Quality & Process Improvement


Health Catalyst Editors

Emergency Department Quality Improvement: Transforming the Delivery of Care

Overcrowding in the emergency department has been associated with increased inpatient mortality, increased length of stay, and increased costs for admitted patients. ED wait times and patients who leave without seeing a qualified medical provider are indicators of overcrowding. A data-driven system approach is needed to address these problems and redesign the delivery of emergency care.
This article explores common problems in emergency care and insights into embarking on a successful quality improvement journey to transform care delivery in the ED, including an exploration of the following topics:

A four-step approach to redesigning the delivery of emergency care.
Understanding ED performance.
Revising High-Impact Workflows.
Revising Staffing Patterns.
Setting Leadership Expectations.
Improving the Patient Experience.

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Curt Sellke

Healthcare Project Management Techniques: A Pragmatic Approach to Outcomes Improvement

Project management skills and good project managers are increasingly important to the healthcare industry because they can help control costs, manage risk, and speed improvement project outcomes. By applying project management techniques, from waterfall to agile methodologies, organizations can plan, organize, and execute a set of tasks efficiently in order to maximize resources and achieve specific goals.
This article explores project management techniques and offers considerations for healthcare leaders when adapting these techniques for clinical, financial, and operational process improvement. The author also shares a pragmatic application and practical tips for implementing these project management techniques in a healthcare environment.

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Health Catalyst

Lean Healthcare: 6 Methodologies for Improvement from Dr. Brent James

The survival of healthcare organizations depends on applying lean principles. Organizations that adopt lean principles can reduce waste while improving the quality of care. By applying stringent clinical data measurement approaches to routine care delivery, healthcare systems identify best practice protocols and incorporate those into the clinical workflow. Data from these best practices are applied through continuous-learning loop that enables teams across the organization to update and improve protocols–ultimately reducing waste, lowering costs, and improving access to care.
This executive report based on a presentation by Dr. Brent James at a regional medical center, covers the following:

How lean healthcare principles can help improve the quality of care.
The steps healthcare organizations need to take to create a continuous-learning loop.
How a lean approach creates financial leverage by eliminating waste and improving net operating margins and ROI.

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Lloyd Provost

Four Essential Ways Control Charts Guide Healthcare Improvement

Control charts are a critical asset to any health system seeking effective, sustainable improvement. With a simple three-line format, control charts show process change over time, including the average of the data, upper control limit, and lower control limit. This insight helps improvement teams monitor projects, understand opportunities and the impact of initiatives, and sustain improved processes.
Also known as Shewhart charts or statistical process control charts, control charts drive effective improvement by addressing three fundamental questions:

What is the goal of the improvement project?
How will the organization know that a change is an improvement?
What change can the organization make that will result in improvement?

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John Haughom, MD

Five Deming Principles That Help Healthcare Process Improvement

Dr. John Haughom explains 5 key Deming processes that can be applied to healthcare process improvement. These include 1) quality improvement as the science of process management, 2) if you cannot measure it, you cannot improve it, 3) managed care means managing the processes of care (not managing physicians and nurses), 4) the importance of the right data in the right format at the right time in the right hands, and 5) engaging the “smart cogs” of healthcare.

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Ann Tinker, MSN, RN
Dan Hopkins

Transforming Healthcare Analytics: Five Critical Steps

By committing to transforming healthcare analytics, organizations can eventually save hundreds of millions of dollars (depending on their size) and achieve comprehensive outcomes improvement. The transformation helps organizations achieve the analytics efficiency needed to navigate the complex healthcare landscape of technology, regulatory, and financial challenges and the challenges of value-based care.
To achieve analytics transformation and ROI within a short timeframe, organizations can follow five phases to become data driven:

Establish a data-driven culture.
Acquire and access data.
Establish data stewardship.
Establish data quality.
Spread data use.

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Lloyd Provost

A Guide to Applying Quality Improvement to Healthcare: Five Principles

Healthcare is an art and a science. What many in the industry don’t understand is that systems and processes can coexist with personalized care. Quality improvement methods can be as effective in healthcare as they have been in other industries (e.g., agriculture, manufacturing, etc.).
Quality improvement in healthcare is not just achievable, it’s an absolute necessity given the amount of wasteful spending in the U.S. on healthcare. Organizations can reduce this wasteful spending while improving their processes by applying these five guiding principles:

Facilitate adoption through hands-on improvement projects.
Define quality and get agreement.
Measure for improvement, not accountability.
Use a quality improvement framework and PDSA cycles.
Learn from variation in data.

By using these principles and starting small, organizations can quicken the pace of quality improvement in healthcare.

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Taylor Larsen

Why Health Systems Must Use Data Science to Improve Outcomes

In today’s improvement-driven healthcare environment, organizations must ensure that improvement measures help them reach desired outcomes and focus on the opportunities with optimal ROI. With data science-based analysis, health systems leverage machine learning to determine if improvement measures align with specific outcomes and avoid the risk and cost of carrying out interventions that are unlikely to support their goals.
There are four essential reasons that insights from data science help health systems implement and sustain improvement:

Measures aligned with desired outcomes drive improvement.
Improvement teams focus on processes they can impact.
Outcome-specific interventions might impact other outcomes.
Identifies opportunities with optimal ROI.

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John Hansmann, MSIE, LFHIMSS, DSHS

The Top 8 Skills Every Healthcare Process Improvement Leader Must Have

Healthcare process improvement leaders not only have to be a jack-of-all-trades, but they need to be a master, as well. This is one of the most important leadership roles in the healthcare system with responsibilities that can ultimately end up saving lives, improving the patient experience, improving caregiver job satisfaction, and reducing costs. Although there are many others, these eight skills are the most critical for the efficient, and ultimately, successful process improvement leader:

Trust Building
Understanding Process Management
Understanding Care Management Personnel
Constructive Accountability and Constructive Conflict
Resiliency and Persistency
Seeing the Big Picture

Along with the right training, education, and sponsorship, it’s easy to see why this role blends many elements of art and science.

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Aaron Neiderhiser
Dorian DiNardo

Introducing Touchstone: The Next-Generation Healthcare Benchmarking and Opportunity Prioritization Tool

To do healthcare benchmarking effectively and efficiently, healthcare organizations need to know where they’re underperforming, where they’re performing well, and how to focus and prioritize their improvement efforts. They also need a new approach to benchmarking that isn’t limited to the inpatient setting.
The Health Catalyst® Touchstone™ product is the next-generation healthcare benchmarking and prioritization tool that delivers what antiquated benchmarking technologies cannot:

Risk-adjusted benchmarking across the full continuum of care.
Artificial intelligence-powered recommendations.
Ranked lists of improvement opportunities.
Detailed analytics and an intuitive user interface that enable the easy exploration of factors driving performance issues.
Democratized benchmarking that’s available to as many people as the organization wants.

Touchstone was designed with many users and use cases in mind, from population health analysts looking to improve ACO performance to C-suite leaders who need a data-driven approach to prioritizing improvement opportunities.

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Bryan Oshiro, MD

6 Proven Strategies for Engaging Physicians—and 4 Ways to Fail

For healthcare organizations to be successful with their quality and cost improvement initiatives, physicians must be engaged with the proposed changes. But many physicians are not engaged because their morale is suffering. While some strategies to encourage buy-in for improvement initiatives don’t work, there are six strategies that have proven to be effective: (1) discover a common purpose, (2) adopt an engaging style, (3) turn physicians into partners, not customers, (4) segment the engagement plan, (5) use “engaging” improvement methods, and (6) provide them with backup—all the way to the board. Once the organization has their trust, physicians will gain enthusiasm to move forward with improvement efforts that will benefit everyone.

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David Grauer, MBA, MHSA
Tom Burton

Outcomes Improvement Governance: A Handbook for Success and Achieving More with Less

For healthcare organizations looking to achieve outcomes improvement goals, effective governance is the most essential must-have. This leadership culture ensures success by enabling health systems to invest in outcomes improvement and allocate resources appropriately toward these goals.
This executive report is an outcomes improvement governance handbook centered on four guiding principles (and associated helpful steps) health systems can follow to achieve effective governance and start achieving more with less:

Stakeholder engagement
Shared understanding

With these four principles, organizations can build a foundation of engagement and focus around the work, where they maximize strengths, and discover and address weaknesses. They establish an improvement methodology, define their goals, and sustain and standardize improvement work.

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Daniel Barlow, MD

Why Clinicians Are the Missing Link in Healthcare Quality Improvement and Three Principles to Solve the Problem

When it comes to successful quality improvement (QI) in healthcare, clinicians tend to be the missing link. Fortunately, the disconnect between QI initiatives and the day-to-day work of clinicians can be explained and resolved if health systems adopt and embrace three clinician-focused principles:

Principle #1: QI starts at the front line (initiatives should be identified and driven by clinicians).
Principle #2: QI makes it easy for clinicians to do the right thing (removes barriers to good work rather than increasing the amount of work clinicians do).
Principle #3: QI empowers clinicians to adapt care (even if it’s not QI protocol).

Although some clinicians are enthusiastic advocates of their systems’ QI efforts, most are suspicious because they’re frequently cut out of the decision-making process or forced to ignore their best clinical judgement. Health systems that work to close the gap between leaders and clinicians by embracing these three principles will add the missing link—clinicians—back into successful healthcare QI.

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Tom Burton

Data for Improving Healthcare vs. Data for Exasperating Healthcare Workers

For better or worse, hospitals are obligated to collect and report data for regulatory purposes. Or they feel compelled to meet some reputational metric. The problem is, an inordinate amount of time can be spent on what is considered data for accountability or punishment, when the real focus should be on data for learning and improvement. When time, effort, and resources are dedicated to the latter, it leads to real outcomes improvement.
Deming has three views of focusing on a process and this article applies them to healthcare:

Sub-optimization, over-emphasizing a single part at the expense of the whole.
Extreme over-emphasis, also called gaming the system.
The right amount of focus, the only path to improvement.

With data for learning as the primary goal, improving clinical, operational, and financial processes becomes an internal strategy that lifts the entire healthcare system.

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Kirstin Scott
Tracy Vayo

The Top Seven Analytics-Driven Approaches for Reducing Diagnostic Error and Improving Patient Safety

From a wrong diagnosis to a delayed one, diagnostic error is a growing concern in the industry. Diagnostic error consequences are severe—they are responsible for 17 percent of preventable deaths (according to a Harvard Medical Practice study) and account for the highest portion of total payments (32.5 percent), according to a 1986-2010 analysis of malpractice claims. Patient safety depends heavily on getting the diagnosis right the first time.
Health systems know reducing diagnostic error to improve patient safety is a top priority, but knowing where to start is a challenge. Systems can start by implementing the top seven analytics-driven approaches for reducing diagnostic error:

Use KPA to Target Improvement Areas
Always Consider Delayed Diagnosis
Diagnose Earlier Using Data
Use the Choosing Wisely Initiative as a Guide
Understand Patient Populations Using Data
Collaborate with Improvement Teams
Include Patients and Their Families

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Cherbon VanEtten
Sherry Martin

How to Create Change Agents Who Will Sustain those Hard-earned Healthcare Improvements

Establishing a healthcare improvement initiative is just the first step toward transformation. The real work of improvement lies in sustaining it, which is why qualified change agent are essential to meaningful progress.
Change agents are trained to lead organizations in:

Case for change
Data management
Change management concepts
Cost Benefit Analysis

Health Catalyst’s Accelerated Practices Program gives change agents adaptive leadership training to guide systemwide change within their organizations. They are prepared to meet technical adaptive challenges while keeping teams engaged and productive, and, importantly, to use data analysis to improve quality, cost, and patient satisfaction outcomes.

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Val Ulstad, MD, MPA, MPH

Leading Adaptive Change to Create Value in Healthcare

In pursuit of the Triple Aim, healthcare leaders work hard to improve care, reduce costs, and improve the patient experience. But accomplishing these goals requires an engaged staff that makes progress, day in and day out. Adaptive Leadership (AL) principles help leaders understand human behavior to mobilize change and overcome work avoidance, which happens when staff operate above or below the productive zone of tension.
By understanding what adaptive work actually is (and that adaptive problems can’t be solved with technical fixes), and why work avoidance happens (because people are overwhelmed; the heat is too high), leaders can keep their teams engaged by using influence and leadership—not authority—to “lower the heat” on their people:

Validate the difficulty of the situation.
Simplify/clarify the work.
Provide additional resources (time, training, etc.)

Dr. Ulstad has worked with healthcare leaders and teams for the last 20 years to help them understand behaviors triggered by rapid, high-volume change, and apply AL principles to guide the changes critical to their organizations’ success.

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Ann Tinker, MSN, RN
Leslie Falk

The Top Five Essentials for Outcomes Improvement

Outcomes improvement is complicated, but we’re beginning to understand what successful quality improvement programs have in common:

Adaptive leadership, culture, and governance
Evidence- and consensus-based best practices
Financial alignment

Although understanding the top five essentials for quality improvement in healthcare is key, it’s equally important to understand the most useful definitions and key considerations. For example, how different service delivery models (telemedicine, ACO, etc.) impact quality improvement programs and how quality improvement starts with an organization’s underlying systems of care.
This executive report takes an in-depth look at quality improvement with the goal of providing health systems with not only the top five essentials but also a more comprehensive understanding of the topic so they’re in a better position to improve quality and, ultimately, transform healthcare.

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Ed Corbett, MD

Standardized Care vs. Personalization: Can They Coexist?

Perceptions of standardization and personalization vary widely by healthcare industry role. Advocates of standardized care say it improves efficiency, outcomes, and patient safety. Advocates of personalization, however, don’t want to see a one-size-fits-all approach become the norm. They want to see a healthcare system in which physicians treat patients like unique individuals.
But what if standardization and personalization didn’t have to be mutually exclusive? What if these historically competitive approaches to care improvement could work together to improve care?
Dr. Corbett describes how health systems can prioritize standardization and personalization using data to bridge the gap. Data enables informed decision making, customized treatment plans, and patient engagement. It supports both standardization and personalization approaches in the ultimate quest for care delivery improvement.

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Tom Burton

Why Process Measures Are Often More Important Than Outcome Measures in Healthcare

The healthcare industry is currently obsessed with outcome measures — and for good reason. But tracking outcome measures alone is insufficient to reach the goals of better quality and reduced costs. Instead, health systems must get more granular with their data by tracking process measures. Process measures make it possible to identify the root cause of a health system’s failures. They’re the checklists of systematically guaranteeing that the right care will be delivered to every patient, every time. By using these checklists, organizations will be able to improve quality and cost by reducing the amount of variation in care delivery.

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Ann Frasher
Ann Tinker, MSN, RN

5 IT Must-Haves for Quality Initiatives in Healthcare

IT teams are the guardians of health system data. Their role in quality initiatives in healthcare is undeniable. Yet maximizing IT contributions to quality initiatives requires a shift in IT’s traditional role.
Traditionally supporters of data governance, security, privacy, and access—all important for achieving quality initiatives—IT teams need to do more. They need to integrate five must-haves:

Real-time feedback
Interoperable infrastructure
Data best practices
Engaged frontline staff

The industry is up against expanding regulatory requirements that will place high demands on IT teams, including ONC’s goal to reduce the collection and reporting burden on providers. IT teams that embrace these five must-haves are best positioned to create user-centric tools and processes that reduce this burden.

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Cherbon VanEtten

The Best Way to Use Data to Determine Clinical Interventions

One of the most important aspects of managing clinical interventions is how you measure an intervention to determine if it is effective. A run chart is a very important tool for measuring improvement, but it doesn’t give you all the information you need to assess the effectiveness of your process change. The next step in maturation of your measurement process is creating a statistical process control (SPC) chart. An SPC chart shows you if your intervention is changing the process in a significant way or whether changes in the data just represent random variation.

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Paul Horstmeier

Michael Porter and Others Show How to Deliver Better Care in Value-based Healthcare Documentary

Healthcare organizations from Hamburg to Gothenburg to Boston are realizing the future of care delivery through a value-based approach, as portrayed in this video documentary featuring professor Michael Porter of the Harvard Business School. Measured Outcomes: A Future View of Value-Based Healthcare explains how value-based care is a methodology that involves standardizing outcome measurements, tracking them over the long term, and putting clinical teams in place with the longevity needed to build a sustainable program. More importantly, it is healthcare that matters most to patients because they report and track their own quality measurements, giving them a say in their own healthcare experience. Providers are winning, patients are winning, and the results for the organizations showcased in this video are remarkable, such as an 88 percent prostatectomy success rate for the Martini-Klinik in Hamburg, Germany, compared to a 32.8 percent rate for the rest of the country. And with just 10 surgeons on staff, they are doing more volume than any other facility in the world, by far, all attributable to their value-based approach.

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Steve Catmull

Patient Engagement And Outcomes Improvement from the Patient’s Perspective

Usually, when we think of the phrase “patient engagement,” we think of what providers and healthcare systems are doing to involve patients in their own care. Patient engagement is often defined as providing access to a patient portal or reaching out to patients through social media channels or via an organization’s website. But it’s also about patients proactively becoming involved in their own care, in partnership with their healthcare providers. Call it “DIY” or “personalized” medicine, but it can reduce preventable admissions and shorten lengths of stay. It can also significantly improve an individual’s outcomes and always creates better awareness of one’s symptoms and how they are changing. With proper tracking, patients can create a view of their personal data that enhances what’s conventionally available to their providers. This is one motivated patient’s account through an episode of personalized medicine.

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Jason Burke
Stephen Hess

Lean Principles in Healthcare: 2 Important Tools Organizations Must Have

The transition from fee-for-service to value-based reimbursement is driving many healthcare systems to fine-tune processes and work waste out of the system. In the search for quality improvement tools there has been much buzz surrounding lean, touted for its ability to remove waste from processes. Many have tried lean and, failing to achieve any sustainable benefit, are learning that applying lean principles to healthcare can be quite difficult. The lean approach isn’t a magic potion. Sustainable change will never become real without a committed organization dedicated to making it a reality. Lean, or any quality improvement tool, works in healthcare only when it is part of a larger initiative driving real cultural change.

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