Outcomes Improvement

Insights

Health Catalyst Editors

A Framework for High-Reliability Organizations in Healthcare

Drs. Allen Frankel and Michael Leonard have developed a framework for creating high-reliability organizations in healthcare. This report, based on their 2018 webinar, covers the components and factors of this frame work, including:

Leadership
Transparency
Reliability
Improvement and Measurement
Continuous Learning
Negotiation
Teamwork and Communication
Accountability
Psychological Safety

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Elaine St. James, BSN, RN, CPHQ
Josh Ferguson
Nancy Casazza, BSN, MMI, RN

How to Achieve Your Clinical Data Analytics Goals

Healthcare organizations know that they need to an effective clinical data analytics strategy to improve and survive in today’s challenging environment. In order to make these necessary improvements, healthcare leaders need to establish clear goals for their clinical data analytics initiatives.
Achieving these goals requires clinical teams to clearly identify problems and plan for how to achieve them. This article walks improvement teams through sometimes confusing process of identifying problems, setting clear, achievable goals, and common pitfalls along the way. Topics covered include:

Six categories of clinical data.
Three types of goals: outcome, process, and balance.
How to write an outcome goal.
Internal vs. External Benchmarks.
Mitigation strategies.
Getting clinical buy-in.

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Ann Tinker, MSN, RN

The Top Seven Healthcare Outcome Measures and Three Measurement Essentials

Healthcare outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this article adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples. The top seven categories of outcome measures are:

Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging

CMS used these seven outcome measures to calculate overall hospital quality and arrive at its 2018 hospital star ratings. This article also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement.

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Kyle Salyers

How UPMC and Health Catalyst Improve Outcomes Using Innovation in Activity-based Costing

UPMC and Health Catalyst created a great business partnership focused on sharing risks and rewards to innovate how activity-based costing (ABC) is done in healthcare. The partners relied on complementary intellectual property, complementary talent, and complementary risks and rewards to drive benefits that extend beyond either organization’s borders. Health Catalyst licensed UPMC’s activity-based costing software, which served as the foundation for the Health Catalyst CORUS suite. Together, the partners will continue to work for innovations in ABC to drive outcomes improvements in healthcare.

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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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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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Dorian DiNardo
Aaron Neiderhiser

Prioritizing Healthcare Projects to Optimize ROI

Healthcare organizations have long relied on traditional benchmarking to compare their performance to others and determine where they can do better; however, to identify the highest ROI improvement opportunities and understand how to take action, organizations need more comprehensive data.
Next-generation opportunity analysis tools, such as Health Catalyst® Touchstone™, use machine learning to identify projects with the greatest need for improvement and the greatest potential ROI. Because Touchstone determines prioritization with data from across the continuum of care, users can drive improvement decisions with information appropriate to their patient population and the domains they’re addressing.

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Holly Rimmasch

Four Population Health Management Strategies that Help Organizations Improve Outcomes

Population health management (PHM) strategies help organizations achieve sustainable outcomes improvement by guiding transformation across the continuum of care, versus focusing improvement resources on limited populations and acute care. Because population health comprises the complete picture of individual and population health (health behaviors, clinical care social and economic factors, and the physical environment), health systems can use PHM strategies to ensure that improvement initiatives comprehensively impact healthcare delivery.
Organizations can leverage four PHM strategies to achieve sustainable improvement:

Data transformation
Analytic transformation
Payment transformation
Care transformation

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Kathleen Clary, BSN, MSN, DNP

Measuring the Value of Care Management: Five Tools to Show Impact

To earn legitimacy and resources within a healthcare organization, care management programs need objective, data-driven ways to demonstrate their success. The value of care management isn’t always obvious; while these programs may, in fact, be responsible for improvements in critical metrics, such as reducing readmissions, C-suite leaders need visibility into care management’s impact and processes to understand precisely how they’re improving care and lowering costs at their organizations.
Five analytics-driven technologies give healthcare leaders a comprehensive understanding of care management performance:

The Patient Stratification Application
The Patient Intake Tool
The Care Coordination Application
The Care Companion Application
The Care Team Insights Tool

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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:

Communication
Trust Building
Coaching
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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Heather Schoonover

Health Equity: Why it Matters and How to Achieve it

According to the Robert Wood Johnson Foundation, health equity is achieved when everyone can attain their full health potential and no one is disadvantaged from achieving this potential because of social position of any other socially defined circumstance.
Without health equity, there are endless social, health, and economic consequences that negatively impact patients, communities, and organizations. The U.S. ranks last on measures of health equity compared to other industrialized countries. Healthcare contributes to this problem in many ways, including ignoring clinician biases toward certain populations and overlooking the importance of social determinants of health.
Fortunately, there are effective, tested steps organizations can take to tackle their health inequities and disparities (e.g., incorporating nonmedical vital signs into their health assessment processes and partnering with community organizations to connect underserved populations with the services they need to be healthy). Some health systems, such as Allina Health, have achieved impressive results by making health equity a systemwide strategic priority.

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Kathleen Merkley, DNP, APRN, FNP

Sepsis Treatment: Target Five Key Areas to Improve Sepsis Outcomes

More people in the U.S. die from sepsis than from prostate cancer, breast cancer, and AIDS…combined. Although health systems continue working to improve outcomes for septic patients, there is tremendous room for improvement.
Preparing health systems to most effectively tackle sepsis starts with an awareness of consensus definitions of sepsis and continues with following evidence-based recommendations from credible organizations, such as the Surviving Sepsis Campaign and the Sepsis Alliance.
Distilling ever-evolving recommendations and best practices for sepsis is time intensive. This article facilitates healthcare’s distillation effort by highlighting the five key areas health systems can target to improve sepsis outcomes (based on evidence-based guidelines and Health Catalyst’s first-hand experience with healthcare partners):

Early ED recognition
Three-hour sepsis bundle compliance
Six-hour sepsis bundle compliance
In-house recognition of sepsis
Sepsis readmissions: prioritize risk stratification

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Heather Schoonover
Taylor Miller

Combatting the Opioid Epidemic with Next-Generation Risk Assessment Tools

The opioid-related death rate in the U.S. has quadrupled since 1999, making more effective ways to predict opioid misuse a healthcare priority. A new generation of machine learning-enabled risk assessment tools promises to deliver broader and more relevant insight into a patient’s risk.
With more comprehensive insight (including comorbidities, other substance abuse, the amount of medication prescribed, and the duration of opioid use), clinicians can make informed decisions when prescribing opioids and reduce the risk that patients will misuse, abuse, or overuse the pain killers. Clinicians will also be able to identify which patients might benefit from alternatives to opioid pain management (non-pharmacologic, multi-modal therapies, or care management programs).

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James Bulger

Medical Libraries: An Essential Resource in Outcomes Improvement

In healthcare outcomes improvement work, where best-practice insight and evidence-based knowledge are critical, medical libraries are an essential resource. Medical libraries are more valuable than ever in today’s digital world, in which information is readily available, but accessing accurate, focused evidence requires specialized skill and means.
Organizations aiming to improve quality and move successfully toward value-based care need both data from the enterprise data warehouse (EDW) and evidence from the medical library. While data identifies opportunities for improvement, evidence furnished by the medical library shows whether proposed solutions are viable. Together, both knowledge bases drive pragmatic, sustainable improvement.

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Cessily Johnson
Michael Buck

Patient Registries Turn Knowledge into Outcomes Improvements

In today’s data-rich healthcare environment, patient registries put knowledge in front of the people who will use it to improve outcomes and population health. Non-IT professionals (e.g., clinicians and researchers) often don’t have direct, timely access to operational and clinical data. As a result, organizations miss out on important improvement opportunities and data-driven point-of-care decisions. Knowledge too often remains siloed in the enterprise data warehouse (EDW) or among specialized groups.
Patient registries remove these barriers. It allows clinicians and researchers to make informed choices and frees up data analysts to focus on their priority areas.

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Neil Andersen

The Healthcare Outcomes Improvement Engine: The Best Way to Ensure Sustainable, Scalable Change

How do healthcare organizations create a systemwide focus on outcomes improvement? They build a healthcare outcomes improvement engine—a mechanism designed to drive successful and sustainable change.
Creating this outcomes improvement engine requires four critical components:

Engaging executives around outcomes improvement.
Prioritizing opportunities most likely to succeed.
Adequately staffing initiatives.
Communicating success early and often.

Once up and running, multidisciplinary engagement and standardized improvement processes fuel the outcomes improvement engine in its mission to produce sustainable, scalable improvement.

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Josh Ferguson

Reducing Unwanted Variation in Healthcare Clears the Way for Outcomes Improvement

According to statistician W. Edwards Deming, “Uncontrolled variation is the enemy of quality.” The statement is particularly true of outcomes improvement in healthcare, where variation threatens quality across processes and outcomes. To improve outcomes, health systems must recognize where and how inconsistency impacts their outcomes and reduce unwanted variation.
There are three key steps to reducing unwanted variation:

Remove obstacles to success on a communitywide level.
Maintain open lines of communication and share lessons learned.
Decrease the magnitude of variation.

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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
Integration

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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Josh Ferguson

The Who, What, and How of Health Outcome Measures

Even though thousands of health outcome measures have the potential to impact the work we do every day, how well do we really understand them? In this article, we take a close look at the definitions, origins, and characteristics of health outcome measures. We break down the financial relevance of certain measures, the relationship between outcome measures and ACOs, and which measures impede, rather than enhance, a typical healthcare system. We review the role of an enterprise data warehouse and analytics, and we touch on the future of health outcome measures, all in an effort to provide deeper insight into some of the mechanics behind outcomes improvement.

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Brian Eliason, MIS

9 Ways Your Outcomes Improvement Program Could Be Delayed

A health system’s outcomes improvement program is an expensive undertaking. It’s worth the results, but there’s no need to make it even more expensive through unforeseen and unnecessary delays. We outline the three phases of managing outcomes improvement programs, from hardware and software acquisition and configuration to resource management to sustaining and scaling the gains. We also examine the nine potential pitfalls that can undermine success in each of these phases:

Hardware and software acquisition delays
Environment readiness
Source system access
Lack of resource capacity
Lack of analytic and technical skills
Data quality paralysis
Lack of clinical or operational engagement
Punitive culture: data used as a weapon
No CEO, no go

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Drew Cardon

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

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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Bill Knowles, MD

Moving Healthcare Outcomes Improvement Projects to the Finish Line

There are many ways to approach outcomes improvement in healthcare. Health Catalyst advocates the three-systems methodology whose individual components remain firm: best practices, adoption, and analytics. There are also various ways to interpret the three systems and this article uncovers nuances in how they are defined. With this unique perspective, organizations may be better able to understand how to develop outcomes improvement projects that not only launch with enthusiasm, but sustain energy over the long-term. Furthermore, outcomes improvement done right is scalable so that small firms, those with fewer resources, can adapt the methodology to improve their performance.

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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
Analytics
Evidence- and consensus-based best practices
Adoption
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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Kirstin Scott
Tracy Vayo

The Top Six Early Detection and Action Must-Haves for Improving Outcomes

Given the industry’s shift toward value-based, outcomes-based healthcare, organizations are working to improve outcomes. One of their top outcomes improvement priorities should be early detection and action, which can significantly improve clinical, financial, and patient experience outcomes. Through early detection and action, systems embrace a proactive approach to healthcare that aims to prevent illness; the earlier a condition is detected, the better the outcome.
But, as with most things in healthcare, improving early detection is easier said than done. This executive report provides helpful, actionable guidance about overcoming common barriers (logistical, cultural, and technical) and improving early detection and action by integrating six must-haves:

Multidisciplinary teams
Analytics
Leadership-driven culture change
Creative customization
Proof-of-concept pilot projects
Health Catalyst tools (knowledge briefs, outcomes improvement packets and worksheets, and care process improvement maps).

The report features a Thibodaux Regional Medical Center sepsis success story that demonstrates how creative customization, when paired with evidence-based standardization, can improve early detection and action efforts, as well as clinical, financial, and patient outcomes.

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Brant Avondet

7 Features of Highly Effective Outcomes Improvement Projects

There’s a formula for success when putting together outcomes improvement projects and organizing the teams that make them prosper. Too often, critically strategic projects launch without the proper planning, structure, and people in place to ensure viability and long-term sustainability. They never achieve the critical mass required to realize substantial improvements, or they do, but then the project fades away and the former state returns. The formula for enduring success follows seven simple steps:

Take an Outcomes Versus Accountability Focus
Define Your Goal and Aim Statements Early and Stick to Them
Assign an Owner of the Analytics (Report or Application) Up Front
Get End Users Involved In the Process
Design to Make Doing the Right Thing Easy
Don’t Underestimate the Power of 1:1 Training
Get the Champion Involved

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