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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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How to Improve Clinical Programs by Breaking the Cycle of Waste in Healthcare

To succeed with value-based care, health systems must demonstrate to CMS they operate more effectively, efficiently, and safely. This requires organizations to identify and improve three types of waste commonly found in clinical programs: ordering waste, workflow and operational variations waste, and defect waste. Finding these areas, however, requires three critical solutions: an EDW, a KPA Application, and organizational readiness assessments.

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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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Planning for Healthcare Improvement: A Goal Without a Plan Is Just a Wish

While our current health system has accomplished some great things, the complexity is producing serious quality issues. Healthcare improvement will require that the system changes how it is organized and operated. The best approach to this kind of change and improvement will be the develop a systematic plan composed of the Analytic System (where organizations unlock their data), the Deployment System (organizational, team-based structures), and the Content System (knowledge and best-practices management).

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Using Clinical Metrics the Right Way: 5 Considerations Every Hospital Should Know

The ability to analyze data is more important than ever as the healthcare industry shifts from fee-for-service to a pay-for-performance model. And the wealth of clinical data now available is larger than ever. But just having that data isn’t enough. The data, clinical, financial, operational, etc., must be combined to form the powerful foundation that will drive quality improvement. The destination is higher quality care for improved patient outcomes. The route is having the right clinical metrics.

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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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My Wake-Up Call: How Data Saves Lives

Have you ever had one of those "wake up moments" where you literally learn a lesson that impacts and changes the trajectory of your life?   Read this personal story by Dr. Bryan Oshiro of his "wake up" call where he learned the importance of data to save lives.  He learned this first-hand when he saw rows of babies on ventilators in the neonatal unit and realized that they had all been electively delivered before 39 weeks. But he didn’t have the data compiled to make a compelling case to his physicians to stop elective pre-39 week deliveries. Working with his technology team, he gathered the data, analyzed it, and successfully engaged his physician team in a quality improvement project to reduce these elective deliveries.

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3 Ways to Decrease Nosocomial Infections in Hospitals

Health systems waste enormous amounts of money on treating and tracking nosocomial infections. Instead of waiting for hospital-acquired infections to surface, health systems should proactively work to prevent such easily preventable infections. These three suggestions will help health systems reduce the rate of nosocomial infections: 1) Use an EDW to reduce wasted tracking time. 2) Create a data-driven culture of commitment. 3) Manage the data on an enterprise level.

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Leveraging Healthcare Analytics to Reduce Heart Failure Readmission Rates

Heart failure patients are adding an enormous strain to the US healthcare system. In addition, readmission rates for these diseases are adding to the burden.  Healthcare analytics can play a key role.  By following these 4 steps, all of which include data analytics, health systems can begin to reduce readmission rates: 1) Understand your true admission rates. 2) Establish reliable baseline measures. 3) Be aware of balance measures. 4) Establish an EDW.

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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.

Read More
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3 Steps to Prioritize Clinical Quality Improvement in Healthcare

With all of the discussion about clinical quality improvement in healthcare, you know you need to find out which areas to focus on for improvement initiatives. But how do you prioritize which areas will provide the greatest results? These three steps will help eliminate the guesswork so you can make decisions based on data: 1) Implement a healthcare enterprise data warehouse foundation. 2) Identify improvement priorities. 3) Gain consensus.

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Improving Clinical Workflow: An Example from the Emergency Department

ED workflow, when it is efficient, saves time, money, and lives. In the shift to value-based reimbursements, it can also significantly affect payment. A few ways CMS measures the care quality in an ED includes median time of arrival to department for admitted patients, for discharged patients, and median time from admit decision to departure for admitted patients. This means that the workflow of EDs will be publicly evaluated. To improve workflow and throughput, it’s helpful to look at two things: a value-stream map and throughput analytics. Using the Health Catalyst application Patient Flow Explorer, you can see all this and more.

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How Analytics Will Help You Achieve the Triple Aim

Many years ago, Dr. Donald Burwick and the IHI developed the concept of the Triple Aim to improve healthcare but little interest ensued. However, with the government’s focus on healthcare reform, there’s now a widespread interest in using the Triple Aim to achieve three main goals: 1) Improve the experience of care. 2) Improve the health of populations. 3) Reduce the per capita costs of healthcare. By using analytics, health systems will be able to achieve all three components of the Triple Aim.

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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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Practice Management Solutions: The Key to Efficient Primary Care Delivery

Primary care practices are being asked to treat more and more patients—while reimbursement levels shrink. One of the best ways to tackle this challenge is to make sure that every member of a clinic’s staff is empowered to operate at the maximum level of his or her qualifications. For this to succeed, a system for coordinating care across the patient panel is necessary. And a solution built on the foundation of a healthcare EDW can do that, including: i. Generate near real-time lists of patients who aren’t compliant with recommended, evidence-based care guidelines. ii. Show clinicians and staff a patient’s health status at a glance. iii. Increase efficiency and accuracy of working with healthcare data. iv. View clinical, operational, and regulatory information about your patients all in one place. v. Track and manage patient volume. vi. Analyze performance of your patient panel as a whole—and your performance on various regulatory measures. vii. Drill down into data for further insights into practice performance

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How to Improve Patient Outcomes for Chronic Diseases and Comorbidities

Managing and treating patients with chronic conditions and comorbidities is difficult without coordination between the various treating physicians. To improve patient outcomes for such complex situations, an enterprise data warehouse can deliver the necessary quality improvements and coordinated care these types of patient populations require.

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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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The Best Way to Track and Improve Cancer Patient Outcomes

The cancer care delivery system is in crisis- amplified by the complexity of cancer care and historical limitations in quality-improvement tools. Learn how this hospital used data warehousing and business intelligence tools to increase their staging data capture by 450% and identified variation in care.

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Texas Children’s Hospital Reduces Clinical Quality Improvement Project Time by 85%

Clinical Quality Improvement projects follow a standard process: articulate the problem statement; define the population; identify data gaps; collect the data; and, implement evidence based practice interventions to deliver measurable and sustainable improvement. If you’ve led or been a part of these projects, you know the kick-off process of articulating the problem and defining the population can take six or more months.Texas Children’s Hospital found the secret to rapid-cycle clinical quality process improvement and reduced their project time by 85% using a healthcare enterprise data warehouse (EDW), population registries and healthcare analytics.

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Reducing Waste in Asthma Healthcare: The Impact of Data

Texas Children's Hospital is moving to a form of value-based payment under which hospitals that improve efficiency can keep the savings. To succeed under the new payment system, Texas Children's leaders needed the ability to analyze and better manage specific populations of patients, especially those with costly, chronic conditions like asthma.Texas Children's found 5 ways to reduce waste and improve the quality of care for their asthma patients across the care continuum. Learn how they reduced length of stay by 11 hours and achieved and sustained a 49 percent decrease in unnecessary chest X-ray orders.

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The Glaring Omission in Healthcare: Patient Satisfaction and Outcome Data

As a business person and a CIO, the only two metrics that really matter to me are employee satisfaction and customer satisfaction. As fellow CIOs can attest, we are inundated with metrics. Managing a complex IT environment in a healthcare setting is like surfing in a hurricane of metrics, at every layer of technology that we manage, from the data center to the software application. But... the only two metrics that really matter are employee satisfaction and customer satisfaction. Every other metric is a means to those two ends.

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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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Defining Patient Populations Using Analytical Tools

Defining patient populations is an important first step when identifying opportunities for clinical improvement, but it can be a daunting one. How can a clinician easily find a specific patient population? Then, once found, how does that list turn into actionable steps that improve outcomes? In this Insight, Kathy describes how Health Catalyst helps clients define patient populations by using the Cohort Builder application and then using risk stratification, an exciting methodology that assists in identifying outcomes for specific patient populations.

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The Best Way to Prioritize Your Population Health Management Efforts

Are you looking for the best way to prioritize your population health efforts? Population health management involves improving and maintaining the health of a defined subset, or cohort, of patients. Effective population health management starts with clearly defining those cohorts and determining on which clinical processes to focus improvement efforts. The Health Catalyst Key Process Analysis (KPA) application applies Pareto analysis to each health system’s data to identify the care processes, care process families and clinical programs that offer the greatest clinical, cost and safety improvement opportunities. The application determines the highest variation and highest resource consumption by integrating and analyzing clinical and financial data.

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Keys to Improving Your Clinical Program Effectiveness

As a Registered Nurse, I’ve seen first-hand the difficulties associated with narrowing the focus of a clinical program improvement project. Healthcare is a complex business consisting of thousands of clinical improvement opportunities. The first important step is the desire to do a project – at least by one influential team member. The next step, to keep the process simple and prioritize your projects, is directly related to the complexity of healthcare. Following a structured process with representation from all stakeholders will help to ensure success. In this Insight, Ann details how effective prioritization requires 4 elements: 1) an enterprise data warehouse (EDW), 2) healthcare analytics, 3) a clinical integration hierarchy, and 4) an organizational readiness assessment.

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Population Health Management: One Example That Shows Why It Really Matters

One of our clients recently launched a Population Health Management initiative in just eight weeks to ten percent of their clinics, potentially improving care delivery for approximately 2,300 patients. When the initiative is completed it will impact nearly 50,000 patients. The interdisciplinary team of clinicians, IT, care coordinators, and business analysts now have a single source of truth and near-real time results to proactively engage and work with their patients to manage care. According to their Director of Clinical Business Analytics, “What we’ve accomplished with Population Health is something we’ve been trying to do for over 20 years with our various clinics. We used to manually pull together reports, all with varying data, and we had no way to proactively monitor our populations. Now, we have near real-time data that enables our care coordinators to drive preventive care and ultimately lower our population health costs.”

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