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Leadership, Culture, Governance

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Governance in Healthcare: Leadership for Successful Improvement

Successful outcomes improvement in healthcare requires strong leadership to make decisions, allocate resources, and prioritize initiatives. For improvement to succeed and endure, health systems can’t leave any part of leadership to chance. Instead, effective governance requires thoughtful, deliberate development. Otherwise, improvement initiatives stall or fail to launch, as stakeholders debate goals and strategies. To succeed, governance structure must be solid enough to withstand any challenges to improvement initiatives—from resource constraints to skeptics. Effective governance in healthcare operates with four guiding principles:

  1. Engage the right stakeholders.
  2. Establish a shared understanding of objectives.
  3. Align incentives and rules of engagement.
  4. Practice disciplined prioritization.

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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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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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Improving Strategic Engagement for Healthcare CIOs with Five Key Questions

A healthcare CIO’s role can demand such an intense focus on technology that IT leaders may struggle to find natural opportunities to engage with their C-suite peers in non-technical conversations. To bridge the gap, healthcare CIOs can answer five fundamental questions to better align their programs with organizational strategic goals and guide IT services to their full potential:

  1. Whom do we serve?
  2. What services do we provide?
  3. How do we know we are doing a great job?
  4. How do we provide the services?
  5. How do we organize?

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Health Catalyst Named 2019 Healthcare IT Corporate Innovator

Utah HIMSS (UHIMSS) recognized Health Catalyst for its innovative leadership with the 2019 UHIMSS Healthcare IT Corporate Innovator award. Dale Sanders, Health Catalyst President of Technology, accepted the honor on behalf of his organization at the UHIMSS 2019 spring conference on May 17. He shared some key insights into what makes a great environment for ongoing innovation, including these valuable sources for invention and originality:

  1. Mischief
  2. Humor
  3. Depression
  4. Pen and paper
  5. Naivety
  6. Pattern recognition
  7. Walking

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Engaging Health System Boards of Trustees in Quality and Safety: Six Must-Know Guidelines

The quality and patient safety movement of the early 21st century called for greater board of trustee involvement in improvement. However, too many health systems still don’t have the resources in place to effectively engage their boards around quality and safety measures. Six guidelines describe how organizations can better leverage data to inform their boards:

  1. Emphasize quality and patient safety goals.
  2. Leverage National Quality Forum-endorsed measures.
  3. Use benchmarking and risk adjustment to select targets.
  4. Access data beyond the EHR.
  5. Provide data and information for multiple organizational levels.
  6. Develop a board-specific measurement and presentation strategy.

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The Future of Employer Health Insurance

Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success. Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:

  1. Driving additional value by reducing utilization of healthcare services within these employer populations.
  2. Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
  3. Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.

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The Missing Ingredient in Healthcare Analytics: The Executive Sponsor

Despite the complexity of healthcare analytics, one key strategy for effective, sustainable analytics stands out: designating an executive sponsor to oversee the program. This sponsor is a C-suite level leader who’s committed to championing analytics throughout the organization and has the influence and relationships to drive widespread outcomes improvement. Healthcare executives can use four criteria to identify a great executive sponsor for their analytics programs:

  1. Have a single accountable leader.
  2. Find a sponsor with passion for and knowledge about data.
  3. Choose organizational clout and a vision for analytics over a specific title.
  4. Build a partnership with the CIO.

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Addressing Healthcare Waste Through Centralization

Healthcare generates an estimated $1 trillion in waste each year, including supply costs, unnecessary tests, and surgeries that aren’t clinically indicated by best practices. One effective way health systems can reduce waste is by centralizing duplicated services into one high-performing center for that service. For example, instead of having a few cardiac catheterization (cath) labs, a health system can consolidate its cath services into one facility, cutting equipment, staffing, and space requirements. Despite its clinical and financial benefits, centralization can be challenging for health system leaders, who may face operational and political challenges when cutting services from certain locations. To navigate these challenges, leadership must use a data- and analytics-driven centralization strategy and a data and analytics system that can measure performance at the surgeon, facility, and program levels.

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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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Employer Health Plans: Keys to Lowering Cost, Boosting Benefits

Employers that offer robust employee health plans at affordable costs are more likely to attract and retain a great workforce. Healthcare, however, is often a top expense for organizations, making balancing attractive benefits with attractive costs a complex undertaking. Employers need a deep understanding of employee populations and opportunities to manage health plan costs without sacrificing quality. An analytics-driven approach to employee population health management gives employers insight into two key steps to lower healthcare costs and enhance benefits:

  1. Manage easily fixed cost issues.
  2. Use healthcare cost savings to fund expanded benefits.

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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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Critical Healthcare M&A Strategies: A Data-driven Approach

Historically technology and talent were primary assets used to weigh the value of M&A activity, but data is an equal pillar. Buyers (the acquiring organizations) face enormous responsibility and risk with M&A transactions. C-suite leaders have a lot to consider—enterprise-wide technology, finances, operations, facilities, talent, processes, workflows, etc.—during the due diligence process. But attention is often heavily weighted toward time-honored balance sheet and facility assets rather than next-generation assets with the long-term strategic value in the M&A process: data. The model for conducting due diligence around data involves four disciplines:

  • Establish the strategic objectives of the M&A with the leadership team.
  • Prioritize data along with the standardization of solutions and the design of a new IT organization (i.e., a co-equal effort for data, tools, and talent).
  • Identify the near-term data strategic priorities, stakeholders, and tools.
  • Assess the talent and consider creating an analytics center of excellence (ACOE) to harness organizational capabilities.

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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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Diversity in the Workplace: A Principle-Driven Approach to Broadening the Talent Pool

Improving diversity and inclusivity in healthcare, and any industry, is more than just the right thing to do: it’s an intelligent business decision with impacts on productivity, sales, and innovation. Organizations committed to addressing the lack of diversity and inclusivity in healthcare should start by thinking about the principles and values that underlie their cultures. At Health Catalyst, every diversity initiative is founded in one of the core principles that motivates our work and is embodied by every team member:

  1. Respect
  2. Humility
  3. Transparency
  4. Advocacy
But turning the tide on monumental challenges, like closing the gender gap in technology (women hold less than 26 percent of U.S. technology jobs), requires more than a return to values; it requires initiatives, from equitable hiring practices to mentorship programs, that reflect an understanding of the diverse populations in the talent pool.  

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Saving Lives: Effective Healthcare Communication Empowers Care Management

With an estimated 80 percent of medical errors resulting from miscommunication among healthcare teams, organizations can significantly improve outcomes with better communication. A communication methodology outlines the essential information clinicians need to share, giving care teams the knowledge they need, when they need it, to make informed treatment decisions. One communication toolkit, SBAR (Situation, Background, Assessment, Recommendation), defines the essential information clinicians must share when they hand off patient care from the inpatient to the ambulatory setting:

  1. S (situation): The patient’s current situation.
  2. B (background): Information about the current situation.
  3. A (assessment): Assessment of the situation and background and potential treatment options.
  4. R (recommendation): Recommended action.

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Communication in Healthcare Culture: Eight Steps to Uphold Outcomes Improvement

Healthcare leaders looking to establish and sustain a culture of large-scale outcomes improvement must communicate their health system’s values, beliefs, and norms throughout the entire organization. Effective communication spreads understanding of outcomes improvement, ensuring broad engagement and ongoing progress toward shared goals. An eight-step strategy describes essential elements of organizational outcomes improvement communication plan:

  1. Include a communications specialist on the outcomes improvement leadership team.
  2.  Analyze the stakeholders early and often.
  3. Craft the central message around shared values.
  4. Be a constant champion.
  5. Commit to regular times and mechanisms for communication.
  6. Make sure communication flows both ways.
  7. Be transparent.
  8. Be creative.

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Healthcare Culture: Choosing a Systems-Based Approach Over Punishment and Reward

It’s often human nature to look for a culprit or hero when there’s a setback or success. In healthcare, however, this punishment-and-reward formula puts patient outcomes at risk, as it doesn’t consider all factors that contribute to a result and lead to a better process. The key to failure or success is most likely a chain of events, and not an individual action. To avoid the same mistake again or build on good practices, healthcare leaders must look at the system, not the individual or their actions. Effective improvement leadership will standby a systems approach, even under the most challenging circumstances.

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Investing in Partnerships for Outcomes Improvement

Many healthcare organizations invest for financial, strategic, and operational reasons. These investments cover a broad spectrum of opportunities, from medical technology, to delivery models, to promising new research. Health Catalyst follows these investment avenues, building long-term relationships, and connecting with its partners in three ways:

  1. As owners.
  2. As innovators.
  3. As customers.
The sole focus of these investments and partnerships is outcomes improvement—a unique approach in healthcare—supported by the operating principles of ownership, pragmatic innovation, and transparency. In this first article of a series, Kyle Salyers, Health Catalyst Senior Vice President of Business Development, explores the partnership “flywheel” and the collaborative nature that underscores a successful healthcare investment platform.

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