How to Develop a Robust Clinical Content System
Seventeen years. That’s how long it takes, on average, for medical research findings to make it into standard clinical practice. Developing a strong content system improves the ability to quickly integrate new evidenced-based best practices into everyday care delivery. Healthcare systems that successfully develop a robust best practice system are well on their way to improving the quality of care for their patients.
Key Components of the Content (Best Practice) System
Establishing a content (best practice) system means developing best-practice care processes the organization can use to drive care improvement. At its most basic, the best practice system introduces evidence-based knowledge assets into everyday care delivery in a systematic way. For example, if the goal is to improve heart failure care and reduce hospital readmissions, deciding how to accomplish that goal through the definition and implementation of best practices is critical—and that is accomplished using the best practice system.
How to Create a Content (Best Practice) System
The following are important steps for developing a robust best practice system:
1. Performing key process analysis. Every organization has limited resources for improvement initiatives, so resources must be focused on projects that will likely have a significant impact on real savings and improvements. At Health Catalyst, we’ve used our clinical content, best practices, and workflow expertise to categorize almost every clinical process using the key process analysis. The key process analysis examines clinical processes in the organization to determine where the most variation in the cost of delivering care exists. This structured, data-driven examination reveals which care processes offer the greatest opportunities for improvement. Care delivery processes with lots of variation can be greatly improved by standardizing the process and delivery. Reduced variation, when clinically appropriate, means quality patient care that is more efficient. Identify the areas that will deliver the fastest return possible. Remember, it takes just as many resources to work on a low-impact, low-variation process as it does to work on a high-impact, high-variation process.
2. Understanding the population. Once the care process is determined, the organization needs to define precise patient registries (the population affected by the targeted care process). For example, if the focus area is heart failure, an exact definition of which group of heart failure patients will be analyzed is needed: Is it those with systolic heart failure? Diastolic heart failure? Or both? What inclusion and exclusion criteria should be used? In addition to diagnosis codes, the organization should refine the cohort using other elements such as procedures, labs, medications, and/or clinical symptoms. This step may sound straightforward, but these cohort definitions require significant feedback and fingerprinting from clinicians and other stakeholders who want to make sure their criteria for this cohort is considered in the definition process.
3. Understanding best practices and current state. Next, the organization needs to define the best practices that will deliver improved outcomes for the processes that have been targeted and to review and summarize major guidelines, primary literature, and regulatory and accreditation measures. Consideration should also be given to reviewing any order sets, checklists, and protocols available. This step also involves care process mapping—working with clinicians and other stakeholders to map out the entire care process, identify key decision points and phases in care, and determine which best practices should be applied at which points in the process.
4. Identifying key metrics: An effective best practice system identifies upfront the key metrics that data analysts will need to track the success of the improvement initiative. Identifying these metrics typically occurs during the mapping process. As best practices are identified, decisions on the best way to measure whether those practices implemented—and what outcomes should result from those implementations—are decided.
5. Defining specific goals: Now the focus is on creating a specific goal(s) to address the identified problem. Continuing with the heart failure example, hypothetical research indicates that implementing some 10 key best practices are shown to have an impact on heart failure readmissions. Should all 10 be tackled at once? Probably not. It’s simply too difficult to operationalize every best practice at the same time. A smarter approach is to target the intervention strategies around very specific, narrow aim statements. The data that helped identify the variation should help drive these targets too. In this example, if the organization decides to work on two of the 10 areas—perhaps medication reconciliation and discharge processes for heart failure patients—it should define an aim statement that focuses on improvements for each area. These aim statements should include specific, achievable, and actionable targets within an identified timeframe.
Once the best practice system in place, implementing improvements in a systematic way using two other systems—the adoption system and the analytics system—can begin. The adoption system facilitates how an organization shares and diffuses improvements throughout the entire enterprise. The analytics system allows the organization to measure and collect data needed to drive improvement. Eric Just details all three systems in The Three Systems Critical to Healthcare Analytics Success. At this point, the organization can start to produce actionable visualizations to track progress, while working on an adoption plan to diffuse the improvement. During this process, it is likely that new standard knowledge assets (order sets, checklists, indications, or protocols) will need to be determined and put in place to make it easier for the clinician to do the right thing. And the cycle starts again.
Tips for Creating an Effective Best Practice System
Here are a few additional recommendations that can strengthen the best practice system and deliver a faster time-to-value:
- Choose an analytics vendor with robust content starter sets. Defining populations and determining the best practices that should be applied to each care process is difficult, time-consuming work. The best vendors have done much of the work already by developing starter content sets. They’ve already analyzed and prioritized the clinical care opportunities and defined the target patient populations. They’ve already mapped out the care processes and identified best practices that can be applied. And they’ve already developed possible aim statements and associated metrics to guide the implementation. Having this work done for the team beforehand speeds the time to value.
- Begin with a starter set—but refine any definitions and processes to fit the needs of the organization. People with core knowledge—physicians, nurses, operations leaders, finance, etc.—will need to collaborate to refine starter sets to match their organization’s needs. This hands-on work with the starter sets is very important. It gives key stakeholders in the organization the chance to fingerprint these improvement processes. Having clinicians, leaders, and staff vet and modify the content not only enables better processes tailored to the organization, it also fosters the engagement and buy-in critical to any improvement initiative.
- Don’t worry about having everything perfect up front. Instead, expect an iterative approach. Put the best practice system in place as best as possible. Then, over time, the analytics system will deliver valuable metrics and insight that will help the team tweak and refine the content.
A best practice system builds a foundation of consistent processes to guide improvement initiatives. This methodology is an important and effective tool for achieving clinical integration and improved outcomes across the organization.
Would you like to use or share these concepts? Download this quality improvement presentation highlighting the key main points.