Hospitals are under extreme pressure to reduce costs while maintaining quality. Physician-driven collaboration with the hospital is the most effective means of maintaining profitably through clinical cost containment while minimizing the possibilities of compromised care. Using physician-directed, best practice improvements, the hospital can make data-driven decisions that reduce the misuse and/or overuse of hospital resources.
Healthcare leaders are being asked:
The uncertainties about healthcare reform have enormous implications to hospitals and physicians nationwide. To maintain sustainable operations the collaboration between hospitals and physicians will be the most effective means to create clinical cost containment while minimizing the possibilities of compromising care. Now more than ever is the time for healthcare leaders to combine data analytics with innovative thinking.
Through a comprehensive assessment of individual cases, specific types of variation and best practice care models will be identified. This data driven approach is used as a guide in the creation of new service delivery models improving the patient journey while reducing overall costs.
Dedicated, fulltime analysts are required to work hand in hand with physicians, middle managers and staff. The analyst(s), supported by physicians, nurses and operations specialists will coordinate:
Identify internal best practices
Although external metrics for targeting and goal setting can be examined, identification of internal demonstrated best practices derived from your actual patient population is used to establish target goals.
Raw data used to develop the Accountable Care Index is further defined and enhanced through an in-depth analysis to determine the cause and effect relationships that may exist to influence statistical results. By understanding both individual and organizational behaviors or processes that are influencing the current results organization can:
Begin managing change and implementation from day 1
At the start, engage key stakeholders in a collaborative approach to change that is focused primarily on people related issues and risks that will impact success. A multi-faceted approach to change management is recommended including tools and methodologies designed to create
The first step is to begin mining into the data by type of resources, when the resources are ordered/consumed, and who initiated use of the resource. If possible utilize “live queries” of your data with the physicians. In many cases the four-week process will include pulling case charts in order to align specific events back to the data. It is also important to validate all elements of the data in order to eliminate data defensiveness and move forward with changing behaviors and processes.
In addition to physician practices, support processes must be assessed such as case management, resulting reporting, supply movement and other factors that may contribute to clinical variation.
By week 4 expect to have:
ALIGNING – WEEKS 5-8
Having an understanding of where clinical variation is occurring, begin to array targeting results and begin to define required interventions. These interventions may be aligned as:
By the end of week, plan to have completed:
EDUCATING - WEEKS 9-12
At this point it is time to assemble specific implementation strategies. Focusing on established goals, educational sessions are structured to initiate specific strategies including. Multiple educational sessions and workshops are geared toward the entire organization.
Current clinical data should be assembled monthly and integrated into the monitoring systems. The new data will show improvements since baseline data was created aligning current clinical variations with interventions defined in the implementation plan.
Additional education sessions will be required as the new processes/policies and monitoring continues. When monitoring and reporting are in full swing, many physicians will ask for additional interpretations of their performance changes.
At week 12, expect:
Continuous Implementation
Implementation of the new interventions will set the stage for moving through all clinical services. Having completed the first 12-week cycle, future services areas can take advantage of improved infrastructure and common process improvements.
Although the approach described is highly collaborative in nature, it was developed to internally continue to transfer knowledge so that implementation can continue to develop required interventions.
Dr. Styles is president of Verras Consulting (www.verrasconsulting.com). Incorporating Verras Ltd. data-driven services, Verras Consulting services are designed to assist in the transformation of current healthcare systems operations, strategies and preliminary planning for local market integration of independent and community hospitals. Dr. Styles can be reached at kes@verrasconsulting.com.
Healthcare leaders are being asked:
- How will the hospital and physicians build a closer working relationship?
- How are your physicians working together to improve patient outcomes?
- How will you enhance the contribution from your core services?
- Where can you find cost reductions with out negatively impacting patient care?
The uncertainties about healthcare reform have enormous implications to hospitals and physicians nationwide. To maintain sustainable operations the collaboration between hospitals and physicians will be the most effective means to create clinical cost containment while minimizing the possibilities of compromising care. Now more than ever is the time for healthcare leaders to combine data analytics with innovative thinking.
Through a comprehensive assessment of individual cases, specific types of variation and best practice care models will be identified. This data driven approach is used as a guide in the creation of new service delivery models improving the patient journey while reducing overall costs.
Creating a framework for change
Dedicate an analystDedicated, fulltime analysts are required to work hand in hand with physicians, middle managers and staff. The analyst(s), supported by physicians, nurses and operations specialists will coordinate:
- Applying appropriate analytical tools to assess current processes
- 1:1 coaching and educational sessions with physicians to validate practices against data
- A culture of “Moving Toward Evidenced Practices” for the organization
- Enlisting specialists as needed to address unique practices or external data
- Establishing consensus on baselines and key indicators
Identify internal best practices
Although external metrics for targeting and goal setting can be examined, identification of internal demonstrated best practices derived from your actual patient population is used to establish target goals.
Raw data used to develop the Accountable Care Index is further defined and enhanced through an in-depth analysis to determine the cause and effect relationships that may exist to influence statistical results. By understanding both individual and organizational behaviors or processes that are influencing the current results organization can:
- Consolidate the variations into common themes and further define them into categories for actionable interventions
- Identify internal best practices for the organization to adopt in part or in totality
Begin managing change and implementation from day 1
At the start, engage key stakeholders in a collaborative approach to change that is focused primarily on people related issues and risks that will impact success. A multi-faceted approach to change management is recommended including tools and methodologies designed to create
- Stakeholder engagement
- Identify and mitigate organizational risks
- Prepare leadership, staff and users to manage the change
- Support the development of solutions that will make positive changes sustainable over time
The 12-week cycle
TARGETING –WEEKS 1-4The first step is to begin mining into the data by type of resources, when the resources are ordered/consumed, and who initiated use of the resource. If possible utilize “live queries” of your data with the physicians. In many cases the four-week process will include pulling case charts in order to align specific events back to the data. It is also important to validate all elements of the data in order to eliminate data defensiveness and move forward with changing behaviors and processes.
In addition to physician practices, support processes must be assessed such as case management, resulting reporting, supply movement and other factors that may contribute to clinical variation.
By week 4 expect to have:
- Detailed data by type of variation
- A plan for aligning the issues
- Documentation of individual physician and group issues
- Documented baselines and goals for selected clinical service areas
ALIGNING – WEEKS 5-8
Having an understanding of where clinical variation is occurring, begin to array targeting results and begin to define required interventions. These interventions may be aligned as:
- Common themes (implants, drugs, results reporting, scheduling)
- Issues/processes not directly related to the current diagnostic categories (supply contracts, medical management or payor interventions)
- Policy issues (OR practices, staffing or other general operational inefficiencies)
- Process failures (scheduling, transport, documentation and coding)
- Admitting/pre-procedures (delays, documentation, diagnostics)
- Discharge planning/throughput (admitting physician/referral delays, holding for transfers, emergency room/observation costs)
By the end of week, plan to have completed:
- Documentation/draft of action plans by intervention type
- Assessment perceptions found during interview processes with data to either validate of invalidate generated hypothesis
- Consolidation of general operational findings.
- Updated financial impact statement
EDUCATING - WEEKS 9-12
At this point it is time to assemble specific implementation strategies. Focusing on established goals, educational sessions are structured to initiate specific strategies including. Multiple educational sessions and workshops are geared toward the entire organization.
Current clinical data should be assembled monthly and integrated into the monitoring systems. The new data will show improvements since baseline data was created aligning current clinical variations with interventions defined in the implementation plan.
Additional education sessions will be required as the new processes/policies and monitoring continues. When monitoring and reporting are in full swing, many physicians will ask for additional interpretations of their performance changes.
At week 12, expect:
- An Implementation plan with designated responsibilities
- Completion 10-15 educational sessions per clinical service area (most organization assess 2-3 clinical services at a time
- Updated financial impact statement, now integrated with implementation plan
- Established continuous reporting
- Constant questions from your medical staff.....this is a good thing!
Continuous Implementation
Implementation of the new interventions will set the stage for moving through all clinical services. Having completed the first 12-week cycle, future services areas can take advantage of improved infrastructure and common process improvements.
Although the approach described is highly collaborative in nature, it was developed to internally continue to transfer knowledge so that implementation can continue to develop required interventions.
Dr. Styles is president of Verras Consulting (www.verrasconsulting.com). Incorporating Verras Ltd. data-driven services, Verras Consulting services are designed to assist in the transformation of current healthcare systems operations, strategies and preliminary planning for local market integration of independent and community hospitals. Dr. Styles can be reached at kes@verrasconsulting.com.