Six Steps Towards Meaningful, Ongoing Healthcare Performance Improvement

Six Steps Towards
Meaningful, Ongoing
Healthcare Performance
Improvement

© 2021 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Six Steps to Healthcare Performance Improvement
Health systems primarily concentrate
performance improvement initiatives
around critical areas, including clinical
outcomes, patient experiences, and
organizational costs.
While this high-value improvement
approach has the potential for
significant impact, its long-term
success relies on strategic execution.

Six Steps to Healthcare Performance Improvement
Performance improvement efforts fall
short of their desired results when
organizations approach improvement
as a series of one-off projects.
To achieve an effective and sustainable
performance improvement, organizations
must develop and perform their initiatives
within an ongoing performance
infrastructure and program.

An Infrastructure for Ongoing Performance
Improvement Initiatives
The ongoing performance improvement
infrastructure comprises the following
three systems-based elements:
1. An analytic system
2. An adoption system
3. A best practice system

1. An analytics system to measure improvement.
A performance improvement analytics system
(e.g., the Health Catalyst Data Operating
System (DOS™)) integrates the organization’s
data sources (e.g., clinical, claims, financial,
operational, etc.) and facilitates quick,
accessible data sharing.

2. An adoption system to create permanent
cross-functional workgroup teams focused
on identifying, deploying, and monitoring
the effectiveness of quality improvements.
Interdisciplinary teams analyze the data
and discover patterns that lead to insights
and progress through different levels of
healthcare analytics, per the Healthcare
Analytics Adoption Model (Figure 1).

Level 9 Direct-to-Patient Analytics and Artificial Intelligence
Level 8 Personalized Medicine & Prescriptive Analytics
Level 7 Clinical Risk Intervention & Predictive Analytics
Level 6 Population Health Management & Suggestive Analytics
Level 5 Waste & Care Variability Reduction
Level 4 Automated External Reporting
Level 3 Automated Internal Reporting
Level 2 Standardized Vocabulary & Patient Registries
Level 1 Enterprise Data Operating System
Level 0 Fragmented Point Solutions
Figure 1: The Healthcare Analytics Adoption Model.

3. A best practice system to deploy a
data-driven approach to implementing
evidence-based best practices.

Six Steps to Implementing a Sustainable and
Impactful Performance Improvement Program
With the improvement infrastructure in place, healthcare organizations can
follow six steps for a sustainable, impactful performance improvement program:
Step 1:
Integrate
Performance
Improvement
into Strategic
Objectives
Step 2:
Use Analytics to
Unlock Data and
Identify Areas of
Opportunity
Step 3:
Prioritize
Programs Using
a Combination
of Analytics and
an Adoption
System
Step 4:
Define the
Performance
Improvement
Program’s
Permanent
Teams
Step 5:
Use a Best-
Practice System
to Define
Program
Outcomes and
Interventions Step 6:
Estimate the
ROI

1: Integrate Performance Improvement into Strategic Objectives
Healthcare is a complex, adaptive system
comprised of interactions and relationships
between different components.
Health systems must integrate performance
improvement within the organization’s
strategic objectives (e.g., forming an ACO or
focusing on population health management).
Integrating performance improvement also
improves efficiency and focuses resources
on programs most likely to yield meaningful
overall benefit.

2: Use Analytics to Unlock Data and Identify Areas of Opportunity
An analytics application can help an organization
identify opportunities for improvement efforts by
uncovering variation.
Variation points to a potential for standardizing
processes because the existence of variation
inherently means that some care practices are
more efficient and produce higher-quality
outcomes than others.

There also is a greater likelihood that some
practices are not achieving optimum outcomes.
Hospitals and health systems will have a
significant opportunity for care improvement
if they can identify their highest-performing
practices and begin to make those practices
and evidence-based practices the standards
for all caregivers.

Variation in cost can be a good surrogate
for quality of care because the higher cost
may result from the delivery of inefficient
or unnecessary services.
As the prescribers of care, clinicians are
among the most significant influencers in
managing variable cost, representing the
direct cost.

By focusing on variable cost (i.e., looking
at the volume of procedures and cost per
procedure, in particular), they can identify
avoidable costs and begin working with
clinicians, using evidence-based
practices, to address them.

3: Prioritize Programs Using a Combination of Analytics and an Adoption System
Successfully improving clinical outcomes and
streamlining operations requires a strong
organizational commitment and changes in
culture, organizational structure, staff
education, and workflow processes.

Consequently, any organization that
embarks on a performance improvement
journey should first assess its readiness
for change.
Examples of criteria that an organizational
readiness assessment evaluates include
clinical leadership readiness, data
availability, shared vision, and admin-
istrative support (e.g., data manager,
outcomes analyst availability).

A readiness assessment helps the organiz-
ation determine how ready the teams are to
accept change, to estimate what, if any,
impact there is on staffing and the potential
implications for frontline caregivers.
Understanding the strategic objectives and
integrating results from a readiness
assessment and analytics help the
organization prioritize which care families
(clinical services) can be starting points.

4: Define the Performance Improvement Program’s Permanent Teams
The organization will require permanent
performance improvement teams to review
and analyze data, define evidence-based and
best practices, and monitor ongoing results.
Improvement teams should include the
following components:
 Guidance team
 Clinical improvement teams
 Workgroups

A guidance team should have accountability
for clinical quality across the continuum of
care in a specific domain (such as women
and children).
The primary role of such a team is to select
goals, prioritize work, allocate resources, and
remove barriers.
The guidance team then delegates account-
ability to clinical improvement teams to
improve care.

Clinical improvement teams typically report to a
physician and nurse and consist of frontline staff who
understand the processes targeted for improvement.
These teams define workgroup outputs and lead
process improvement implementation.
Whenever possible, clinical improvement teams
should represent a broad range of departments,
clinics, hospitals, and regions to help disseminate
knowledge across the organization.
These teams generally create workgroups to
perform detailed work.

Workgroups generally report to a physician
and nurse subject matter expert and include
best practices, analytics, and technical experts.
These teams frequently meet to analyze
processes and data and look for trends and
improvements.
Their role is to develop aim statements, identify
interventions, draft knowledge assets (e.g.,
order sets, patient safety protocols, etc.), define
the analytic system, and provide ongoing
feedback of the status of the care process
improvement initiatives.

5: Use a Best-Practice System to Define Program Outcomes and Interventions
The focus of performance improvement
initiatives for many organizations tends to
be on low-performance outliers—that is,
identifying instances where costs are much
higher and outcomes substantially poorer
than averages among caregivers.
However, a more effective approach is to
identify those practices that consistently
lead to the best outcomes and promote
them, with evidence-based guidelines, to
improve outcomes across the board—in
other words, best practices.

Step 6: Estimate the ROI
As the guidance team sets priorities for
performance improvement, the team may
also estimate the potential ROI for each
initiative based on available information.
The team can start by identifying
organizational costs and assessing
benefits using industry benchmarks for
similar projects, vendor case studies,
and internal estimates.

Most organizations will need to educate their
clinicians, operations, and finance depart-
ments on the value of sharing data and
working together on interdisciplinary teams
rather than keeping everything in silos.

Next, the team should identify direct benefits
and savings (either from enhanced efficiency
and productivity) or from clinical improvement
and waste reduction.
Then, the team can identify indirect benefits,
such as a reduction in future infections or an
improvement in patient satisfaction.
The team also should consider revenue
opportunities, such as higher market share
and patient volume, an increase in contract
compliance, or a reduction of bad debt.

Building the Framework for Healthcare
Performance Improvement Initiatives
Creating a foundation for sustainable
improvement and prioritizing initiatives
does not have to be overwhelming.
By following these steps and establishing
a framework for performance improvement
based on analytics, the right teams, and
evidence-based practices, an organization
can obtain the right tools to achieve and
sustain performance improvement gains
into the future.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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Health Catalyst Success Stories

Marlowe Dazley is Senior Vice President and Managing Director at Health Catalyst,
responsible for financial advisory services providing strategic financial management
expertise and consulting for healthcare payers and providers. Prior to joining Health
Catalyst, Marlowe lead PNC Bank’s healthcare consulting division. Mr. Dazley has 30
years of healthcare experience in various organizations, including the office of the
U.S. Surgeon General, managed care operations, finance, administration, and
consulting. He has worked as a healthcare consultant since 1996, for Ernst & Young in the Los
Angeles healthcare consulting practice, Phase 2 Consulting and Premier. Marlowe has participated in
numerous strategic planning engagements, mergers and acquisitions and performance improvement
initiatives and has led numerous financial turnarounds for clients across the country specializing in
healthcare strategy, revenue cycle improvement and financial operations initiatives. Mr. Dazley
received a dual Master of Business Administration and Master of Health Services Administration from
the University of Utah. He is a member of the Healthcare Financial Management Association and has
performed numerous speaking engagements at local regional, and national levels for HFMA including
HFMA’s Annual National Institute. In addition, he delivers numerous addresses to the University
Health System Consortium, State Hospital Associations, hospital boards and medical staff and various
other industry leaders.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Marlowe Dazley

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in
support of more than 65 million patients for organizations ranging from the largest US health system
to forward-thinking physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

Six Steps Towards Meaningful, Ongoing Healthcare Performance Improvement

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