As healthcare organizations pursue greater efficiency and shift focus from volume to value, quality improvement efforts are more important than ever. If improvement efforts are poorly managed or executed, projects can easily stall out and take up valuable time, money, and resources, while returning little in the way of results. To combat this, Health Catalyst recommends a Seven Guiding Questions Framework for Outcomes Improvement. This framework leverages the Three Systems: the systematic integration of analytics, best practices, and adoption functions to drive transformation in healthcare. However, even improvement efforts that have the right people, processes, and technology in place can struggle to make sufficient progress.
Cross-functional teams, while vitally important, take time to reach a shared understanding because of their varied backgrounds, frames of reference, and even vocabularies about why and how to tackle specific improvement projects. Improvement teams can struggle to identify and select manageable chunks of work to focus on. Momentum slows and enthusiasm evaporates. What is the improvement team missing that can help speed time to adoption and value? A medical writer with healthcare knowledge and strong information design skills may be the missing accelerant to outcomes improvement.
Medical writers with the right skills can fill an invaluable role on healthcare improvement teams. They can help teams investigate the problem, standardize processes to address and measure progress, and unite best practice, analytics, and adoption systems to drive improvement.
Mike Noke, Senior Vice President of Professional Services at Health Catalyst, said about working with writers in this setting, “When working in complex healthcare environments, relevant and clear communication and documentation is essential, but requires a skillset often not inherently found on clinical and technical teams. Medical writers combine healthcare domain awareness with effective communication skills that assist in articulating the intent, the methods, and value of improvement teams so that these may be more broadly understood and leveraged.”
So, what exactly can a medical writer in this setting do? Here are four skills that a writer with strong information design skills brings to an improvement team:
The unique skill set of medical writers/information designers in the healthcare domain is best illustrated with specific examples from their work on improvement teams.
Writers can create artifacts that helps answer questions such as, “What does a work process look like?” “What are the most important best practices?” and “For the greatest positive impact, where should we measure and manage?” An example of this is the CAUTI Prevention Care Process Improvement Map shown below in Figure 1.
The care map above draws on multiple source documents—clinical guidelines, systematic reviews and meta-analyses, cohort and cross-sectional studies—to help orient team members to the scope of a care process, the major outcomes it affects, and the application metrics that support work in this area of care. Overlaying analytics, improvement opportunities, and clinical practice in a single, simple visual, the map communicates across disciplines—helping data experts, administrators, and clinicians get on the same page. This accelerates quality improvement around the care process.
As writers document the improvement teams’ work and plans through iterative drafts and reviews, they can use plain language to help people focus (and re-focus) on what matters most. Does the team understand the problem? Do they know what to change? Are the changes resulting in improvement? Writers can also absorb and reflect the concerns of the multidisciplinary team members to create materials that support change. What do stakeholders need to know in order to act? Figure 2 below shows a page from the handbook Implementing Governance for Outcomes Improvement.
To develop the handbook on governance, writers worked with subject matter experts (SMEs) from a range of backgrounds. They organized the copious amount of input from SMEs, including anecdotes, research, and recommendations, and, in an iterative process, developed a set of actionable steps applicable to any organization.
Just as in client organizations that work with writers, the Health Catalyst team found that the shared development work powerfully engaged team members and helped them become more knowledgeable and empowered—and ultimately led them to become effective champions of our organization’s approach to governance.
Writers can devise presentation modes that help teams negotiate a common tension in improvement work: “How can we drive standardization and improve reliability while allowing for warranted variation and pragmatic innovation?” The blueprint shown in Figure 3 is a good example of writers’ information design abilities to do this.
This blueprint records an organization’s experience with digital innovation, centered on its key activities and including lessons learned along the way. The complete blueprint covers several dimensions and levels of detail of the organization’s transformation and provides supporting artifacts that give project details, examples, and tools. Ultimately, all the information in a blueprint will be searchable and filterable by different users.
The blueprint has a narrative structure that is broken into phases and discrete steps. The goal being to demonstrate the value of new technology and make it easier, quicker, and cheaper to replicate the innovation while avoiding the “one-size-fits-all” prescriptiveness that would likely generate resistance. The writers who worked on this project found that the story structure was engaging and allowed the client to instruct, inspire, and empower, while at the same time balancing the ideal and the actual, the theoretical and the practical, and the site-specific advice.
Writers may not have the same clinical or technical expertise as domain experts, but they possess many soft skills, like the ones described in Liz Wiseman’s book, “Rookie Smarts: Why Learning Beats Knowing in the New Game of Work.” One of the major tenets of the book is that experience can sometimes be a hindrance when it comes to collaborative thinking about complex problems. “Someone operating with rookie smarts provides much-needed orchestration, reframing the issues, posing the question, searching for truth, and then bringing the newfound intelligence back to bear on the problem.” It’s this precise ability that writers bring to the table for improvement teams.
Other important skills for writers in this space include:
Where does an organization find someone with this skill set? While a medical writer may have past experience in medical or technical writing or communications, the right person for this role could already be part of the organization. Look for the skills above, especially the soft skills described in Wiseman’s book. To be successful in this niche area, a writer must possess a unique skill set not often found on clinical or technical teams.
The skill set writers/information designers bring to the table can help speed the work of improvement teams, as shown in the examples above, by helping teams identify manageable tasks to focus on, articulating the process, and creating visual artifacts to help improve and clarify communication. Additionally, they can help communicate the value of improvement teams to a larger audience and speed future improvement projects by creating tools for transformation that can be used again.
Dr. David Burton, former senior vice president of Intermountain Healthcare and founding CEO of Intermountain’s managed care plan, SelectHealth, is a big proponent of having medical writers on improvement teams. He said, “Writers are a catalyst to help clinicians, administrators, financial and technical experts digest into words and visual images the process by which healthcare is made available and provided to members and patients of healthcare systems. They are an extremely important catalyst to process improvement.” Ultimately, adding the role of a medical writer and information designer to an improvement team will help keep teams focused and engaged in order to speed improvement work.
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