By Rick Halton, VP Product & Marketing, Lumeon
In a healthcare conversation that often leads back to questions of cost, there’s a major source of potential cost savings that gets far too little attention. Reducing waste in care delivery can make it possible to halve the cost of care overall. It is no exaggeration to say that this is the single biggest opportunity for healthcare leadership to transform their organizations.
I recently listened to a talk on this topic by Brent James, professor at the University of Utah’s David Eccles School of Business and past executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare. His contention is that health systems can reduce unwarranted variation and still get much better clinical results by eliminating care delivery process waste. He identified three categories of wastefulness in care delivery:
- 20% of waste comes from actions that shouldn’t occur but do, which are not only unnecessary but in fact, increase patient risk.
- 40%-60% of waste comes from care that patients don’t actually want; when the patient is given a full fair choice in their care journey, they opt for less care.
- 30% of waste comes from hospitalizations that could be prevented if care were concentrated upstream at the primary level and if care teams are trained to reduce unwarranted variability in their activity.
While the opportunity is huge, and thanks to people like Dr. James we know a lot about how to improve care delivery, the industry has yet to take a concerted approach to systematizing care delivery to correct for inevitable errors in human judgment.
But as health care providers increasingly get reimbursed with at-risk payment models, particularly for common procedures and surgeries, reducing the cost of care delivery may well be the difference between thriving, surviving, or failing in the marketplace.
To provide perspective to health care leaders struggling to kick-start their organizations’ care delivery transformation initiatives, here are my key takeaways from those who are getting it right.
Where to begin
Care delivery transformation can appear to be overwhelming and complex, but it doesn’t need to be. Finding the right starting point with the right internal champions is the key to success. The idea is to get your first win, build a strong business case, prove it works, attract broader organization buy-in, and then learn and evolve quickly.
Surgery readiness and recovery are often relatively easy starting points since the OR is one of the most expensive resources in the health system. ORs also have large patient volumes and many standardization initiatives in place already (e.g., ERAS or PSH). OR nursing staff tend to be overwhelmed and ready to embrace better processes that reduce strain by coordinating care activity. Wherever you decide to start, make sure it’s with a process that is readily amendable to change.
Managing the culture shift
Introduce your transformations gradually in a pre-meditated way so that clinicians will be more accepting and flexible. Change should initially focus on reducing clinician stress by standardizing and automating routine tasks that they already find repetitive or arduous. For example, give clinicians real-time visibility to patient readiness, provide tools to help them focus on at-risk patients, or set up automatic reminders for patients to complete tasks.
Starting by introducing changes that make it easier for clinicians to be effective without a steep learning curve will help win them over to your side from the outset. And by building a team of internal stakeholders and champions, initial successes can spread quickly as people warm up to the idea that process transformation will facilitate work and help the organization succeed in its mission to deliver the best possible care.
The importance of the physician
Although the physician might be at the tail-end of care delivery process change, they will play an important role in facilitating decisions for their fellow nurses and administrators. Even the best automated care processes will require frequent clinical decision points and oversight, prompting the nurse to seek physician input to move the patient to the next step.
Ensuring robust physician involvement also prevents generalizing the care delivery process, instead making it more likely that the transformation process will adapt care delivery to fit the risks, compliance, preferences, and needs of every patient.
Technology beyond the EHR
Leading tech-savvy health systems have already started using management platforms to design, deploy, and manage care delivery best-practices. These platforms can provide ready-made blueprints for clinical flows — also called care pathways — that coordinate care team activity, tailor it to the needs of individual patients, and virtually engage patients.
Care pathways will be the living logic behind your efforts to leverage technology to deliver care in more sophisticated ways. A complete pathway management system combines capabilities such as adaptive workflow, worklists, task escalation, task assignment, electronic forms, patient engagement, patient content, order set gap assessment, digital patient triage, clinical decision support, monitoring milestones, and patient compliance and risks. And it does all this while integrating with the EHR data set, scheduling system, website, apps, and patient portal.
How to measure
The advantage of care pathway management infrastructure is that the clinical flow it automates will continually produce measurement data, with results monitored over time. The clinical flow will help measure process improvement KPIs such as referral stickiness, patient compliance, patient satisfaction, care team utilization, order set accuracy, patient risks, patient readiness, appointment no-shows, late OR cancellations, OR delays, recovery times, readmissions, and successful care transitions.
This measurement activity can then be sent to your corporate data warehouse to be analyzed by your existing management reporting systems. Coordinating change in clinical flows and business operations can result in full-scale systemic transformation.
Get results quickly
Care process improvements are subject to much debate and interpretation, with large academic studies covering many aspects of the topic. But it’s a common understanding that improvement occurs when clinical actions are tied directly to outcomes, as they happen.
Tying actions to outcomes provides the opportunity to objectively test what works. In the context of care pathway management, that means testing new, improved clinical flows and comparing the results against previous processes. This robust stream of work calls for a new role — clinical data analyst — to take care of troubleshooting, testing, and improving automated clinical flows to maximize care delivery efficiencies.
Working with a partner
You might be tempted to try to get this initiative going with no outside help. The conditions may seem favorable: You’ve got an internal champion who has gravitas across your organization, your CMO feels like they know what needs to be done, and your CFO has identified where your top issues are, while your CIO is buried in EHR upgrades and juggling a multitude of apps. But, you’re missing something.
Probably the biggest reason we see organizations stumble is that they are missing the operational model for enacting clinical flows. Clinical flows are well understood, but operational flows are not. While clinical flows define the “what,” operational flows define the “who, when, and how” to do things. By bringing in an external expert to help you operationalize your clinical flows, you will be able to leapfrog your competitors by accessing hard-won know-how.
Good luck on your transformation journey. Feel free to reach out to me using the form below to find out more.