Comprehensive Approach to CAUTI Prevention Leads to Dramatic Reduction in Infections

Despite being common, healthcare-associated infections are potentially deadly and carry a significant financial cost. Of healthcare associated infections, catheter-associated urinary tract infections (CAUTI) are one of the most common, despite most instances of CAUTI being preventable.

As CAUTI was determined to be one of the top five influential factors in the publicly report quality scores, Piedmont Healthcare looked to data for more visibility into factors that were contributing to CAUTI rate in an effort to permanently reduce the number of infections. By engaging staff for compliance with CAUTI prevention best practices, Piedmont has seen sustainable improvements.

Results:

  • 50.2 percent relative reduction in CAUTI standardized infection ratio (SIR). This translates to 37 fewer patients with infections than expected.
  • 6.7 percent relative improvement in insertion bundle compliance.
  • Maintenance bundle compliance improved dramatically, with nearly a three-fold increase in the percentage of patients receiving the maintenance bundle.
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Using Analytics and Technology to Improve the ED Patient Experience

Substantial evidence indicates a correlation between a patient’s experience in a healthcare setting and adherence to medical advice, appropriate use of healthcare services, and clinical outcomes. Many organizations evaluate patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey scores.

Mission Health’s patient experience survey scores in the emergency department (ED) were significantly lower than desired. Extended wait times negatively impact patient experience and perceptions of quality of care.

To improve the wait-time experience, Mission changed to a quick registration process, implemented patient notifications via text messaging, and began notifying patients of anticipated delays due to volume surges, thus better managing expectations. Text messaging also improved patient privacy, as did remodeling the waiting room to create a private registration area.

In just over a year, Mission’s ED achieved the highest patient experience ratings it had ever received:

  • Threefold improvement in patient ranking of:
    • Overall quality of care.
    • Provider communication.
  • 29 percent relative reduction in time from discharge order to patient discharge.
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Quick Registration Dramatically Reduces Delays in ED Patient Care

Patient registration is an essential step in the emergency department (ED) workflow—it is required to initiate EHR documentation and impacts patient safety. Correctly identifying patients during registration is critical, as caregivers use historical data in the EHR to make treatment decisions.

Mission Health, as part of its ongoing performance improvement work, discovered that its registration process was lengthy—patients were waiting in line for as long as 15 minutes to be checked into the ED to receive treatment.

To improve its registration process, Mission implemented a quick registration process (e.g., asking fewer questions upon patient presentation at the ED) based on frontline staff feedback that, in a little over one year, dramatically reduced delays in ED patient care:

  • 70 percent relative reduction in the time to complete registration, with current performance under one minute.
  • 33 percent relative improvement in time from patient arrival to triage start time.
  • 24 percent relative reduction in median length of stay (LOS) for discharged patients, 15 percent relative reduction for admitted patients, and 42 percent relative reduction in median LOS for behavioral health patients.
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Emergency Department Triage Redesign Dramatically Reduces Wait Times, LOS, and Left Without Being Seen Rates

Overcrowding in the emergency department (ED) has been associated with increased inpatient mortality, increased length of stay (LOS), and increased costs for admitted patients. ED wait times and left without being seen (LWBS) rates—patients who present to the ED but leave before receiving a medical evaluation—are indicators of overcrowding.

Mission Health needed to address overcrowding in its ED. The community hospital system confirmed overcrowding when it determined that approximately 4,000 patients were leaving its ED each year without being seen.

Mission implemented an improvement process to address ED overcrowding. The hospital leveraged its analytics platform to develop an ED analytics application that provided actionable, timely ED performance data to focus improvement efforts on four areas: staffing patterns, registration, triage assessment by the registered nurse (RN), and early access to a qualified medical provider.

Mission achieved significant ED performance improvements:

  • 89 percent relative reduction in LWBS rate, with current performance at 0.4 percent.
  • 85 percent relative reduction in percentage of patients who left before treatment complete, with current performance at 0.58 percent.
  • 75 percent relative reduction in median door to assessment by a qualified provider, with current performance under 15 minutes.

 

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Standardized Best Practices Improve Elective Colon Surgery Outcomes

Nationally, readmission within 90 days after colorectal surgery occurs in about one in four patients, at a cost of approximately $9,000 per readmission. Committed to improving its clinical and financial outcomes, MultiCare, an integrated healthcare delivery system in the Pacific Northwest, decided to focus an improvement effort on elective colorectal surgery when it recognized that patient population had a high opportunity for improvement in both clinical outcomes and cost.

Effectively using its existing quality improvement methodology and Collaborative structure, MultiCare leveraged the work of the Enhanced Recovery After Surgery (ERAS) Society and identified and implemented standardized best practice care routines and interventions that would benefit this population. By using the information in the Enterprise Data Warehouse and analytics applications to monitor clinical outcomes and compliance, and leveraging technology in the EHR to provide decision support and order sets at the point of care, MultiCare was able to significantly improve the clinical outcomes for these patients.

Results:

  • 19 percent reduction in readmission rates.
  • 22 percent reduction in length of stay.
  • 85 percent reduction in infections related to colorectal surgery.
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Successfully Sustaining Sepsis Outcomes

Increasingly, high-functioning healthcare organizations are recognizing the challenge of sustaining results following successful clinical improvement initiatives. Sepsis is a major driver of mortality in the U.S. In fact, it is estimated that up to half of all hospital deaths are linked to sepsis. After executing a successful strategy to improve outcomes for patients with sepsis, Piedmont Healthcare was determined to sustain those critical reductions in mortality, length of stay, and cost.

The health system “hardwired” process changes into the EHR, monitored performance compliance via a well-developed analytics application, and fostered strong leadership on the frontlines to champion a culture of continuous improvement. In the second year of its latest sepsis improvement effort, Piedmont was able to not only sustain, but also to further improve upon its first-year improvement results.

Second-year results:

  • 14.2 percent reduction in mortality for severe sepsis and septic shock translating to 68 lives saved in one year.
  • 30.7 percent improvement in number of patients receiving calculated fluid target.
  • $1.2 million saved in one year from decreased variable cost.
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Driving Down Costly COPD-related Readmissions with NOREADMITS Bundle

Nationally, approximately 700,000 hospitalizations occur each year with the principle diagnosis of Chronic Obstructive Pulmonary Disease (COPD), with one in five patients being readmitted within 30 days. Even with a national cost for each COPD readmission costing between $9,000 and $12,000, evidence-based measures that improve patient outcomes and decrease COPD readmissions are largely lacking.

When reviewing organizational performance for 30-day all cause readmission, MultiCare Health System identified COPD as one of the top two readmission diagnoses, along with a rate higher than expected. This prompted the organization to take action. MultiCare implemented a NOREADMITS bundle, using the Health Catalyst Analytics Platform and integrating performance measures for each element of the bundle, resulting in:

  • 16.5 percent reduction in readmission rate.
    • Approximately 34 fewer patients with COPD readmitted each year, saving an estimated $360,000 annually based on national benchmarks.
  • 95 percent of COPD patients were assessed for readmission risk.
  • Two-fold increase in COPD order set utilization.
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Systematic Improvement of Diabetes Care in the Inpatient Setting

Texas Children’s Hospital is improving the care delivery of its patients with diabetes, one of the most common diseases in school-aged children. How? Powered by dedicated improvement teams and analytics, they have focused on order utilization, timeliness of IV and subcutaneous insulin administration, length of stay (LOS), establishing a diabetic care unit (DCU), educating core diabetic nurses (CDNs), frontline staff adoption, and more.

Care delivery improvements include the following:

  • 94 percent of patients with diabetic ketoacidosis (DKA) are assigned to diabetic care unit.
  • 17 percent relative increase in patients with DKA receiving an evidence-based evaluation and order sets.
  • 19 percent relative increase in patients with DKA receiving IV insulin within one hour of order.
  • 50 percentage point improvement in the percentage of patients transitioning to SubQ insulin in less than four hours after medical readiness.
  • 44 percent relative decrease in LOS for patients with DKA.

 

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DKA Risk Prediction Tool Helps Reduce Hospitalizations

Each year, more than 12,700 pediatric patients are diagnosed with diabetic ketoacidosis (DKA), a life threatening complication of diabetes. Texas Children’s Hospital sought a way to accurately predict risk of DKA in time for care team members to intervene before these patients suffered a severe episode.

The health system ultimately formed a multidisciplinary high risk diabetes team to devise pre- and post-discharge strategies, and DKA risk prediction tools aided by the Health Catalyst Analytics Platform built using the Late-BindingTM Data Warehouse.

Results:

  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 90 percent of all patients with new onset type 1 diabetes at the Medical Center Campus have a documented RIPGC in their medical chart.
  • 100 percent of patients with type 1 diabetes have a risk index for DKA documented every 6 months.
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Improving Population Health for Children with Diabetes

Diabetes is the most common chronic illness for children living in developed countries. Leaders at Texas Children’s Hospital wanted to take a more data-driven approach to population health management for children with diabetes. They created a Care Process Team (CPT) to pursue outcomes improvements related to diabetic ketoacidosis (DKA) since data from the EDW revealed that 64% of diabetes patients discharged had this life-threatening condition.

After the CPT achieved their initial goal of improving care for patients admitted to the hospital with DKA, they set out to implement larger improvements that would benefit the entire population of diabetes patients.

By empowering CPT members, leveraging data to drive decisions, and implementing new interventions effectively, the Diabetes CPT members have improved population health for patients with diabetes across all settings of care. Below are a few of the most significant results.

  • 44 percent relative decrease in LOS for patients with DKA.
  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 34.4 percent relative improvement in the percentage of patients with diabetes who receive the influenza vaccine.
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Improving Diabetic Care in the Ambulatory Environment

Diabetes is the most common life-threatening, chronic illness in children who live in developed countries. With effective management of diabetes, children with diabetes can live long, healthy, and active lives.

Texas Children’s Hospital believes that diabetes patients and their families are most successful in managing their disease if they receive standardized, family-centered, multidisciplinary care in both inpatient and outpatient settings.

Texas Children’s created a new Clinic Care Process Team (CPT) which developed a comprehensive approach to standardizing diabetes care by automating best practice alerts that help clinicians recognize the need for testing, so they order labs more quickly.

Within one month of implementation Texas Children’s saw measurable improvements:

  • Screening percentages for each test improved to >80 percent.
  • 28.2 percent relative improvement in the percentage of patients receiving recommended annual thyroid-stimulating hormone (TSH) testing, with current performance greater than 90 percent.
  • 23 percent relative improvement in the percentage of patients receiving recommended annual lipid testing, with current performance greater than 90 percent.
  • 54.1 percent relative improvement in the percentage of patients receiving annual retinal examinations, with current performance at 94 percent.
  • Patient satisfaction is on an upward trend.
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How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience.

Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.

Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.

Thibodaux’s efforts are driving measurable improvements in the hospital’s inpatient admission process, including:

  • 55 percent reduction in average inpatient admission time
  • Ranked 99th percentile for patient experience
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From the Boardroom to the Bedside—Using Analytics to Drive a Culture of Continuous Improvement

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.

Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.

Results:

  • 20 percent improvement in compliance with severe sepsis; 32 percent reduction in mortality rates; 58 percent increase in sepsis detection.
  • 7 percent reduction in LOS for bowel surgery patients.
  • 34 percent improvement in heart failure LVEF assessment rates.
  • 20 percent increase in “on time” starts as result of OR dashboard.

 

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How to Significantly Reduce Sepsis Mortality

Up to 50 percent of all hospital deaths in the United States are linked to sepsis. That sepsis mortality statistic was not lost on Piedmont Healthcare, a system of six hospitals and more than 100 physician and specialist offices across greater Atlanta and North Georgia. Sepsis accounted for half of Piedmont’s mortality rate, despite years of progress in sepsis care.

Piedmont leaders recognized that they needed an innovative quality improvement methodology to spread best practices and sustain improvement, supported by an accessible source of timely, reliable, and actionable information. They therefore implemented a “core and spread” team structure to promote enterprise-wide adoption of best practices. The health system also deployed a sepsis prevention analytics application to deliver performance insight to all levels of the organization, and discovered a high correlation between better patient and financial outcomes and the number of bundle elements the patient received.  Being able to tie outcomes to interventions, along with the incorporation of nurse driven protocols, resulted in sustained practice change and greater engagement from physicians, nursing and frontline staff, all the way to the Board level.

As a result, Piedmont achieved the following impressive outcomes:

  • 5.8 percent reduction in mortality for all patients with severe sepsis and septic shock, translating to 26 lives saved in one year.
  • 2.5 percent reduction in total inpatient length of stay (LOS).
  • 8.2 percent reduction in variable cost per case, equating to $4.3 million saved in one year.
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ICU Avoidance: Lowering Costs, Patient Risk, and LOS

A stay in the intensive care unit (ICU) is both costly and risky. In a sobering example of the latter, nearly one third of patients admitted to the ICU experience delirium, a state of cognitive impairment that can increase risk of death in the hospital. Still, many cardiovascular patients need intensive care that can only be provided safely in an intensive care unit, requiring hospitals to assure enough beds and skilled ICU staff for these patients—while quickly identifying which patients can receive care as good or better in another unit.

Allina Health has achieved this dual objective with a concerted ICU avoidance strategy for specific complex sub-populations of cardiovascular (CV) patients. The foundation of this strategy is risk-informed decisions about which patients can avoid the ICU; clinical staff education; and an analytics platform and enterprise data warehouse (EDW) from Health Catalyst that enables CV care leaders to monitor safety metrics for those patients who avoid a stay in the ICU. So far, Allina Health’s efforts have resulted in the following achievements:

  • 636 additional ICU days made available for more critically ill patients by employing ICU avoidance strategies
  • One-day reduction length of stay (LOS) for Transcatheter Aortic Valve Replacement (TAVR) patients
  • $589,000 cumulative cost savings
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Nurse-Driven Protocol Optimizes Management of Post Op Afib While Reducing LOS and Costs

Post Operative Atrial Fibrillation occurs in up to 30 percent of all patients after cardiac surgery. This serious complication increases the length of the patient’s hospital stay, and is associated with a twofold increase in the incidence of cerebral infarction and an increased risk of 30-day mortality. Timely and consistent management of Post Op Afib can prevent significant complications and help prevent death. To standardize such an approach to managing Post Op Afib, Allina Health’s Minneapolis Heart Institute created a physician committee to raise consensus on and develop a protocol for Post Op Afib management.

The committee ultimately created a nurse-driven protocol and decision support algorithm linked to the health system’s electronic health record (EHR). Additionally, it uses analytics, supported by Health Catalyst’s Late-Binding™ Enterprise Data Warehouse (EDW), to track physician ordering rate, patient outcomes, and cost. This combination of people, processes, and analytics tools has made a significant difference for Allina and its patients.

  • Two-day reduction in ICU LOS.
  • 5.9 percentage point reduction in ICU readmission rate.
  • $1.5 million savings.
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Leveraging Risk Assessment to Decrease LOS and Cost for PCI Patients

Percutaneous Cardiac Intervention (PCI) is a minimally-invasive alternative to open heart surgery—a procedure that approximately 600,000 U.S. patients will undergo this year.

Allina Health, a non-profit health system with 90+ clinics and 13 hospitals with locations throughout Minnesota and western Wisconsin, is a leading provider of the procedure in Minnesota. Allina Health discovered that major bleeding events following PCI procedures (the most common non cardiac complication of PCI), though not affecting mortality, were increasing length of stay (LOS) and cost.

To improve the quality of its PCI procedures and decrease costs, Allina Health recognized the need to accurately assess bleeding risk and then implemented best-practice interventions to prevent major bleeding events.

Already, physicians and patients have seen that these new interventions, which includes a bleeding risk assessment tool, allows clinicians to focus interventions based on risk and reduce complications. The top results from Allina Health’s interventions include:

  • 5.3 percentage point reduction (a 21.7 percent relative reduction) in complication rate.
  • $1.8M cost savings.
  • 1.4 percentage point reduction (a 36.5 percent relative reduction) in LOS for patients at high risk for bleeding who receive a closure device.
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A Service Line Approach Improves Women’s Health at UPMC

By the age of 60, more than one-third of women in the United States have had a hysterectomy. Healthcare systems across the country are recognizing that a women’s health service line offers a pathway to improving care and decreasing cost for these patients. Having accurate activity-based costing information is necessary to uncover opportunities for clinical practice improvement and cost reduction.

The University of Pittsburgh Medical Center (UPMC) made the decision to organize Women’s Health as a service line across the entire health system. UPMC fortified this approach with strong and collaborative leadership, an enterprise data warehouse, and an activity-based cost management system. The results:

  • 20 percent reduction in inpatient length of stay for hysterectomies (over a three-year time period)
  • 34 percent reduction in open hysterectomies
  • 28.3 percent reduction in 30-day readmissions for hysterectomies

These results were obtained during a time when this clinical service saw a 25 percent improvement in its contribution margin.

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How to Reduce Clinical Variation and Improve Outcomes While Demonstrating a Positive ROI

Clinical variation can be frustrating for patients and their families, often leaving the impression that healthcare team members are not on the same page and don’t agree on the plan for the patient’s diagnosis or treatment. It is also costly—the Institute of Medicine estimates that $265 billion (30 percent) of healthcare spending is waste that directly results from clinical variation.

To reduce unwanted variation, Texas Children’s Hospital invested considerable resources to develop clinical standards tools, including evidence-based order sets; however, demonstrating the effectiveness and utilization of those guidelines, pathways, and order sets had been daunting. To that end, Texas Children’s deployed an analytics platform from Health Catalyst to aggregate and analyze the data needed to perform both of these critical functions.

Results:

  • $2,401 reduction in cost per patient with order set utilization, and an 8.4-day difference in average length of stay (LOS).
  • $15 million reduction in total direct variable costs in Fiscal Year 2015, $32 million anticipated reduction in Fiscal Year 2016 at the current order set usage rate, and a potential $64 million annual reduction with a hypothetical 80 percent order set usage rate.
  • 1,629 percent return on investment (ROI).
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Reducing HAC Rates to Keep Kids Safe and Healthy

Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1

Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.

The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:

  • $1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
  • 23 percent reduction in central line-associated blood stream infections (CLABSIs)
  • 74 percent reduction of pressure ulcers (PUs)
  • 68 percent reduction in venous thromboembolisms (VTEs)
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Evidence-Based Care Process Model Reduces SSIs and Readmissions

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.

In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.

Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.

Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

  • 92 percent reduction in colorectal surgery SSI rates
  • 28.5 percent reduction in mortality
  • 10.6 percent reduction in 30-day readmissions
  • 4.4 percent reduction in LOS
  • 8.5 percent reduction in cost per case
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Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs

U.S. hospital stays cost the health system at least $377.5 billion per year. In today’s value-based care environment, hospitals are under increasing pressure to avoid patient harm and maintain quality while also lowering costs. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals.

El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. However, when it came to its goal of reducing LOS, leaders recognized that they faced some major challenges, including:

  • The complexity of implementing a multi-layered, multi-disciplinary approach to improving the patient discharge process.
  • Identifying what issues were contributing the most to increased LOS so that they could be addressed.

By implementing analytics and protocols that provide access to actionable data, the LOS reduction team was able to identify patients at high risk for increased LOS so that they could develop and track critical interventions. El Camino’s patient-centered approach to tackling LOS reduction also included multi-disciplinary cooperation, leadership buy-in, and additional resources to enhance discharge care coordination.

This innovative, systematic approach resulted in not only a better than anticipated reduction in ALOS of 7.8 percent, but also:

  • 14.8 percent reduction in readmissions
  • 55 percent reduction in healthcare acquired conditions (HACs)
  • 32 percent reduction in incidence of AHRQ patient safety indicators (PSIs).
  • $2.2 million projected annual cost savings
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A Care Model to Support the Needs of Medically Complex Patients

People with disabilities face daunting challenges in accessing basic healthcare. As a result, they frequently use hospitals and emergency rooms, and are four times as likely to be hospitalized compared to the general population.

Allina Health has deployed an effective “primary care medical home” model that gives patients with disabilities the care and support they need outside of the hospital setting. Key strategies of the model include assigning dedicated care coordinators to each patient; strengthening care coordination across the continuum of services; and an analytics platform from Health Catalyst to target opportunities for improvements and savings.

Allina’s data-driven efforts to strengthen care of patients with disabilities have made a clear and meaningful impact; most importantly, on patient outcomes. They have achieved: 30% reduction in hospitalizations and 66% reduction in hospitalization days; 79% reduction in 30-day readmissions days; significantly improved access to care; and saved $4.5 million over a one-year period.

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Nationally Recognized Transitional Rehabilitation Program’s Strategies

Serving patients with special needs, such as traumatic injury or multiple high acuity co-morbidities, is a costly and complex endeavor. Allina Health’s Transitional Rehabilitation Program (TRP) tackled both of these realities head-on—resulting in cost savings while helping this vulnerable patient population achieve a higher quality of life.

Recognizing the need for high-quality data that could prove the TRP’s value to its patients and community, Allina implemented analytics that enabled it to track and report outcomes and costs, demonstrate value, and generate savings for the health system and the community.

The initiative has reaped wide-ranging results in patient improvements and cost savings including saving health systems and communities $3.2 million over a one-year period, 20 percent greater success than traditional skilled nursing facilities in discharging patients to home and community, 20 percent improvement in impairment in brain injury patients (MPAI-4), and 84 percent improvement in spinal cord independence measure (SCIM).

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Care Management Strategy Improves Lives of Stroke Patients

Stroke is a leading cause of hospitalizations among elderly often resulting in serious long-term disability, readmissions (up to 27% are readmitted to the hospital in year one), or secondary stroke. Allina Health’s Courage Kenny Rehabilitation Institute (CKRI) had deployed a successful care coordination model for other complicated, high-risk populations that it was confident would help stroke patients, as well.

CKRI created a holistic program for stroke patients that delivers comprehensive, seamless care across inpatient, outpatient and support services. A data warehouse and analytics platform merges data across the care continuum, and enables Allina to target high-risk stroke patients for coordinated care, track their progress and measure their outcomes.

Within a year, Allina was able to prove the value of this new care model for stroke by realizing $350,000 in cost savings and, most importantly, through actual lives saved and improved.

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Allina Health’s Dedication to Quality Improvement Delivers On the Triple Aim

Improving clinical outcomes is good for patients and good for health systems. In fact, Allina Health’s focus on data-driven outcomes improvement realized a total financial improvement of $125 million in a single year.

Allina embraced the mandate of achieving the Triple Aim: improving the quality and cost of care, as well as the patient experience. To achieve this goal, Allina’s leaders recognized that they would need to realign their strategies, organizational structures, and management practices. Confident that data would help the health system improve the quality of patient care and reduce costs, they implemented a data-driven performance improvement strategy.

The results are astounding. This strategy has achieved financial improvements for the health system of $100+ million per year, four years running, while also advancing Allina Health’s Triple Aim goals of improved clinical outcomes and a better patient experience through dozens of improvement initiatives.

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Innovative Approach to Rehabilitation Care Improves Patient Outcomes

Disability is one of the United States’ most important public health issues—with approximately 15 percent of citizens affected. Allina Health created The Courage Kenny Rehabilitation Institute (CKRI) to help people with disabilities, injuries, or complex medical conditions achieve the highest possible degree of health, functionality, and quality of life.

CKRI’s advanced model for rehabilitation care focuses on the whole person, one that looks beyond the medical to address vocational, social, and emotional needs. This collaborative model enables comprehensive and seamless care across the continuum while preparing the organization to operate in a value-based, at-risk environment. CKRI also implemented an analytics infrastructure to help focus its resources appropriately and to measure success.

This innovative approach has optimized patients’ quality of life with up to 76 percent reduction in hospitalizations and 53 percent reduction in ED visits – resulting in annual community cost savings of $11.2 M.

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Saving Lives with Best Practices and Improvements in Sepsis Care

Every year, severe sepsis impacts more than 1 million Americans, and an estimated 25 percent die from the condition. Thibodaux Regional Medical Center is committed to driving and keeping its sepsis mortality rate to less than have the national average. How is this health system achieving these outcomes? Thibodaux formed a sepsis improvement team charged with reducing sepsis mortality and lowering costs while improving the patient experience. The team implemented best-practice care protocols, an analytics system, and an adoption approach that engaged clinicians using education and data. Backed by executive leadership and guided by clear goals, the sepsis improvement initiative has achieved impressive results in just six months that include a decrease in sepsis mortality rate to half of the national average, a 3 percent reduction in average variable cost, a reduction in LOS in the ICU by one day, and a 7 percent improvement in patient satisfaction.

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Allina Health: A Successful Approach to Improving VTE Care and Prevention across a Large Health System

An estimated 1 million cases of venous thromboembolism (VTE) occur each year in the United States—with approximately 300,000 of these cases resulting in death. These sobering statistics led Allina Health to embark on a journey to address prevention and improved care for its VTE patients—one of the most common causes of hospital-related death in the United States—and one of the most preventable. Supported with analytics, Allina implemented a physician-led, multidisciplinary workgroup to standardize order sets and engage clinicians in improvement efforts. To date, their system-wide efforts have generated measurable improvements including an 11 percent increase in VTE bundle compliance rate, a 96.9 percent compliance with VTE prophylaxis, and a 41 percent increase in compliance with VTE warfarin therapy discharge instructions.

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How Allina Health Improved Spine Care Variation and Outcomes

Low back pain (LBP) is a common and expensive problem. The annual cost to patients, employers, and insurers collectively exceeds $100 billion in the U.S. alone. Additionally, LBP care treatment variations, impact outcomes. In 2011, Allina Health created the Spine Institute to deliver care that supports the IHI Triple Aim in the treatment of spine disorders and LBP. All clinical disciplines involved in spine care are part of the program, and care providers follow standard spine care and management evidence-based models. Access to quality data enables Allina to measure performance across providers. With this successful spine care coordination program and advanced clinical analytics, Allina has reduced length of stay by 16 percent and post-op complications by 3.6 percent, while projecting $2.7 million in savings.

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Achieve Reduced Heart Failure Readmission Rates: One Healthcare Organization’s Care Coordination Strategy

Heart failure (HF) sends more US adults over 65 to the hospital than any other cause—costing Medicare alone more than $17 billion annually—with readmissions significantly contributing to the issue. For large integrated networks like Allina Health, efforts to reduce readmissions for HF patients are challenged by the need for coordinated care and consolidated data across the care continuum. Allina implemented a multidisciplinary HF management program with a nurse care coordinator and nurse practitioners who assure patient engagement and provide a “bridge” between different points in the care continuum. These important people and processes are aided by access to data from an enterprise data warehouse that merges data across the health system and gives providers insight into HF care and performance metrics. The program has helped Allina achieve a 30-day HF readmission rate well below the national average —17 percent in 10 of 11 hospitals doing cardiac care.

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How an IDS Improves Outcomes Using a Clinical Collaborative Structure

MultiCare, an integrated delivery system (IDS) in the Pacific Northwest, has established a Clinically Integrated Network (CIN) to serve as a model for value creation that benefits patients, providers, and payers. However, to create a truly integrated network, MultiCare needed to build a system of collaboratives—multidisciplinary, clinically focused teams charged with developing clinical care standards and pathways and then collaborating with operations to get them implemented across the enterprise—to improve outcomes in a growing range of clinical domains including Critical Care, Women’s, Surgery, Medicine, Cardiac, and Pediatric. The outcomes of this collaborative care include a 65 percent reduction in sepsis mortality rate, a 75 percent reduction in time required to approve system-wide care guidelines, and a significant contribution to a system-wide cost savings trajectory of more than $100 million over the last three years.

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Standardizing Labor and Delivery Best Practices to Improve Outcomes

Advancing women’s health is a key part of the nation’s healthcare quality improvement and population health management agenda. Mission Health has embarked on a journey to standardize its best practices and develop a more systematic method for collecting and analyzing data related to perinatal care. With an EDW serving as its analytics platform, and a newly implemented clinical improvement model, Mission is able to monitor performance on several evidence-based practices designed to improve maternal and newborn care. Learn how they have sustained a zero elective delivery rate, and how they have reduced the time they spend manually collecting data and calculating rates.

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New Initiative Supports Cardiac Patients on a Better Path to Health

With nearly one in four Medicare patients hospitalized with heart failure (HF) being readmitted to hospitals within 30 days of discharge, healthcare organizations like MultiCare are primed to develop care improvement initiatives focused on reducing readmissions. MultiCare has had a HF collaborative for several years, focused on standardizing and increasing the quality of care for its cardiac patients—resulting in a 24 percent improvement in HF readmission rates and an 18 percent improvement in mortality rates. With this proven commitment to its patients, MultiCare was selected for participation in the American College of Cardiology’s Patient Navigator program, opening up the opportunity to provide cardiac patients with an advocate dedicated to helping patients navigate their pathway to improvement. Through participation in this patient navigator program, MultiCare has ability to further bring the patient’s voice to the forefront and improve its quality of cardiac care even more dramatically in the future.

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Effective Practice Management Results in Quality Care for More Patients

Effective practice management can help provide quality patient care, increase revenues— and enhance patient and employee satisfaction. Ineffective practice management may cause patients to seek care elsewhere. As the healthcare industry transitions to value-based care, clinics must align provider scheduling as tightly as possible with patient demand while maintaining a high level of physician and patient satisfaction. Learn how practice managers, clinicians and operational executives are improving practice management, patient access and provider productivity, which has contributed to an estimated $20 million in savings.

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$74M in Healthcare Operational Improvements: How Texas Children’s Hospital Is Delivering on Its Vision

Federal and state funding reductions, along with increased competition, are the latest profitability challenges facing healthcare organizations. Texas Children’s recently faced this challenge head-on when projections indicated they would fall $50 million short of what was needed to build capital reserves and to maintain their bond rating. To improve financial performance and prepare for the future, the leadership team launched a system-wide performance improvement project called “Delivering on the Vision” (DOTV). DOTV would involve increasing accessibility for patients as well as driving healthcare operation savings. Texas Children’s goal, of increasing operating margins over 18 months by achieving $60 million in savings, has been surpassed — realizing $74 million in cost savings to date.

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Improving Healthcare Provider Productivity with Advanced Analytics

Improving provider productivity to enhance access to care and positively impact the bottom line is one of the most important tasks facing healthcare organization today. Historically the approach to evaluating provider productivity was complicated, time-consuming and inconsistent. This left providers struggling to effectively manage in their areas of responsibility. Learn how section chiefs, providers and operational leaders at one healthcare organization now have access to near real-time data, a single source of truth, and national benchmarks that enable them to optimize productivity—which resulted in their ability to see more patients and increase revenue per clinical FTE, contributing $20M in organizational savings.

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Improving Healthcare Performance through Analytics and Cultural Transformation: One Healthcare Organization’s Journey

OSF HealthCare, a pioneer accountable care organization (ACO), was looking to deliver superior clinical outcomes, improve the patient experience, and enhance the affordability and sustainability of its services. OSF’s leaders recognized that to effectively achieve these goals, they needed to reinvent the organization’s performance improvement measurement and reporting system. In addition to deploying new analytics technology, OSF knew they needed to drive a cultural shift throughout the organization to embrace a data-empowered system. By engaging leadership, aligning the initiative with business strategies, and building data-driven clinical and operational improvement teams, OSF was able to save $9-12 million over three years—through both process improvement and cost avoidance. OSF also drove clinical performance improvements in key areas including heart failure and palliative care.

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Operating Room Excellence: How One Hospital System is Driving Improvements with the Use of Advanced Analytics

Mission Health in North Carolina has always been dedicated to expanding access to care. To preserve this commitment in an era of declining reimbursement rates, Mission needed better access to data for quick and flexible decision-making. As at most hospitals, operating rooms are Mission’s biggest revenue generator, but they also represent a significant cost center. So, leveraging their new analytics capabilities to drive operational improvements across their system of operating rooms was a strategic opportunity. Mission now has improved ability to drive care and operational improvements with integrated data and analytic tools like their OR Dashboard—resulting in dramatic improvements including a 20% increase in first-case on-time surgical starts.

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Quality Improvement in Healthcare: An ACO Palliative Care Case Study

Quality improvement in healthcare is essential for healthcare organizations as they transition to value-based care. Including palliative care in the planning and implementation of value-based care initiatives is more important than ever—especially for accountable care organizations (ACOs). This case study reviews the OSF Healthcare community-wide palliative care program and examines their key results: a) completion of 4300 advance care plans and engagement of more than 980 physician and community facilitators; b) leveraged a healthcare enterprise data warehouse (EDW) in a heterogeneous EHR environment; c) enabled data transparency at all levels through reporting and visualizations.

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How to Reduce Heart Failure Readmission Rates: One Hospital’s Story

An estimated 24 percent of patients who are discharged with heart failure (HF) are readmitted to the hospital within 30 days. Learn how this healthcare organization engaged physicians and multidisciplinary teams to improve their outcomes. Deploying evidence best practices—medication reconciliation, follow-up appointments, follow-up phone calls and teach back—they reduced and sustained their 30-day HF readmission rates by 29 percent, and their 90-day HF readmissions by 14 percent. They have seen their process measures increase significantly: 120 percent increase in follow-up appointments; 78 percent increase in pharmacist medication reconciliation; 87 percent increase in follow-up phone calls; 84 percent increase in teach-back interventions.

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Hospital Readmissions Reduction Program for Heart Failure: A Healthcare System Case Study

The Centers for Medicare & Medicaid Services (CMS) is tying reimbursement to hospital readmissions. Healthcare systems are investigating hospital readmissions reduction programs to improve patient outcomes and avoid CMS penalties. Learn how this healthcare system, determined to improve heart failure care for its patients, increased their documented follow-up appointments by 270 percent.

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How to Reduce Unnecessary Elective Deliveries: A Powerful Case Study

Studies have shown that elective deliveries before 39 weeks increase the risk of newborn respiratory distress as well as increase the rates of C-sections where there is a higher rate of postpartum anemia and longer lengths of stay for both mothers and babies. Payers are partnering with healthcare organizations to lower elective delivery rates. Learn how this healthcare organization reduced their elective deliveries by 75 percent in just six months and received a six-figure payer partner bonus.

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How to Improve Appendectomy Care Outcomes Using Advanced Analytics in Healthcare

Quality and efficiency have become even more important to hospitals amid the impending transformation of the reimbursement system from fee-for-service to value-based payments. Learn how this hospital used using analytics technology, team-based processes and evidence-based best practices to drive cultural transformation, improve appendectomy outcomes and reduce costs, and deploy end-to-end workflow optimization. The results are impressive: they reduced postoperative length of stay by 36 percent; they reduced average variable direct costs by 19 percent; they increased order set adoption rates by 36 percent; they increased the percentage of patients receiving recommended antibiotic as first antibiotic by 53 percent.

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How to Improve Sepsis Diagnosis and Outcomes through Innovative Healthcare Analytics

Sepsis affects more than 750,000 hospitalized patients and results in 570,000 ED visits per year. Learn how this large medical center is tackling their sepsis care challenges by leveraging their EDW and healthcare analytics. They defined and built a sepsis registry and analytics platform in 10 weeks to measure 6 interventions and 4 outcome measures — including mortality rates, length of stay, total hospital stay and 30-day readmits.

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The Problem of Measuring Spinal Surgery Outcomes and How Analytics Can Help

Spinal problems are a common issue with a profound impact on healthcare costs. Faced with the high cost of surgical spine care in an industry transitioning to value-based payments, health systems need analytic solutions to evaluate the effectiveness of surgical interventions. Read how this medical center: 1) built a Spine Registry, 2) drove patient engagement through patient portal usage, 3) integrated data from a multitude of quality of life surveys, and 4) developed a healthcare analytics platform to measure spinal surgery outcomes.

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How to Reduce CAUTI Costs Using a Hospital Enterprise Data Warehouse

North Memorial Health Care is a 518-bed health system providing healthcare services in the Northwest metro area of Minneapolis-St. Paul, Minnesota, and beyond. The system comprises North Memorial Medical Center, a Level I Trauma Center; Maple Grove Hospital, a community-based hospital; and a network of primary, urgent care and specialty care clinics. North Memorial also operates one of the nation’s largest hospital-based air and ground ambulance services.

According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the most common type of healthcare-associated infection, causing 450,000 annual infections leading to 13,000 deaths, increasing lengths of stay by as many as four days, and increasing healthcare costs by as much as $500 million per year nationally. Seventy-five percent of UTIs are Catheter-Associated Urinary Tract Infections (CAUTIs), and 15-25 percent of hospitalized patients receive urinary catheters during their hospital stay.

To satisfy new proposed Centers for Medicare and Medicaid Services (CMS) reporting requirements, North Memorial Health Care needed to expand its CAUTI monitoring – a time- and labor-intensive process for even one unit – to track patients in all their units across multiple facilities. Their solution: leverage existing Late-Binding™ Enterprise Data Warehouse (EDW) and Patient Injury Advanced Application- CAUTI Module solutions from Health Catalyst.

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Building a High-quality Cancer Care Delivery System

In a recent report, the Institute of Medicine (IOM) declared that the cancer care delivery system is in crisis—amplified by the complexity of cancer care and historical limitations in quality-improvement tools.

As a result of an aging population, the IOM predicts a 30 percent increase in cancer survivors by 2022 and a 45 percent increase in cancer incidence by 2030. Parallel to this increase in incidence is a trend toward increasing costs. In 2010, $125 billion was spent on cancer care compared to $72 billion in 2004. In fact, the cost of cancer is expected to reach $173 billion by 2020—a 39 percent increase in just seven years.

One renowned health system recently implemented a solution to mitigate this crisis: a high-quality cancer care delivery system based on healthcare analytics and business intelligence. The health system has implemented a framework for data-driven clinical improvement.

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Launching an EDW to Rapidly Reduce Waste in Asthma Care

See how one children’s hospital used its enterprise data warehouse and related analysis tools to uncover a faulty order set in an EHR that was resulting in too many chest xrays. End result? A 49% reduction in x-rays ordered in the first six months. And the numbers just keep getting better.

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Hospital Acquired Infections – How to Reduce Surveillance Waste

Adopting an enterprise data warehouse had a number of positive affects for one medical center. Not only did they create way to more effectively discover and treat certain hospital-acquired infections, the organization also developed five steams of quality improvement—infectious disease, population health, cardiovascular, neuroscience and oncology.

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How to Reduce Sepsis Mortality Rates by 22%

Northwest healthcare organization Multicare reduced septecemia by 22 percent, leading to a $1.3 million cost savings in the same period. Now the organization is tackling other areas of improvement. Discover what triggered the improvements — and how these resulted in savings.

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Other Content in Clinical Analytics and Decision Support

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Healthcare Decision Support: A Modern Tool for Today’s Chief Nursing Officer

Chief Nursing Officers (CNOs), essential members of health system C-Suite teams, need healthcare decision support to align nursing resources with systemwide goals.

Although nursing’s purpose hasn’t changed, the tools and skills needed to achieve it have. In today’s data-driven, increasingly complex care environment, nursing leaders rely on skills that extend beyond their initial training as nurses; they need expertise in finance, IT, and analytics, among other areas.

CNOs, like Faye of Pennington Health, depend on healthcare decision support systems for easy access to data that helps them identify and prioritize the best opportunities, address challenges, and improve outcomes.

CNOs who embrace the fact that advanced analytical tools are critical to improving care quality and reducing care costs are poised to effectively lead their systems toward achieving financial, strategic, clinical, and operational objectives.

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Why Healthcare Decision Support Is No Longer Optional for Chief Operating Officers

Without daily access to healthcare decision support, health system COOs struggle to make rapid, meaningful decisions. Healthcare decision support systems are no longer optional for these highly visible leaders, who play critical roles in their organizations’ success, for many reasons:

  • Aggregates reliable, up-to-date information from all available sources.
  • Presents information in user-friendly, user-configurable ways.
  • Makes trends and important conclusions more recognizable and understandable.
  • Enhances C-Suite’s ability to drill down into data in search of a problem’s root cause.
  • Improves C-Suite communication and collaboration.
  • Unites C-suites around a common vision and strategy.

Healthcare COOs (and other C-Suites) need healthcare decision support to be data-driven problem solvers and collaborative leaders who achieve clinical, financial, and operational success for their systems. Given the industry’s increasing complexity, healthcare decision support is now an industrywide imperative.

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Healthcare Decision Support Helps CFOs Achieve Their Top Goal: Timely, Accurate, Agile Decision Making

Supporting decision making is a top goal for CFOs today, according to a 2017 Kaufmann Hall CFO survey. Healthcare decision support empowers CFOs and their finance teams to make accurate, agile, and timely decisions, from rolling forecasts of future trends to risk-adjusted scenario modeling.

In addition to helping CFOs make good decisions, healthcare decision support helps CFOs lead their teams and organizations improve in four key ways:

  1. Data-driven growth and practice expansion.
  2. Improved ability to negotiate favorable risk-based contracts with payers.
  3. Effectively and fairly address important physician compensation issues.
  4. Improve population health management.

With healthcare decision support, CFOs and their health systems have a distinct competitive advantage (e.g., shortened planning cycles and more accurate cost measurement). They can adjust to unexpected challenges and take advantage of new opportunities.

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Why CMOs Need Healthcare Executive Dashboards to Lead High-Performing Systems

It’s no easy task to lead a real-time, outcomes-focused, high-performing health system. That’s why every chief medical officer (CMO) needs a healthcare executive dashboard—a decision support tool that helps these senior physician leaders ensure their organizations continue to achieve the seven key attributes of a high-performing health system:

  1. Efficient provision of services.
  2. Organized system of care.
  3. Quality measurement and improvement activities.
  4. Care coordination.
  5. Use of information technology and evidence-based medicine.
  6. Compensation practices that promote the above-listed objectives.
  7. Accountability.

Healthcare executive dashboards help CMOs integrate information, identify key issues and care gaps, and present information to their teams in a meaningful, data-driven, actionable format. Executive dashboards are an essential component of the CMO leadership toolset.

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Decision Support: Why the Executive Dashboard Is a Healthcare CEO’s Best Advisor

Healthcare CEOs and other C-Suite leaders can’t make quality decisions in today’s rapidly changing, complex environment without decision support.

Healthcare CEOs are starting to realize that executive dashboards with personally tailored views of key metrics are no longer a luxury, but an absolute necessity, for three key reasons:

  • Helps leaders analyze and digest large amounts of data relating to care quality, operations, contracting, and major purchasing decisions.
  • Gives leaders a clear understanding of the financial aspects of their systems, such as revenue streams, cost drivers, costs of capital, bundled payments, and payment reforms.
  • Facilitates conflict resolution and helps leaders work collaboratively—using a matrix management approach—with peers, direct reports, and system experts.

Today’s healthcare CEO must be skilled problem solvers, strategic and analytical thinkers, and collaborative leaders who understand both the clinical and financial sides of healthcare—goals made possible with an executive dashboard.

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