In healthcare, many of us are motivated by a need to fix whats not working, whether thats curing a patient of disease or remedying ineffective safety protocols. Take it from Hartford HealthCare, an integrated healthcare system that reduced its serious safety events by 70 percent over five years.
When leaders at the six-hospital system in Connecticut set a goal to lower the incidence of patient harm, they began with executive alignment and the basic principles of accountability and respect. From there, they defined the foundational elements required to achieve high reliability: business intelligence and collaboration.
By focusing on data-driven opportunities and engaging staff and clinicians, leaders reasoned, safety would naturally improve. They were right. Not only did Hartford HealthCare significantly decrease its incidence of serious safety events, but its values-driven culture enabled the spread of the work from the facility level to systemwide.
Hartford's success exemplifies how critical organizational readiness is to optimize care delivery, as competitive positioning starts with understanding where you are to determine where you need to go. Empowered by a clear vision and powerful analytics, health systems can remove unwanted variation and improve outcomes.
Crystalize the Why
For many organizations, a journey to becoming a high reliability organization (HRO) begins when staff and clinicians hear about an awful event that occurred that could have been prevented.
"It should never have happened" and "there has to be something that can be done" are two refrains that begin at the frontline and reverberate toward the c-suite. With momentum from staff, it’s not often difficult to find a leader champion to align executives toward action.
While an HRO objective may not be a tough sell, leaders must mind other strategic priorities that are in motion. In a Premier survey of 260 health system leaders, 51 percent identified competing priorities as a barrier to achieving high reliability.
To ensure success, leaders can integrate HRO aims into current performance improvement efforts –enhancing present initiatives versus instituting new ones – and encourage the linkage between zero harm and the organization's behaviors and values. Connecting HRO communications to preestablished values demonstrates how this goal fits seamlessly into the culture and vision.
Let Data Drive Action
With leaders and staff aligned, organizations should set measurable, achievable benchmarks using timely and robust data on facility and system performance, as well as risk-adjusted data that enables comparison to national peers. At Hartford HealthCare, for example, PremierConnect® quality analytics produced regular optimization reports pinpointing clinical variation, allowing leaders the business intelligence needed to target specific efforts to reduce harm across the system.
With objectives identified, the next step is to cascade the goals to facility leaders who determine how individual units and departments will contribute.
It’s important to keep HRO successes and barriers in constant conversation to heighten organizational awareness of the new care delivery model. Successful HROs use monthly data reports to encourage transparent discussions on progress and continually refer back to why patients deserve highly reliable care.
Maintain the Momentum
Perhaps the most difficult aspect of care delivery optimization is sustaining the improvement. Results like Hartford HealthCare’s require time and commitment to a long-term strategy, but we’ve seen that when an organization is ready to change, results follow.
Take this example: In 2015, Texas Health Huguley in Fort Worth recognized it had an opportunity to better educate staff to recognize patients at risk of maternal harm. The women’s services leaders studied existing nationwide hemorrhage bundles and modeled their own after it. They also committed to standard measurement of blood loss during delivery versus estimating it.
From 2015-2018, the facility marked a 36 percent decrease in severe postpartum hemorrhage cases and a 60 percent decline in units of blood used. As staff and physicians recognized the value in quantifying blood loss from delivery, they bought in on standard language to ensure proper protocols for patients at risk. Today, postpartum hemorrhage management is built into the culture through chart audits on every delivery, nursing drills and debriefs, and continuous information sharing on progress and outcomes measures.
As Texas Health shows, a culture that revolves around the patient and continuous improvement is ripe for care delivery optimization through the lens of high reliability.
Optimal care delivery is not about short-term wins or fixing mistakes. It's about preventing problems in the first place so that over time, patients receive the highest-quality, safest care. We’ve all seen care delivery efforts that dive right into goal-setting and process maps, but the most impactful efforts begin with conversation, alignment and analysis before action.
Using data as the foundation for care delivery optimization, Premier experts help providers identify where to find and how to tackle clinical variation to enhance care, improve outcomes and reduce costs.
Across many industries there's the familiar saying "if you can't measure it, you can't manage it." In healthcare, it's partially true. People aren't motivated to improve unless they know how they're doing. But when it comes to variation in care delivery, if the right stakeholders aren't aligned and accountable, improvement efforts won't be sustainable enough to last long term.
Healthcare organizations that want to succeed in value-based care and payment models must take steps to understand where variation lies, identify the best clinical practice and then optimize that practice to drive standards, align incentives and hardwire disciplined improvement processes across the continuum that can be sustained over time.
Analysis
The first step to tackling variation is to understand readiness for change. Timely and actionable system-wide data can empower leadership teams with the information needed to support clinical efficiency while maintaining or improving quality.
Take the ICU – putting patients in the ICU when it's not necessary or keeping them there longer than needed is potentially harmful. ICU stays have been linked to increased risk for hospital-acquired infections (HAIs) and other adverse events. Looking at nearly 800 hospitals in a recent analysis, Premier found opportunities to reduce ICU days by 200,000 per year for patients with diagnoses that had the greatest variation, such as sepsis patients and patients that were undergoing cardiac valve and other major cardiothoracic procedures.
ICU optimization is no easy task but using robust data and analytics to conduct gap analysis assessments can help unveil and pinpoint opportunities to rapidly improve high-reliability efforts. Premier found that providers making progress in optimizing ICU care have decreased patient length-of-stay by 13 percent across the top diagnoses with the greatest variation in this setting.
But analysis doesn't stop at identifying gaps. Care delivery must be monitored throughout a patient's care journey to avoid complications that extend stays. Technology that alerts clinicians and nurses to use evidence-based practices, proactively identifies patients at-risk for HAIs and other harmful drug interactions, and tracks and monitors clinician performance goals to ensure consistent use of medications and therapies for targeted disease states is also a key piece to optimizing care delivery.
Alignment
Strong leaders that are visibly involved in sustainably removing barriers to change use structured processes, cross-continuum care paths and communication forums that are aligned with the organization's mission and goals, and encourage communication, teamwork, system-wide awareness and staff empowerment.
For example, providers that were successful in lowering length-of-stay in the ICU created multidisciplinary teams to ensure all of the patient's care providers were together at the same time to collaboratively determine the next steps in the most efficient way for each patient. Driving engagement by tapping the insights of physicians, nurse leaders, primary nurses, case managers or social workers, pharmacists, respiratory therapists, physical therapists, dietitians and others was vital to the success of the multidisciplinary ICU team. Overall, patients treated at these hospitals spent 24 percent less time in the ICU.
Additionally, identifying and aligning quality metrics and incentives that are targeted on reducing care variation with physician groups is critical. Engaging physicians is vital to establishing the framework and foundational elements required to determine and achieve medical group buy-in for the most impactful strategies. After all, the only way to earn revenues for achieving high-reliability is through aligned, value-based incentives.
Accountability
An accountability structure using checklists, scorecards and incentives that are based on measurable, objective data must be set in place to increase speed to results, solidify alignment efforts, standardize care and sustain success within any care redesign effort.
Anticipating and preparing for the barriers and setbacks that will occur is also critical. As the project structure takes shape, consistently and transparently sharing and encouraging dialogue around leadership goals, membership, and timelines provides a hyper focus on the accountability of each leader, team and staff member redesigning the needed processes.
Every unnecessary day a patient spends in the hospital is a threat to the bottom line. To keep providers accountable, dashboards that highlight progress and clinician scorecards that identify what is working and pinpoint improvement opportunities provide a continuing feedback loop of measurement and analysis of success along the way.
Dollars follow high-reliability investments that optimize care delivery. While it's not easy, clinical staff are increasingly in tune with the importance of standardizing care to benefit patients, deliver value and reduce costs. Having the right data and analytics to analyze readiness, understanding how to best operationalize and streamline workflows, and keeping leadership and staff accountable are all essential components of creating a culture of care delivery optimization.