Is Your Quality-Safety System Really a Do-it-Yourself Project? Should it be?

We frequently describe ActionCue Clinical Intelligence as redefining and facilitating the management process for quality-safety improvement. Understanding that taking on quality-safety improvement can bring some apprehension, we want to make clear that we do this to bring a radical increase in efficiency to the process of improving patient care delivery for clinical staff, managers and executives.

Whether a facility or system’s solutions for quality and safety management, tracking, and reporting consists of paper and Excel spreadsheets, internally developed systems, or commercial applications, most of those scenarios have something in common: They require clinical management to spend a good bit of time on manual work. This can include:

• Researching required performance measure definitions and their application within the facility
• Setting the structure of criteria, measures, reports, graphs and notifications within the system
• Entering, manipulating and checking data multiple times as it moves from safety tools and organizations to the quality management arena, and on to the places, tools, and people involved in performance improvement and management information systems
• Creating and executing the mechanisms for communication and collaborating with various staff to carry out multiple fractured workflow processes
• Producing forms, diagrams and other artifacts, the primary purpose of which is to demonstrate adherence to the chosen process and methodology
• Using additional tools, systems or steps to produce static reports in a variety of formats for management review meetings
• Revising and re-doing much of the above repeatedly in response to changing external reporting requirements, additional or revised inquiries, recurring meetings, staff turnover, etc.

It should be noted that in many cases, a good bit of that manual work could be done by administrative workers but is too interwoven in the clinical and quality-safety work to hand it off without major disruption in productivity. In other cases, it requires the clinical professionals to develop skills in information technology and data manipulation that should arguably not be required of them. Both of these instances seriously dilute the application of their best skills, education and professional abilities to improving quality-safety.

Unfortunately, many clinical managers and their senior management accept this kind of manual effort, and the resources it consumes, as the norm for working in quality, safety and improvement. Some believe it is the only way for solutions to work exactly as they want. Even by turning to multiple commercial software vendors, much of this same function building is required as the vendor happily customizes their product and charges significantly for it both upfront and on a continuous basis, while tying up hospital staff in planning and reviewing the customization. After-sale charges can even become the vendor’s primary business model. At Epic Systems’ User Group Meeting in September of 2016, CEO Judy Faulkner said she identifies Epic as a programming shop. The company spends just over 50 percent of operating expenses on research and development each year. With that perspective, how likely is it that such a vendor is going to make the application itself match the needs of its users, or reduce the work of installation, amount of training needed, or degree to which the vendor’s billable time is needed for ongoing administration and updates?

Costs that may be dispersed into the operating budget are often “hidden,” but really add up when considering the Total Cost of Ownership (TCO) for the solution. Almost all of this fits into the “administrative overhead” component of healthcare costs, which is understood by most in the C-suite of hospitals today to be increasing disproportionately.

Once this “build our own” mentality sets in, inertia takes hold. It is common for quality and safety solution acquisitions to focus on one of these “toolkits,” or basic products needing customization that lasts months after purchase. Over time, the organization feels as if it has invested so much into their status quo solution that they certainly don’t want to make a substantial change and start the process all over again. This is especially true when it could impact the many overt work processes in which they have also invested time, money and training.

Many managers initiating searches for quality and safety management solutions may not realize that a well-designed “turnkey” application—embodying not only effective technology but also expertly-crafted healthcare operational design—can be configured in days, not months, to fit their organizations and operations, and similarly be reconfigured to match their evolving needs. While turnkey applications such as ActionCue may be uncommon in healthcare IT, distancing the organization from the practice of costly extensive internal or vendor-teamed software development is something companies in almost all other verticals have done over the years. Although this requires some adjustment in perspective when reviewing products designed for a large healthcare marketplace, the very common mentality of “doing what you’ve always done” is something healthcare providers can simply no longer afford.

Re-Thinking: Four Ways to Advance Healthcare Quality and Safety

For decades, I practiced and taught others a model of developing new software products in which the creator begins with at least two innovation concepts before thinking about technology choices, features or even architecture. These concepts must represent a new way to reach important objectives, not just tweak current tasks and activities. They must eliminate current hurdles and transcend problems. This model has proven to be the best way to ensure that the benefits of the product stem from fundamental values, are sustainable, provide room for growth, and build on an evergreen strategy.

In some cases, healthcare staff, management and executive IT users are hesitant to change the way they do things, but such changes have been proven to be the only way to make substantive progress. These innovative concepts are at the core of Prista’s ActionCue Clinical Intelligence platform, helping healthcare professionals reach real quality improvement goals that are fundamental in alleviating the operational, financial and regulatory issues with which hospital leaders wrestle every day. Even if hospital leaders believe the quality and safety activities in their organization are productive and successful, we believe those activities could be significantly more effective, positively impacting patient outcomes, revenue, staff workload, management and executive participation, and the culture of quality in the organization. The following are four ways healthcare organizations and management can advance healthcare quality and safety.

1. Shift focus toward goals instead of traditional activities 

For individuals and organizations, doing “what we’ve always done” is comforting, pays respect to past decisions and accomplishments, and, importantly, avoids any risk in trying to improve by doing things differently. Some will focus on “risk” in that statement; others on “better.” Improvement, something we discuss often, inescapably means change, and the degree to which we avoid changes in process can systematically limit improvement. The tendency is to start rationalizing complacency and praising stability, solidarity and tradition.

The problem with the willingness to hold on to traditional activities manifests itself when organizations maintain the functional silos of Quality, Risk Management and Performance Improvement in hospitals. Whether individuals, groups or entire departments, tradition supports these institutions having different leaders, processes, tools, methodologies and data. With these functions compartmentalized, their objectives—and rewards—are limited to their respective stages of development instead of contributing to the overall goal of improvement. Simply reporting metrics and incidents is the finish line for some, while others carry on with other activities. This leads to dependence upon human endeavor to unify all those differences, in traditional mechanical ways, to serve the goal all healthcare organizations should be working toward: better patient care and outcomes delivered with efficiency.

The ActionCue application provides innovative consolidation of all performance metrics. No more silo-ing of core measures, audits, EOC, or protocols. Event reporting and investigation and improvement action plans are highly integrated. All data and information flows together and is readily accessible, enabling each task and activity to tie into performance improvement.  Not only does this design serve the common goal better, it saves the staff, managers and executives a lot of time and mental exertion.

2. Own quality-safety improvement internally and make it efficient 

Historically, most of a hospital quality department’s activities were focused on submitting data, reports and documents to external regulators and other stakeholders. A good portion of that information is intended for licensure/accreditation, long-term research and, especially in recent years, reimbursement. The aim in hospitals, typically among overworked managers, has become to “check the box” noting required submissions have been accomplished. Using the compiled information internally to improve quality and safety has become secondary to executives looking for checked boxes, and such perspectives tend to trickle down as real and perceived guidance. Yet, the return and yield from the submissions to those external organizations, in terms of enabling patient care improvement, is usually disappointing and always later than desired. With that view of comparative value, it is sometimes difficult for clinicians to remain motivated to genuinely improve quality and safety, and it’s equally difficult to get budgetary investment for innovative, efficient tools and processes as opposed to maintaining the traditional—and sub-optimal—activities and approaches.

ActionCue is far more than a reporting tool. It is a composite platform for the entire clinical staff, management and other stakeholders to work collaboratively and efficiently, while pursuing continuous improvement, which has long been little more than a slogan or buzzword.  Its value in executive awareness and required reporting is exceptional. Users report a near elimination of “survey preparation” and surveyors from several states, as well as accreditors such as CIHQ, TJC and DNV, have commended its clarity, accessibility, accountability and demonstrated utilization and results.

3. Improve division of labor between humans and technology 

Many healthcare IT users have come to understand that many applications are little more than an electronic filing cabinet, mostly utilized for storage and retrieval of information in the same format as that in which it was input. This places a burden on staff to compile commonly used information, perform calculations, and turn raw data into intelligence and insight. For a long time, organizations’ leaders have accepted that quality and safety efforts require a large amount of time and effort in mundane process mechanics. Applications serving important enterprise functions should focus on collaboration and workflows that not only match the natural tasks and processes of users, but also shape the users’ behavior by embodying methodologies and disciplines that yield the targeted results with efficiency and accountability.

Additionally, when the application is designed to partner with the user in his or her work through well-known, disciplined workflows, it can provide valuable, relevant, up-to-date content in the context of the task at hand, such as researched industry and academic performance measures, evolving best practices, educational materials, forms, contact information and a wealth of other materials the user, or the user’s work group, no longer have to spend time researching, compiling and updating. This sort of sophisticated, enabling design should become commonplace in healthcare IT applications, as it has been for decades in other fields.

ActionCue’s design goes beyond ease-of-use to advance the way in which healthcare organizations engage with information in an application. The platform proves to be an enjoyable working team member, increasing productivity and facilitating education and improvement towards goals. ActionCue users develop and maintain a strong “Culture of Quality.

4. Opt for a turnkey application utilizing a SaaS model 

The technology used to support hospitals’ important quality and safety work usually starts out as a “toolkit” in which the organization invests a lot of time, money and attention to build and maintain the intended “solution.” Ranging from paper and Excel spreadsheets, to internally developed tools and applications, to major commercial systems that undergo extensive customization by their vendors and “add-on” technicians and analysts, healthcare organizations spend a lot of money and resources—often incrementally staffing consultants and specialists— to get the job done. Despite the high costs, many organizations believe such an approach is the only one that will work, and it is often based largely on what they have used historically. In such a setting, real innovation is rare and very expensive.

When an application provider has utilized healthcare expertise in its core design, delivery and support functions, it can anticipate a great deal of the functionality needed by its users and apply best practices to deliver a “turnkey application,” ready to run right after the sale. Foregoing full customization can be readily accepted as a trade-off for saving tens of thousands of dollars (or more) in visible and hidden costs. Turnkey applications also frequently have value-adding content that is continuously researched and updated, providing constant improvement in the use of the application. Setting a high bar when reviewing turnkey applications and providers has long been the standard approach for organizations of all sizes outside of healthcare that are adept at considering total cost of ownership (TCO).

The next step forward in evaluation of a solution is the true Software as a Service, or SaaS, business model. With the fundamental distinction of being web-based and accessed via a browser, SaaS applications save buyers a great deal by avoiding the costs of acquiring and maintaining expensive computing and storage infrastructure to support on-premise systems.  Leading companies offering SaaS model applications go much further than “renting software,” thought by some to be an unnecessary expense. The best practitioners of the SaaS model accomplish three major things that are impossible, difficult or very expensive with other models.

• Update the application frequently: Because the process of distributing updates is simpler and less expensive than with on-premise software, SaaS-model companies frequently provide quarterly or even monthly updates. Such updates typically include enhancements and extensions of functionality, as well as adaptations required by regulators and other authorities in healthcare. This same advantage in efficiency makes it possible and likely that the delivery of software corrections and “fixes” can take place in hours, instead of weeks or months, as is often the case with on premise software.
• Operate efficiently and pass savings on to customers: SaaS-model companies operate on the latest technology platforms, facilitating rapid development and deployment of changes, making them far easier and less expensive to maintain. Companies that have started out as such build their entire operations around utilizing the most up-to-date technologies and methodologies, so their internal operating expenses are lower than those of traditional software companies. These and other efficiencies allow SaaS-model companies to pass their savings along to customers, driving down prices, usually as non-capitalized monthly or annual subscriptions.
• Provide proactive, expert support: Unrelated to the technology side of the SaaS model, the best of these providers work on the principle of an ongoing collaboration with each of their customers. The frequent updates and efficient operations mentioned above allow SaaS-model companies to focus on providing support staff that are highly skilled, have in many cases done the work of the very users they support, and are responsive to, or anticipatory of, the evolving needs of their customers. In the case of healthcare quality, safety and improvement efforts, this approach involves leveraging research on evolving performance measure definitions, best practices, and information submission mandates carried out by the support staff, and integrating them into the application for all to use, saving a great deal of the users’ time.

Understanding what SaaS-model companies represent and offer, healthcare executives can appreciate that this means of operating is exactly what is needed in the strategic advancement of healthcare information technology.

As a fully actualized example of a SaaS-model offering, Prista and its ActionCue application transform the relationship an organization has with its information technology. No longer a bottom-line cost, source of frustration for staff, or drain on productivity, ActionCue is a critical facilitator of clinical performance improvement, providing tactical and strategic benefits for the organization’s people and processes, and delivering ROI.

Taken one by one, any of these departures from the status quo would be valuable and beneficial to a hospital and even more so for a healthcare system. Each of these steps forward would be truly strategic, with broad and long-term positive effects. But taken altogether, these changes in thinking and the realization of them in a platform like ActionCue Clinical Intelligence is truly a transformational step forward for healthcare organizations.

Physician Leadership in a VUCA World

By Keith Thurgood, PhD – Prista Board of Directors

We live in a VUCA world. Developed as an operational construct by the United States Army in the late 1990s, VUCA describes the world in four adjectives:  volatile, uncertain, complex, ambiguous.

Since the Affordable Care Act (ACA) was signed into law in 2010, VUCA, as it relates to healthcare, has taken on new meaning with deeply imbedded dilemmas.  Moreover these dilemmas are magnified by the fact that while doctors have been well-trained trained to practice the art and science of medicine, they have had little preparation for managing and leading change.

Healthcare enterprises are increasingly focused on transforming all aspects of care delivery, including cost structure, clinical quality, data transparency, patient experience and the overall efficiency and effectiveness of care delivered. There is no argument that these need to be addressed, but there is a question about who will lead these efforts. The answer has to be physician leaders.

Medicine has traditionally been organized as a craft-based industry where individual physicians, organized around their practice specialization, create a customized plan for each patient. What it’s being transformed into is a team-based practice, organized around patient or disease state, where groups of peers, treating similar patients in a shared setting, execute coordinated care delivery processes using agreed upon clinical guidelines and protocols. To drive and sustain this change, we need physician leaders who understand how to lead change and create alignment, and who don’t confuse being a leader with simply being given a leadership title. We need engaged, adaptive and collaborative leaders at every level of the organization. In short, we need to turn doctors into leaders.

To accomplish this, we need a radically new approach to leadership development. For guidance, we can look to one of the world’s premiere leadership development organizations, the U.S. military. No other institution devotes more time, energy and money to developing the character and competence of its future leaders. The military focuses on character and competence because how leaders get results matters.

The Army conveys this developmental message with the phrase, “Be, Know, Do.”

• Character, underpinned by values, describes what leaders should “BE.” Your value system drives behaviors, and you demonstrate your character by the way you behave.
• The skills a leader needs are the basis of what a leader must “KNOW.” These include interpersonal skills, conceptual skills, and technical and tactical skills.
• Finally, leaders must have a bias for action to deliver results—the “DO.” This includes influencing, making decisions, accomplishing the mission and continuous self-improvement.

This framework encourages developing leaders by leveraging a variety of educational experiences, planning, and staff and positional roles, that challenge one’s character and competencies. The Army’s development of a seasoned combat leader is a 15-year journey supported by a progressive set of experiences that stretch the thinking, innovation and application of key ideas and concepts. The most effective leaders are developed over a long period of time.

Where do we start in healthcare? Rather than reading the latest book or signing up for another class or workshop, aspiring physician leaders should start their leadership development journey at the beginning: by first looking at one’s self. It’s difficult to do because it requires looking in the mirror, not out the window. Start by clearly identifying the type of future leader you want to be, and then develop a plan to bring that to life.

Prista Adds Healthcare Leader Keith Thurgood to Board of Directors

AUSTIN, Texas, November 14, 2017 – Prista Corporation announces the addition of Keith Thurgood, Ph.D., to its Board of Directors, further demonstrating the company’s commitment to improving patient care quality and safety through strategic innovation and leadership.

“This was an easy decision to make, given the strong leadership team already in place and the momentum that Prista has in the marketplace as a technology leader,” said Thurgood.

Thurgood, a Clinical Professor of Healthcare Leadership and Management at the University of Texas at Dallas, brings a unique perspective on healthcare, operations management and leadership, having served in senior level leadership positions at both for-profit and not-for-profit organizations, including the US Army where he served in the Secretary of the Army’s office of Business Transformation and retired as a 2-star General.

In addition to his responsibilities at UT Dallas, Dr. Thurgood is a faculty member and senior advisor for the Thayer Leader Development Group (West Point, New York), and is a managing partner with Pioneer Partnership Development Group.

Thurgood’s arrival coincides with an expansion and re-positioning of Prista’s ActionCue® Clinical Intelligence product to address the deepest, most strategic and most challenging needs of healthcare executives, such as those Keith teaches. Prista’s plan for its ActionCue platform as an innovative, integrated and balanced view of both clinical and financial performance in hospitals is to provide a better source of executive management insight than any other product on the market.

“Prista is uniquely positioned to drive sustainable quality, safety and performance improvements,” Thurgood said. “By leveraging the functionality of an integrated platform like ActionCue, patient safety events are reduced, quality improves, and the performance curve accelerates.”

The newest member of Prista’s Board of Directors, Thurgood joins board members David Conejo, CEO of Rehoboth McKinley Christian Health Care Services, and Dennis Cagan, a recognized authority on corporate governance. He is also welcomed by Prista’s founders Don Jarrell and Billie Anne Schoppman.

“Keith has incredible insights and standing regarding leadership in the healthcare industry,” said Jarrell, CEO of Prista. “He will be extremely valuable to Prista in both direction-setting and substance as we continue to bring key strategic innovation to the management of clinical and financial performance for all sectors of healthcare delivery.”

About Prista

Prista provides the ActionCue® Clinical Intelligence online application, an innovative platform integrating Quality Management, Event Reporting and Investigation, and Performance Improvement functionality. Beyond a dashboard or reporting tool, ActionCue provides a complete work environment for staff, management and executives to obtain immediate insights into all clinical issues and what is being done to improve them, and to own and drive the improvement-centered quality-safety process as never before.

Strategic Hospital Room Design: Improving Your Environments through Better Data

If you’ve ever spent any time as patient in a hospital room, you can recall how your surroundings affected you—for better or for worse. The effects of hospital room design on patients can be profound, according to a New York Times report on specially-designed rooms at the University Medical Center of Princeton. These rooms included comfortable features such as:

• Outdoor views
• Medication dispensed to patient-specific lock-boxes, instead of by floor
• Fold-out guest sofas
• Sinks (for medical hand washing) discreetly tucked out of direct sight
• Extra space for visitors

The results were pretty amazing. Not only did patients report a stunning 99% satisfaction score, but they also asked for nearly a third less pain medication than patients in other rooms. Just as important are the potential safety benefits of a well-designed hospital room. Handholds in the right places can do much to prevent falls, for instance, while the use of non-shiny floor finishes can help individuals with glare-related vision problems. Even the choice of artwork style and subjects on the walls can make a direct impact on patients’ quality of experience.

Imagine how the right mix of safety event reporting and patient satisfaction information, as offered by ActionCue CI‘s integrated solutions, could help you optimize your own hospital rooms. You might find that certain room designs show a higher incidence of falls, leading you to change the flooring material, handhold placement and other features for the better. Even coming to an agreement on the nature of those changes becomes easier when you’re able to prepare easy-to-read staff reports for meetings. If certain medical mistakes seem to be occurring more frequently in specific rooms or areas, you can determine where you need to make adjustments. With ActionCue CI, all of these insights can be readily available. Contact us today for more information.