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6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare

A systematic approach to performance improvement initiative includes three components:  analytics, best practice, and adoption. Taking six steps will help an organization to effectively cover all three  components of success. Step 1: Integrate performance improvement into your strategic objectives. Step 2: Use analytics to unlock data and identity 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 define interventions. Step 6: Estimate the ROI.

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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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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:

  1. Adaptive leadership, culture, and governance
  2. Analytics
  3. Evidence- and consensus-based best practices
  4. Adoption
  5. 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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Use Well-Crafted Aim Statements To Achieve Clinical Quality Improvements

Too often, hospitals and health systems stop at developing broad clinical quality improvement statements that come up short of achieving their desired goals. What’s missing are clearly defined improvement objectives in the form of aim statements that take into account the effects on other areas of the organization: patient safety and satisfaction, physician engagement, and financial contribution. Aim statements help articulate the problems that add value for patients and the organization, but good data, and the analytics tools required to understand the data, are essential to illuminating high-value problem areas. Additionally, aim statements must stick to the SMART guidelines: Specific, Measureable, Achievable, Relevant, and Time-bound.

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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:

  1. Collaboration
  2. Real-time feedback
  3. Interoperable infrastructure
  4. Data best practices
  5. 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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The 4 Clinical Teams Needed to Drive Sustainable Improvement

As the healthcare industry shifts from a fee-for-service to pay-for-performance and accountable care organizations are under greater pressure to make improvements to their clinical, financial and operational outcomes. As clinical quality improvement efforts grow systematically improving and sustaining care across the organization becomes more challenging. In order to ensure sustainable, long-term change a cross-functional, team-based approach that accelerates the implementation of change throughout the organization is necessary. This is the adoption system. Without an adoption system, improvement initiatives become a series of one off projects that may have a temporary positive impact, but soon return to the baseline level.

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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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Healthcare Performance Improvement Readiness Assessment: The Key to Achieving the IHI Triple Aim

Enhanced patient experience, clinical quality improvements, and the ability to provide cost-effective care are all necessary to meet the IHI’s Triple Aim objectives. To prepare for these types of improvement initiatives, healthcare organizations need to assess their readiness to change and also to determine which of the competing priorities to choose from. We’ve found that starting with a performance improvement readiness assessment is the first step to success because the readiness assessment digs into the three systems necessary for a successful performance improvement initiative — the best practice system, the adoption system, and the analytics system. Then the readiness assessment provides an overall roadmap to ensure success with the organization’s specific improvement goals.

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How to Determine the Best Interventions for Clinical Quality Improvement Projects

Health systems use clinical quality improvement projects as a means to improve patient care, but the real improvement in care can only result from deliberate action by your teams. This action is called an intervention and becomes the solution that addresses your clinical quality improvement goal. The secret to selecting the right intervention is this: choose something that offers “gain” or improvement and then provides a means to “sustain that gain.” Finding efficient, effective interventions can be a challenge without knowing where to start, but by using an Aim statement, your teams will have a working template for each of their clinical quality improvement projects.

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Quality Improvement in Healthcare: Where Is the Best Place to Start?

One of the biggest challenges providers face in their quality improvement efforts is knowing where to get started. In my experience, one of the best ways to overcome that “where do we begin?” factor is by using data from an enterprise data warehouse to look for high-cost areas where there are large variations in how health care is delivered. Variation found through the KPA is an indicator of opportunity. The more avoidable variation that is reflected in a particular care process, the more opportunity there is to reduce that variation and standardize the process. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. You will also want to take into consideration the readiness/openness to change in each of those areas.

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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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Overcoming Clinical Data Problems in Quality Improvement Projects

Starting your clinical quality improvement projects with access to data you’ve never seen before is exciting! But as analysis starts, you notice missing and incomplete data. Data quality problems are one of the most common but unexpected initial challenges of any substantive clinical quality improvement. project. Anny and Kathy both share keys to success learned from years of experience to overcome that trough of despair.

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How to Sustain Healthcare Quality Improvement in 3 Critical Steps

Ronald D. Snee, a fellow with the American Society for Quality, articulates that organizations don’t hold quality and cost gains because they don’t make improvement the backbone of their organization. Rather, they approach improvement as a series of initiatives. He states, “Many organizations focus on sustaining the gains only after improvement has been achieved. Intuitively, that may seem the correct sequence, but it is in fact backwards. The time to focus on sustaining improvement gains is well before the initiative is launched.” In this article, I review 3 critical organizational steps that can help sustain those gains.

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Quality & Process Improvement - Additional Content

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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:

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

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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:

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

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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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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:

  1. Establish a data-driven culture.
  2. Acquire and access data.
  3. Establish data stewardship.
  4. Establish data quality.
  5. Spread data use.

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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:

  1. Facilitate adoption through hands-on improvement projects.
  2. Define quality and get agreement.
  3. Measure for improvement, not accountability.
  4. Use a quality improvement framework and PDSA cycles.
  5. 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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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:

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

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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:

  1. Communication
  2. Trust Building
  3. Coaching
  4. Understanding Process Management
  5. Understanding Care Management Personnel
  6. Constructive Accountability and Constructive Conflict
  7. Resiliency and Persistency
  8. 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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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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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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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:

  1. Stakeholder engagement
  2. Shared understanding
  3. Alignment
  4. Focus
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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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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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:

  1. Sub-optimization, over-emphasizing a single part at the expense of the whole.
  2. Extreme over-emphasis, also called gaming the system.
  3. 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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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:

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

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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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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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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:

  1. Adaptive leadership, culture, and governance
  2. Analytics
  3. Evidence- and consensus-based best practices
  4. Adoption
  5. 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.

Read More
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