to streamline
processes and accomplish the following:
 Consume fewer resources.
 Discover cost savings.
 Improve ROI.
 Improve the quality of care.
Where to Focus
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for
Clinical Quality
Improvement in Healthcare
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
With analytic resources in place, health
systems can follow three steps for effective
clinical quality improvement in healthcare:
1. Adopt a healthcare-specific, open, scalable
data platform.
2. Identify improvement priorities using the
80-20 rule
3. Gain consensus from clinical teams on
specific projects and goals.
Effective Clinical Quality Improvement
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
A fundamental first step in quality
improvement is adopting a healthcare-
specific, open, flexible, and scalable data
platform (e.g., the Health Catalyst Data
Operating System (DOS™), Figure 1).
Quality improvement success relies on the
data platform because this resource
extracts data from transactional source
systems, combines disparate data sets into
one source of truth, and queries the
dataset directly. With a single source of
truth, organizations have the foundation to
drive clinical quality improvement
initiatives and identify the areas in the
organization that will yield the most
significant improvements.
Step 1: Adopt a Healthcare-Specific, Open, Scalable Data Platform
Figure 1: DOS.
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
Many health systems have limited resources and can’t tackle all areas that need
improvement at once. Instead, organizations can use a Key Process Analysis
(KPA) application to focus their scarce resources where they’ll be most effective.
The KPA tool uses the 80-20 rule (also known as the Pareto Principle) to identify
the 20 percent of care processes that 80 percent of resources consume.
Specifically, the KPA tool identifies the clinical processes with the highest
variation and highest resource consumption. The tool combines clinical, billing,
and costing data and links ICD-10 codes and all patient refined diagnosis-related
groups (APR-DRGs) and other risk models. Additionally, the KPA application sorts
each patient encounter into a three-tiered hierarchy:
1. Clinical program (e.g., orthopedics).
2. Clinical family (e.g., joint).
3. Clinical work process (e.g., hips or knees).
Step 2: Identify Improvement Priorities Using the 80-20 Rule
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
Many health systems have limited resources and can’t tackle all areas that need
improvement at once. Instead, organizations can use a Key Process Analysis
(KPA) application to focus their scarce resources where they’ll be most effective.
The KPA tool uses the 80-20 rule (also known as the Pareto Principle) to identify
the 20 percent of care processes that 80 percent of resources consume.
Specifically, the KPA tool identifies the clinical processes with the highest
variation and highest resource consumption. The tool combines clinical, billing,
and costing data and links ICD-10 codes and all patient refined diagnosis-related
groups (APR-DRGs) and other risk models. Additionally, the KPA application sorts
each patient encounter into a three-tiered hierarchy:
1. Clinical program (e.g., orthopedics).
2. Clinical family (e.g., joint).
3. Clinical work process (e.g., hips or knees).
Step 2: Identify Improvement Priorities Using the 80-20 Rule
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
With clinical data arranged in the three tiers above and combined with financial
data, health systems can see which clinical programs, families, and work
processes present the greatest opportunity for quality improvement.
Improvement teams can then combine the analytical data with their knowledge
of the organization to answer essential questions like the following:
 Does the workgroup have the right leadership to make the change?
 What teams are formed and working successfully?
For example, the KPA tool might show that 10 of an organization’s costliest care
process families account for 48 percent of the direct variable cost in that health
system. By identifying the costliest areas of care and studying the variations,
improvement teams have identified potential focus areas. Insight into variation
gives health systems a starting point for improvement. From here, organizations
can follow the data and focus on the costliest clinical families, then move to
other process families as they improve those high-impact areas.
Step 2: Identify Improvement Priorities Using the 80-20 Rule
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
Organizing information with the KPA tool also
helps bring clinical teams on board with
improvement efforts. Not only can clinical teams
now view comprehensive data for the
organization, but they can also view data specific
to their specialty, which will help them define
areas for improvement.
For example, the KPA tool might produce a
visualization that plots clinical work processes
against two axes: the total variable direct cost for
all cases for that work process on the x-axis versus
severity-adjusted variation in variable cost on the
y-axis (Figure 2). The bubble size represents the
case count for that clinical work process, and the
upper right quadrant shows the work processes
with the highest variation and cost.
Step 3: Gain Consensus from Clinical Teams on Specific Projects and Goals
Figure 2: Clinical work processes plotted against the variable direct cost (x-axis)
and variation (y-axis).
© Health Catalyst. Confidential and Proprietary.
Follow Three Steps for Clinical Quality Improvement in Healthcare
The visualization in Figure 3 below displays the cost
variation for a specific APR-DRG according to
severity level. Each bubble represents a physician,
and the bubble size is the case count. The position
on the x-axis is the average variable direct cost per
case by physician. The y-axis represents severity.
Focusing on just the inlier for each level reveals
wide variation.
Additional work with clinical teams can determine
the root cause of the variations. Differences in
documentation practices cause some variations,
while in others, physicians and nurses deliver care
in different ways for the same type of patient and
condition. With team member consensus on
priorities, the clinical teams can help determine the
best ways to reduce variation while improving care.
Step 3: Gain Consensus from Clinical Teams on Specific Projects and Goals
Figure 3: Case count by severity level for each physician.
© Health Catalyst. Confidential and Proprietary.
Why the KPA Application
Is So Important in Clinical Quality
Improvement in Healthcare
© Health Catalyst. Confidential and Proprietary.
Why the KPA Application Is So Important in Clinical Quality
Improvement in Healthcare
As the healthcare industry continues
to move to value-based purchasing,
the transformation’s challenges will
persist. Focusing on clinical and cost
outcomes is critical. Having
infrastructure and applications in
place—such as an open data platform
and a KPA tool—can support
meaningful clinical quality
improvement by enabling broad data
access and identifying the most
significant opportunities for impact.
Clinical and Cost Outcomes
© Health Catalyst. Confidential and Proprietary.
1 How to Find the Best Interventions for Clinical
Quality Improvement
3 Six Steps Towards Meaningful, Ongoing Healthcare
Performance Improvement
2 Why Clinical Quality Should Drive Healthcare Business Strategy
Here Are Some Articles We Suggest
Additional Reading
4 The Able Health Quality Measures Solution: Why a
Comprehensive Approach Matters
5 The Top Seven Healthcare Outcome Measures and Three
Measurement Essentials
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Three Steps to Prioritize Clinical Quality Improvement in Healthcare

  • 1. © Health Catalyst. Confidential and Proprietary. Three Steps to Prioritize Clinical Quality Improvement in Healthcare
  • 2. © Health Catalyst. Confidential and Proprietary. Bobbi Brown, MBA Senior Vice President
  • 3. Article Summary Healthcare organizations today have access to so much data from across their systems that they may struggle to know where to focus quality improvement efforts. An analytic framework and a stepwise process ensures organizations have broad data access and can identify the most significant opportunities for impact. With a strategic, data-informed approach to clinical quality improvement, health systems can consume fewer resources, discover cost savings, and improve ROI and the quality of care. Three steps comprise an effective quality improvement process: 1 2 3 Adopt a healthcare- specific, open, scalable data platform. Identify improvement priorities using the 80-20 rule. Gain consensus from clinical teams on specific projects and goals.
  • 4. © Health Catalyst. Confidential and Proprietary. Three Steps to Prioritize Clinical Quality Improvement in Healthcare There’s a lot of discussion in today’s marketplace about clinical quality improvement in healthcare. But with so much data from various systems, such as administrative, research, clinical, human resources, etc., how do healthcare leaders begin to identify where to focus their quality improvement efforts? Before launching quality improvement, organizations can eliminate the guesswork with an analytic framework, such as the Healthcare Analytics Adoption Model, and use quality data to drive any improvement decisions. By systematically advancing through the nine levels of the adoption model, any health system can use its data to streamline processes and accomplish the following:  Consume fewer resources.  Discover cost savings.  Improve ROI.  Improve the quality of care. Where to Focus
  • 5. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare
  • 6. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare With analytic resources in place, health systems can follow three steps for effective clinical quality improvement in healthcare: 1. Adopt a healthcare-specific, open, scalable data platform. 2. Identify improvement priorities using the 80-20 rule 3. Gain consensus from clinical teams on specific projects and goals. Effective Clinical Quality Improvement
  • 7. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare A fundamental first step in quality improvement is adopting a healthcare- specific, open, flexible, and scalable data platform (e.g., the Health Catalyst Data Operating System (DOS™), Figure 1). Quality improvement success relies on the data platform because this resource extracts data from transactional source systems, combines disparate data sets into one source of truth, and queries the dataset directly. With a single source of truth, organizations have the foundation to drive clinical quality improvement initiatives and identify the areas in the organization that will yield the most significant improvements. Step 1: Adopt a Healthcare-Specific, Open, Scalable Data Platform Figure 1: DOS.
  • 8. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare Many health systems have limited resources and can’t tackle all areas that need improvement at once. Instead, organizations can use a Key Process Analysis (KPA) application to focus their scarce resources where they’ll be most effective. The KPA tool uses the 80-20 rule (also known as the Pareto Principle) to identify the 20 percent of care processes that 80 percent of resources consume. Specifically, the KPA tool identifies the clinical processes with the highest variation and highest resource consumption. The tool combines clinical, billing, and costing data and links ICD-10 codes and all patient refined diagnosis-related groups (APR-DRGs) and other risk models. Additionally, the KPA application sorts each patient encounter into a three-tiered hierarchy: 1. Clinical program (e.g., orthopedics). 2. Clinical family (e.g., joint). 3. Clinical work process (e.g., hips or knees). Step 2: Identify Improvement Priorities Using the 80-20 Rule
  • 9. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare Many health systems have limited resources and can’t tackle all areas that need improvement at once. Instead, organizations can use a Key Process Analysis (KPA) application to focus their scarce resources where they’ll be most effective. The KPA tool uses the 80-20 rule (also known as the Pareto Principle) to identify the 20 percent of care processes that 80 percent of resources consume. Specifically, the KPA tool identifies the clinical processes with the highest variation and highest resource consumption. The tool combines clinical, billing, and costing data and links ICD-10 codes and all patient refined diagnosis-related groups (APR-DRGs) and other risk models. Additionally, the KPA application sorts each patient encounter into a three-tiered hierarchy: 1. Clinical program (e.g., orthopedics). 2. Clinical family (e.g., joint). 3. Clinical work process (e.g., hips or knees). Step 2: Identify Improvement Priorities Using the 80-20 Rule
  • 10. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare With clinical data arranged in the three tiers above and combined with financial data, health systems can see which clinical programs, families, and work processes present the greatest opportunity for quality improvement. Improvement teams can then combine the analytical data with their knowledge of the organization to answer essential questions like the following:  Does the workgroup have the right leadership to make the change?  What teams are formed and working successfully? For example, the KPA tool might show that 10 of an organization’s costliest care process families account for 48 percent of the direct variable cost in that health system. By identifying the costliest areas of care and studying the variations, improvement teams have identified potential focus areas. Insight into variation gives health systems a starting point for improvement. From here, organizations can follow the data and focus on the costliest clinical families, then move to other process families as they improve those high-impact areas. Step 2: Identify Improvement Priorities Using the 80-20 Rule
  • 11. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare Organizing information with the KPA tool also helps bring clinical teams on board with improvement efforts. Not only can clinical teams now view comprehensive data for the organization, but they can also view data specific to their specialty, which will help them define areas for improvement. For example, the KPA tool might produce a visualization that plots clinical work processes against two axes: the total variable direct cost for all cases for that work process on the x-axis versus severity-adjusted variation in variable cost on the y-axis (Figure 2). The bubble size represents the case count for that clinical work process, and the upper right quadrant shows the work processes with the highest variation and cost. Step 3: Gain Consensus from Clinical Teams on Specific Projects and Goals Figure 2: Clinical work processes plotted against the variable direct cost (x-axis) and variation (y-axis).
  • 12. © Health Catalyst. Confidential and Proprietary. Follow Three Steps for Clinical Quality Improvement in Healthcare The visualization in Figure 3 below displays the cost variation for a specific APR-DRG according to severity level. Each bubble represents a physician, and the bubble size is the case count. The position on the x-axis is the average variable direct cost per case by physician. The y-axis represents severity. Focusing on just the inlier for each level reveals wide variation. Additional work with clinical teams can determine the root cause of the variations. Differences in documentation practices cause some variations, while in others, physicians and nurses deliver care in different ways for the same type of patient and condition. With team member consensus on priorities, the clinical teams can help determine the best ways to reduce variation while improving care. Step 3: Gain Consensus from Clinical Teams on Specific Projects and Goals Figure 3: Case count by severity level for each physician.
  • 13. © Health Catalyst. Confidential and Proprietary. Why the KPA Application Is So Important in Clinical Quality Improvement in Healthcare
  • 14. © Health Catalyst. Confidential and Proprietary. Why the KPA Application Is So Important in Clinical Quality Improvement in Healthcare As the healthcare industry continues to move to value-based purchasing, the transformation’s challenges will persist. Focusing on clinical and cost outcomes is critical. Having infrastructure and applications in place—such as an open data platform and a KPA tool—can support meaningful clinical quality improvement by enabling broad data access and identifying the most significant opportunities for impact. Clinical and Cost Outcomes
  • 15. © Health Catalyst. Confidential and Proprietary. 1 How to Find the Best Interventions for Clinical Quality Improvement 3 Six Steps Towards Meaningful, Ongoing Healthcare Performance Improvement 2 Why Clinical Quality Should Drive Healthcare Business Strategy Here Are Some Articles We Suggest Additional Reading 4 The Able Health Quality Measures Solution: Why a Comprehensive Approach Matters 5 The Top Seven Healthcare Outcome Measures and Three Measurement Essentials