Lifepoint Health’s CMO shares key insights into reducing unwarranted clinical variation through a clinician-centered, analytics-driven approach.
In today’s rapidly evolving healthcare landscape, reducing unwarranted clinical variation has become a top priority for hospital and health system leaders.
At the recent HealthLeaders CMO Exchange, executives discussed innovative strategies to tackle this issue, with Chris Frost, MD, senior vice president, chief medical officer, and chief quality officer of Lifepoint Health, at the forefront.
Lifepoint’s two-and-a-half-year initiative aims to standardize care, reduce waste, and elevate clinical quality by empowering clinicians and leveraging data-driven strategies.
"Our operational definition of unwarranted clinical variation is variation in healthcare delivery that cannot be explained on the basis of illness, medical need, or evidence-based medicine," Frost says.
Lifepoint has enlisted clinicians to reduce unwarranted clinical variation, according to Frost.
"Our approach is bottom-up as opposed to a top-down approach," he says. "We have a clinician-centered process that helps engage the doctors and advanced practice providers to create standards of care and provide consistent care."
Lifepoint has been deliberate about engaging clinicians early in the process to reduce unwarranted clinical variation, according to Frost.
"We acknowledged early on in our discussions with the doctors that we understood that this effort is not just about reducing costs," he says. "There was an element of reducing waste in healthcare delivery. Ultimately, this is about elevating the quality of care—this is not about robbing clinicians of autonomy."
The initiative has been driven by a four-pronged strategy:
- Quality-focused process improvement
- Leveraging analytics
- Care standardization based on evidence-based medicine
- Deliberate focus on change management
"Overall, we improve quality by using evidence-based medicine as the standard to provide the right care to the right patient at the right time," Frost says.
Change management has been an essential part of the initiative, according to Frost.
"We recognize that if this was as easy as adherence to order sets, we would not need change management," he says. "But there is the people side of change, which is distinct from the process side of change."
Change management in the unwarranted clinical variation reduction initiative has had several components, Frost explains.
- Lifepoint assessed the cost of inaction and perpetuating the status quo.
- The health system was deliberate about identifying outcome measures. For example, sepsis outcome measures were length of stay and mortality, and congestive heart failure outcome measures were length of stay and readmissions.
- Lifepoint also identified process measures. For sepsis and congestive heart failure, order set compliance was a key process measure.
- Process measures were viewed from a team-based care perspective. The health system did not just look at physicians and advanced practice providers, but also other team members such as nurses and lab technicians.
- The health system adjusted the "choice architecture" for treating medical conditions. For example, when Lifepoint clinicians pull up the sepsis order set, there is a listing of the antibiotics alphabetically, but the health system made it easy to choose the ones that have the highest efficacy and are evidence-based for that particular condition.
To maximize the impact of the unwarranted clinical variation reduction initiative, Lifepoint focused on five areas: sepsis, congestive heart failure, length of stay, optimizing blood transfusion utilization, and reducing repetitive lab testing.
There are four takeaways from the initiative so far, according to Frost.
- Unwarranted clinical variation reduction can decrease healthcare waste as well as improve quality.
- You need to prioritize your areas of focus.
- You need to settle on a strategic approach. In Lifepoint's case, the health system adopted a four-pronged approach.
- Never underestimate the importance of change management as it relates to clinician engagement.
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Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
The consequences of inappropriate variation include underusing needed services, overusing unwarranted services, higher costs, and worse clinical outcomes.
Lifepoint Health defines unwarranted clinical variation as variation in healthcare delivery that cannot be explained on the basis of illness, medical need, or evidence-based medicine.
The health system has focused on a handful of areas, including sepsis and congestive heart failure.