Readiness Assessment Crucial First Step in Building an Outcomes Improvement Focused Organization

Healthcare organizations need to be cognizant of their readiness for change, enabling them to create a plan that will enhance the organization’s ability to successfully drive change. While many studies have been completed on the importance of organizational readiness in non-healthcare organizations, there is little research and relatively few,  measurement tools focused specifically on healthcare organizations.

To cement the Pulse Heart Institute (Pulse Heart) as a destination for adult heart health, and ensure its long-term success, Pulse Heart required a better understanding of its readiness to drive and sustain outcomes improvements—which it found through an onsite assessment that leveraged the Health Catalyst® Outcomes Improvement Readiness Assessment (OIRA) framework. Using the assessment findings and subsequent recommendations, Pulse Heart successfully developed, and continues to develop, the findings to guide workplans to improve competencies and enable the organization for long-term outcomes improvements success.

Based on the results of the onsite readiness assessment they have identified and implemented interventions to improve readiness for change in each of the five major OIRA Tool categories:

  • Leadership, culture, and governance
  • Analytics
  • Best practices
  • Adoption
  • Financial Alignment
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MultiCare’s Transformational Journey Toward Sustained Outcomes Improvement

Mixed reviews of the effectiveness of pay-for-performance programs leave hospitals wondering how to affect meaningful change in patient care and outcomes. However, MultiCare’s experience with focused improvement efforts supported by analytics for pneumonia, sepsis, and women’s care showed that better data consistently leads to better patient outcomes.

Committed to improving population health, and informed by their experience as well as national trends and outcomes, MultiCare formed a new partnership with Health Catalyst, a next-generation data, analytics, and decision support company. The shared risk partnership generated an improvement framework and governance structure formed around a Shared Governance Committee which is responsible for prioritizing, resourcing, and aligning improvement initiatives across MultiCare. The committee and the projects it ultimately approves are informed by data-driven opportunity analysis and ongoing analytics support. This partnership and structure have achieved the following:

Results

  • Strategic alignment of outcomes goals across the organization.
  • Established an Analytics Center of Excellence.
  • Integrated financial data into outcomes improvement initiatives.
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Collaborative Partnerships and a Three-System Approach to Driving Healthcare Transformation

Healthcare organizations are among the most complex forms of human organization ever attempted to be managed, making transformation a daunting task. Despite the challenges associated with change, Texas Children’s Hospital identified that it needed to evolve into a data-driven outcomes improvement organization.

Texas Children’s embarked on a journey to transform care, building a three-systems approach—analytics, best practice, and adoption—designed to develop a data-driven quality improvement organization that could achieve outcomes improvement expediently and at scale across the entire organization. Texas Children’s leadership knew that the foundation for clinical systems integration would be meaningful, actionable data. That realization prompted the organization to implement the Health Catalyst Analytics Platform including a Late-Binding™ Data Warehouse (EDW) and a broad suite of analytics applications.

After deploying the analytics platform supported by multidisciplinary quality improvement teams, Texas Children’s was able to improve patient outcomes related to the following:

  • 35 percent relative decrease in hospital-acquired conditions (HACs).
  • 44 percent relative decrease in LOS for patients with Diabetic ketoacidosis (DKA).
  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.

 

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Integrated Care Management – Improves Care and Population Health While Reducing Costs

One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. Moreover, chronic disease accounts for 86 percent of our nation’s healthcare costs.

An integrated delivery system and an accountable care organization with two large academic medical centers and six community hospitals, Partners HealthCare is increasingly compensated for outcomes of care. Recognizing the need to more effectively manage its chronically ill patients, Partners implemented an integrated care management program (iCMP) to improve the outcomes of rising-risk patients and better manage treatment costs. The iCMP is a primary-care embedded, longitudinal care management program led by a nurse care manager working collaboratively with the primary care provider and care team.

The iCMP is contributing to Partners effective management of patients and financial success in at-risk contracts. In its Pilot Phase as a Medicare Demonstration Project, the program achieved the following results:

  • 20 percent lower hospitalization rate per 1,000 patients.
  • 13 percent lower rates of emergency department (ED) utilization.
  • 25 percent relative difference in mortality.
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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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Using Value to Prioritize and Guide Analytics Investments

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.

To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.

To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

  • 32 percent reduction in sepsis mortality
  • 20 percent improved compliance with the sepsis care process
  • 7 percent reduction in LOS for bowel surgery patients
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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 One Hospital Embraced Patient Satisfaction Transparency

As consumers pay more for their healthcare they are demanding more transparency. In a telling example, it’s estimated that over 84 percent of patients use online provider reviews to help make care decisions. With increased transparency, hospitals need to develop strategies to address patient satisfaction while finding a way to participate for more fully in the patient satisfaction dialogue and social media communications, including the rating process.

One large hospital has done just that by increasing transparency in the patient review process. A key component is providing physician star ratings by patients on the hospital’s own website, with patient survey data sourced from Health Catalyst’s analytics platform. While this strategy took time and effort to win over physician acceptance, it has paid off considerably by taking patient satisfaction to new heights.

The overall patient satisfaction improvement initiative, of which the physician transparency effort was a key component, has proven to be resoundingly successful in supporting physicians and staff in the difficult work of providing outstanding and compassionate care – and has reaped impressive results including,

  • Improved patient satisfaction scores from 60 percent to over 90 percent
  • Successfully implemented a physician mitigation strategy with a 98 percent comment acceptance rate
  • Intensified focus on the patient experience through data and education
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How an IDS Standardized Care for Women While Increasing Market Share

One in three pregnant women give birth via cesarean section in the United States, which is more than double the rate the World Health Organization (WHO) recommends. And instead of decreasing, the overall C-section rate in Washington State increased 73 percent from 1996 to 2009. C-section rates are just one area of maternal care where our practice in the U.S. lags behind the science and knowledge of best practice. MultiCare Health System believes that all of its female patients should experience the same high-quality care across its integrated delivery system. The health of the next generation depends on it.

MultiCare recognized that it had to standardize care across its system to meet quality standards, improve its patients’ experiences and outcomes, and maintain its market share. The health system launched a Women’s Collaborative, the sole purpose of which was to improve clinical care and patient outcomes for women’s services systemwide.

By working with clinicians to implement standards of care, and using analytics to measure performance, the Women’s Collaborative achieved the following:

  • NTSV (low-risk, rst-time mother) C-section rate 9 percent less than the national average and already below the 2022 national goal of 23.9 percent
  • Six-point increase in market share for inpatient OB/GYN services
  • Improvements in care delivery:
    • 63 percent reduction in episiotomy rate
    • 
11 percent reduction in SSI rate for C-sections
    • 14 percent reduction in 3rd or 4th degree perineal laceration rate
    • Non medically indicated induction rate consistently less than a quarter of one percent
    • 6.7 percent reduction in the percentage of abdominal hysterectomies
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How Allina Saved $13 Million By Optimizing LOS

Like most large healthcare systems throughout the country, Allina Health’s financial health improves dramatically by optimizing inpatient care for the patients it serves.

Allina recognized optimizing length of stay (LOS) was one of the key drivers of its inpatient financial performance and developed the technical infrastructure and analytic capabilities to understand LOS performance by the minute and not the day; adjust LOS to account for patient acuity and compare performance to national benchmarks; make LOS data available to clinicians across the organization in near real-time; and estimate the financial impact of LOS opportunities to enable targeted interventions for improvement.

Allina leveraged its enterprise data warehouse (EDW) and analytics platform and optimized LOS, yielding the following results in the first two years of its improvement efforts:

  • 26,000+ inpatient days saved
  • $13.4 million in direct operating expenses saved
  • Hospital capacity (bed availability) created for 5,000+ admissions
  • Avoided adverse patient events and reduced the total cost of care
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The Improvement Methodology From Thibodaux That TJC Calls “Best Practice”

Thibodaux Regional Medical Center has always excelled in delivering quality care to its patients, but a fundamental tenet of its culture is continuous improvement.

Driving that continuous improvement is a methodology The Joint Commission called “best practice in how to use data and get physicians engaged.” This quality improvement methodology centers around a three-systems care transformation model that includes best-practice care protocols, analytics, and rapid time-to-value analytics application development and frontline clinician adoption.

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Keys to Successful Quality Improvement: A CEO’s Perspective

We believe healthcare is undergoing a transformation and that CEOs need to promote a culture of dialogue and adaptive learning to drive continuous quality improvement. Thirty years ago Greg Stock, CEO of Thibodaux Regional Medical Center, was seated in a healthcare conference when he heard a presenter say, “Thirty percent of clinical care is waste.” These words triggered something in Stock that sent him down a relentless path to transforming healthcare in his community.

Learn how Stock is leading and sustaining outcomes by establishing a culture of quality with an adaptive leadership style, engaging physicians, and using analytics, best practices and adoption processes that work.

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How Allina Health Deployed Evidence-Based Decision Making and Reduced Variation

To tackle the variation and waste that can arise from different treatment decisions, Allina Health developed a solid framework to establish and deploy standard, evidence-based practices across the enterprise. The transition to a standard evidence-based decision-making process required collaboration and buy-in from multiple stakeholders and physicians. Allina’s established quality governance structure reviewed and approved system-wide clinical practice guidelines for Stage 1 lung cancer treatment and IV heparin treatment. To sustain and improve on this new model of care, a comprehensive checklist was developed to ensure that all future guidelines are based on patient subgroups and preferences, available evidence, stakeholder review, and other important criteria including IOM standards. Adherence to guidelines is monitored with metrics based on data extracted from Allina’s enterprise data warehouse and from the electronic health record. Results to date already indicate notable improvements in variation and cost, including the following: the establishment of a system-wide EBDM model and policy, 20 system-wide approved evidence-based guidelines developed months faster, a 5 percent decrease in Stage 1 lung cancer treatment variation, and a 20 percent decrease in the number of heparin protocols.

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One Healthcare System’s Effective Strategy to Improve Pneumonia Outcomes

MultiCare Health System, an IDS serving communities throughout Washington State, recently undertook an initiative to improve the care of, cost of, and experience for pneumonia patients. This initiative included the building of evidenced-based order sets (and driving their adoption), assigning a team of social workers called “personal health partners” to research and improve patient follow-up and communication, and deploying an analytics application to provide near real-time feedback on compliance and performance while offering a single view of patient-specific data across multiple visits and care settings, such as medication and readmission histories. Through these efforts, MultiCare has realized significant outcome improvements including reducing pneumonia readmissions by 23 percent, a 28 percent reduction in mortality rate, a 2 percent decrease in LOS, and a 6.4 percent reduction in average variable cost per patient.

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Understanding the Market Trends and Business Drivers of a Complex Healthcare Organization

As a Pioneer ACO, Partners HealthCare knew that understanding the healthcare business drivers of hospital volume and other strategic business trends was critical to its success. To increase this understanding, Partners recognized that it needed an advanced population health management analytics application that addressed strategic questions, could be deployed quickly, and would enable users to engage with the application to contribute toward real improvement. By emphasizing strategic questions rather than the technology solution itself, adopting Agile development methodologies, and working with stakeholders to drive adoption, Partners has developed an effective analytics platform that consists of an enterprise data warehouse (EDW) and advanced population health analytics applications. These efforts have resulted in an increase of up to 75 percent in operational efficiency, strategic questions answered up to 10 times faster, and perhaps most importantly, a cultural transformation where data helps drive strategy.

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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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Other Content in Leadership, Culture, Governance

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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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Beyond Healthcare Dashboards: Deeper Decision Support

As access to healthcare data grows, healthcare leaders are using more data to make decisions. Executives and front-line clinicians need a decision-support tool that meets the demands of today’s increasingly data-rich environment. Healthcare dashboards once filled this niche, but no longer keep up with ever-growing data demands. Fortunately, an innovative visual reporting system, Leading Wisely, picks up where dashboards fall short—enabling faster reporting and customized, self-service capability for comprehensive data-driven support.

Leading Wisely’s key next-level features include:

  1. Customization, allowing the individual user to personally tailor measures.
  2. Proactive alerts, prompted by personalized notification settings.
  3. User friendly layout, with easy-to-read highlights that indicate if a measure if moving off course.
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Leading Wisely: Better Executive Decision Support

The next step in the evolution of executive decision support is here—introducing Leading Wisely. With real-time alerts and customizable reports, healthcare leaders now have access to the actionable insights and meaningful information they need to make strategic decisions. Unlike traditional dashboards or static reports, Leading Wisely helps executives avoid being blindsided, giving them complete control over their data.

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Outcomes Improvement Governance: A Handbook for Success and Achieving More with Less

For healthcare organizations looking to achieve outcomes improvement goals, effective governance is the most essential must-have. This leadership culture ensures success by enabling health systems to invest in outcomes improvement and allocate resources appropriately toward these goals.

This executive report is an outcomes improvement governance handbook centered on four guiding principles (and associated helpful steps) health systems can follow to achieve effective governance and start achieving more with less:

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

With these four principles, organizations can build a foundation of engagement and focus around the work, where they maximize strengths, and discover and address weaknesses. They establish an improvement methodology, define their goals, and sustain and standardize improvement work.

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