From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More then Technology

From Installed to Stalled:
Why Sustaining Outcomes Improvement
Requires More than Technology ̶ Drew Cardon

© 2016 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Sustainable Change in a Healthcare System
Igniting change and outcomes improve-
ment within a healthcare system requires
three unique elements.
It’s well accepted that an analytics
platform, with its enterprise data
warehouse (EDW) and advanced
analytics applications plays a pivotal role.
Two other elements—adoption of
analytics across the enterprise and
converting data-driven discoveries to best
practices—are essential for sustaining
healthcare outcomes improvement.

Outcomes Improvement Requires Adoption and
Best Practices
The analytics platform is crucial for driving
any outcomes improvement initiative,
especially over time.
Let’s look at three scenarios that show
why it must be supported by an adoption
methodology and best practices
implementation:
• Without adoption
• Without best practices
• Without analytics

Best Practices
Without adoption
Focusing on best practices and analytics
is insufficient. Without adoption, the
organization ends up with solutions that
never quite create a lasting impact across
the organization as a whole.
While research-focused organizations
have good intentions to use research to
feed the creation of best practices, they
are often prone to academically
appealing ideas with little regard for
practical application.

Best Practices
Without adoption
Sometimes organizations focus
squarely on the technical and analytical
aspects of improving outcomes. These
tend to manifest symptoms of large
report queues and dashboards.
It’s the mentality that says, “if we build
it, they will come!”
But without input and buy-in of the
right stakeholders, the organization
creates many technical solutions
that end up on the shelf.

Best Practices
Without adoption
Finally, there are organizations that are
able to adequately merge the two other
systems of analytics with best
practices, but don’t have the expertise
to get widespread adoption.
They create successful “science
projects,” limited pockets of excellence,
then find themselves unable to rollout
improvements across the organization.

Best Practices
Without best practices
If the organization implements an adoption
system and analytics, but doesn’t include best
practices, it may end up with consistent practices.
But not the right practices, i.e., a standardized
status quo rather than continuous improvement.
We affectionately call this the “paved cow paths”
approach because processes are automated and
adopted, but not truly improved.

Best Practices
Without best practices
To avoid these symptoms, we advocate
permanent teams consisting of frontline
individuals with deep subject matter expertise.
Another symptom could be clinician’s
disengagement of management’s “flavor of
the month,” where there is missing evidence
in the data and missing proof of best practice.
To outperform competitors you must
be dedicated to delivering the best care.

Best Practices
Without analytics
If best practices and a system to spread
adoption are implemented, but ignore analytics,
it has no way to measure effectiveness.
Improvement projects chosen will tend to be
based on who shouts the loudest rather than
focusing its resources on areas with the most
variability in quality and cost.
Organizations without a robust analytics system
experience unsustainable improvements after
only a couple of projects because they don’t
have the automated capabilities to scale.

Challenges of Implementing the Two Elements
Most organizations understand the need
for an analytics system, but many fail to
implement an adoption and best practice
system to feed and nurture the technical
aspects of an improvement project.
Let’s touch on the challenges of
implementing these two critical systems
and then I’ll reveal the characteristics of
organizations that implement them
successfully.

Gaining Adoption
Without adoption, even the best data-
driven improvement projects can stall.
Health Catalyst is working with Piedmont
Healthcare, an integrated delivery system
with six hospitals and close to 100 clinics
in Georgia.
It is a perfect example of how adoption is
so important to process improvement,
and is a great success story of sepsis
care improvement.

Gaining Adoption
Piedmont organized a cross-functional
team consisting of innovative clinicians and
frontline staff, supported by analytical and
process improvement personnel.
As the workgroup built out the solution, they
were constantly feeding the improvements
up the chain so those improvements could
be vetted and implemented across each
hospital in the Piedmont system.

Gaining Adoption
Piedmont brought in Health Catalyst’s
Sepsis Improvement application and then
went through a data validation process to
gain comfort with the data being presented.
Data validation can literally paralyze a
project when there is too much focus on
getting things exactly correct, so the
workgroup was careful to do just enough
validation to garner a high level of
ownership and engagement, aka adoption.

Gaining Adoption
Based on the data and their own
knowledge of clinical workflow, the
Piedmont team made initial decisions
about where to focus improvement efforts.
This group was also tasked with
determining how to implement best
practices that would drive the desired
improvement.
To gain buy-in and receive valuable
feedback, the workgroup presented its
recommendations to peers.

Gaining Adoption
This physician-led process ensured the
perspectives of all key stakeholders
informed any changes to a clinical or
operational process.
It gave clinicians an opportunity to
“fingerprint” new processes—to give their
feedback and make the process their own.
This is more than just coming up with
goals and metrics. It is about using the
team’s knowledge and expertise to drive
out waste and improve processes.

Gaining Adoption
For example, Piedmont wanted to do more
than simply track how well they were
responding to system alerts.
We put the data to work by establishing a
baseline, identifying parameters for improving
alert sensitivity, and implementing triage and
system alert training.
Piedmont also wanted to improve its 3-hour
and 6-hour bundle compliance, so we used
the EDW to track order set utilization and
standard notes and assessments.

Gaining Adoption
Over the years, we have seen these
physician-led workgroups achieve incredible,
sustainable quality improvements.
On the other hand, we see quality improve-
ment projects flounder when driven by IT.
Clinicians tend to view such projects as
imposed from the outside by people who
don’t understand clinical workflow.
Physician leadership and enthusiasm are
absolutely essential to driving adoption
system-wide.

Implementing Best Practices
In U.S. healthcare, spending waste is
estimated at $1 trillion a year.
Best practices are a key to transform-
ing healthcare and reducing waste.
So why is it so hard to implement best
practices throughout an organization?
Why does it take an average of 17
years for a newly discovered best
practice to become standard practice
in healthcare?

One of the biggest reasons is simply
a matter of human nature: most of us
are comfortable with the status quo.
Physicians like to do things the way
they’ve always done them and don’t
like to change. Comfort with the
status quo isn’t limited to physicians.
Fewer than 20 percent of people tend
to be innovators or early adopters.
The rest of us are slower to adopt
new practices.

It’s hard for us to overcome personal
habit and preference.
From the organizational perspective,
it’s even harder to overcome
institutionalized inertia.
For this reason, it is essential to
identify influential physician innovators
and early adopters who can help
spread information about, and
enthusiasm for, a new best practice.

The Piedmont sepsis improvement
project stands as a success story of best
practices implementation.
The improvement team used the Sepsis
Improvement application to show all
stakeholders precisely how well Piedmont
was adhering to the best practice 3-hour
bundle, responses to early sepsis alerts,
and how this performance directly
impacted length-of-stay, mortality, cost,
and patient outcomes.

When clinicians were informed by this
accurate, near real-time individual
feedback, they were motivated to make
adjustments to their practice.
But a lack of resources has historically
been a challenge to implementing best
practices in healthcare organizations.
Some organizations are able to dedicate
resources to discovering best practices.
Others simply don’t have those kinds of
resources.

The best analytics vendors help
organizations overcome that barrier.
They come equipped with best-
practice order sets and other analytic
intellectual property for use by
healthcare organizations.
Physician-led workgroups that form
into permanent teams can then take
these standard best practices and
adapt them for the particular needs
of their organization.

Connecting All the Pieces of the Outcomes
Improvement Puzzle
Organizations that successfully and
sustainably improve outcomes understand
that the analytics system is not an end in
and of itself, but a means to an end.
They understand that adoption and best
practice systems are also essential.
These organizations’ improvement
projects are not driven by IT. Executives
(and especially the chief medical officer)
are engaged and involved in the project.

Improvement Puzzle
At the same time, these organizations
have grassroots champions and
clinician leaders on the frontlines of
care who help elicit enthusiasm and
drive adoption.
Engaged clinicians keep patient
needs in their sights at all times and
don’t get distracted by the bells and
whistles of new technology.

Improvement Puzzle
Finally, successful organizations do not have
an “if you build it, they will come” mentality.
They know that gaining adoption
requires concerted effort and establishing
new organizational structures.
They’re not afraid to break from the
status quo or try a new intervention to
improve care processes.
Instead, they’re willing to break down
barriers and disrupt inertia.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More than Technology
Outcomes Improvement: What You Get When You Mix Good Data with Physician Engagement
Paul Horstmeier, Senior Vice President
Moving Healthcare Outcomes Improvement Projects to the Finish Line
Dr. Bill Knowles, Senior Director of Client Engagement
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet, Vice President of Client Operations
The Top 7 Outcome Measures and 3 Measurement Essentials
Ann Tinker, Engagement Executive, VP
Delivering Excellence: How Stanford Health Care Uses Analytics to Improve Outcomes
Paul Horstmeier, Senior Vice President

Drew Cardon joined Health Catalyst in November 2011 as a data architect. Prior to this, he
worked for nine years in the state tax and revenue industry as a project manager and
implementation consultant with Accenture, and later with Fast Enterprises. He was involved in the
installation of large information technology systems for the State Tax Commissions in Arizona,
Utah, and Oklahoma. He holds a Bachelor’s degree in business from Brigham Young University
and an MBA from the University of Notre Dame.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com

From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More then Technology

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From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More then Technology