Though hospitals and health systems regularly launch clinical care redesign initiatives in hopes of optimizing workflow, improving outcomes and cutting spending, they often find achieving these goals is easier said than done.
Obstacles typically arise in the form of siloed teams, disparate objectives and a lack of executive support or involvement. On top of all that, sometimes the biggest challenge of all is in deciding where to begin.
Hartford (Conn.) HealthCare, however, has experienced remarkable success since beginning its own clinical care redesign project in 2017. In the health system's 2018 fiscal year, the initiative's first full year, HHC experienced more than $9.5 million in savings, then $12.2 million more in just the first three quarters of fiscal year 2019.
During a June 25 webinar hosted by Becker's Hospital Review and sponsored by national healthcare consulting firm Nexera, Rocco Orlando, MD, senior vice president and CMO of HHC, Elise Sinha, HHC's director of clinical care redesign, and Sharon Fried, assistant vice president of supply chain operations at Nexera, discussed how HHC implemented a systemwide transformation effort to slash costs, improve outcomes and foster a more cohesive clinical workflow.
Setting the stage for a successful redesign
HHC's redesign began with establishing a host of clinical value teams. Each team represented a different sector of the health system: surgical services, neurosciences, heart and vascular services, radiology, patient care, support services, oncology, pharmacy, IT services and construction.
The groups also included physician advisors, directors of value analysis and program managers, plus advisors from Nexera embedded at every level. Each team met regularly with two tiers of executive support, a practice that may be "unusual," according to Ms. Sinha, but "really shows how much we value this as an organizational priority."
To get team members at every level, and especially physicians, on board, "the redesign has to be aligned with the clinical mission," Dr. Orlando said. "It has to be about improving quality and safety. If you lead with saving money, you'll get some attention, but not enough."
According to Ms. Sinha, the redesign team targets physicians and other frontline staff by reaching out to clinical leadership, attending staff meetings and sending out newsletters. "We use a full cadre of strategies and we really tailor it to the audience that we're trying to reach," she said.
As such, HHC's structure transformed from regional, siloed teams with disparate goals to a systemwide approach, featuring fully aligned goals and priorities, Ms. Sinha added.
With the councils in place, Nexera and HHC were able to begin working toward their ultimate goals of improved outcomes and quality of care, all under the same oversight and with the same internal structure integrated into the supply chain. As Ms. Fried explained, taking a systemwide approach allowed for the implementation of a single "efficient, repeatable process that is standardized and aligned with our lead principles."
Identifying 'hotspots'
With a stable, standardized organizational structure in place, HHC could then begin to make changes that would boost the quality of care while driving savings. To do so, they utilized an evidence-based, data-driven platform to identify what Dr. Orlando referred to as "hotspots."
"Our 'secret sauce' to this work is that we look for variation and where we see we have economic variation and clinical variation — wide variation in the same spot — we call that a hotspot," he said. "That's probably an opportunity for us to do better, where our quality outcomes are disparate and our economic outcomes are disparate."
HHC identifies these variations by using data analytics, examining, for example, how long different clinicians take to achieve the same results, Dr. Orlando said, adding, "It's a matter of doing the analytics process and no longer having the supply chain analytics be done in a vacuum, but instead being collaborative and marrying the quality data with the cost data."
From there, the health system was able to implement actual changes for margin improvement, adjusting more tactical aspects such as supply expenses before moving toward reducing high-preference products and purchased services. One example Dr. Orlando shared concerned interventional cardiology: After studying the data, the redesign team was able to cut the time spent on certain procedures and reduce post-procedure renal failure and other complications, and also standardized the department's supplies to cut back on high-cost, low-value supplies, all of which led directly to significant financial savings and an improvement in the quality of care.
Along the way, Nexera and HHC measure and track data regarding the expected quality and savings outcomes of each decision, according to Ms. Fried. Ultimately, the data will show that consistently making these changes will bring about total operational and clinical transformation.
To learn more about Nexera, click here.