All posts by Don Jarrell

Why the Healthcare Quadruple Aim Hasn’t (Yet) Hit the Bullseye

In 2014, the Triple Aim proposed by IHI in 2007 became the Quadruple Aim. This transition occurred because the objectives of the Triple Aim – better patient experiences, better population health, and lower costs – had been pursued mainly with what may have been an ill-conceived and dangerous assumption. Specifically, the dedication of clinicians and providers was assumed to be an inexhaustible resource of human initiative, technical expertise, and plain old labor.

This assumption was dangerous because significant driving forces in healthcare, such as administrators, investors, regulators, and vendors within the industry, held this assumption to be true. This view led to initiatives, compliance requirements, and work demands that frequently did not align strongly with those dedicated healthcare professionals’ motivations and goals yet asked more and more of them.

Finally, healthcare team well-being was added to create the vital concept of the Quadruple Aim. How much progress has been made in the eight years since?

Many have reported real progress on parts of the Quadruple Aim. Still, several things stand out. First, gains in one of the Aims sometimes come at a cost, even to the point of backsliding, in others. If the true goal is to optimize for all four Aims, why is this acceptable? Second, some efforts become parochial and limited in focus as though they are driven by more competitive or “better” thinking than the unified way of thinking that is required to serve the four aims. Third, some analysts consider operational efficiency a frequent enabler of competing goals, but honestly, efficiency has never been a core strength or serious pursuit in healthcare. While efficiency is usually the key to serving these competing goals, it may address the fourth Aim, the team’s well-being, the most. And that is why it becomes such a breakthrough for the Quadruple Aim because, with significant weakness in the fourth Aim, the other three are rarely, if ever, met.

Here is a simple but essential chain of thought. Performance Improvement, as the critical path toward the Quadruple Aim, needs to be deftly integrated into all the processes used to manage clinical care. Endless speeches, white papers, classes, and slogans are not enough to accomplish this. Instead, genuinely re-engineering the workflows and tools used is required. Contrary to this requirement, the typical approach to PI is to approach it as a distinct function governed by conceptual methodologies, which are only blueprints for manual human work. Any means of technical facilitation is usually homegrown, lacking standardization and any real efficiency, and so are pinpoint solutions serving only separate tasks in the process chain without real integration or collective advantage. In Enhancing healthcare efficiency to achieve the Quadruple Aim: an exploratory study published in BMC Research Notes, Bengt B. Arnetz et al. said, “To our knowledge, no previous intervention has primarily targeted efficiency for quality improvement.”

An advanced PI software workbench designed with the real goals in mind, not just the separate objectives’ tasks, and strong UI/UX (user interface and user experience) that is directly connected to the processes for tracking, analyzing, and investigating quality metrics and safety event reports, represents a significant and vital innovation that can have tremendous impacts on efficiency for the overall effort. It is certainly worth an exploratory look and, frankly, serious consideration, but many will not take that next step because it is very different from what they have “always done.” So maybe it’s time for a real break out to get to the Quadruple Aim.

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Prista Corporation’s ActionCue® Clinical Intelligence is a new Endorsed Partner by Texas’s TORCH Management Services, Inc. (TMSI)

 

TMSI EndorsedPrista Corporation, maker of ActionCue® Clinical Intelligence, a software platform for healthcare quality-safety and performance improvement is now an Endorsed Partner of TMSI, a wholly-owned subsidiary of the Texas Organization of Rural and Community Hospitals (TORCH).

Prista Corporation, an industry leader in clinical intelligence software for healthcare quality-safety and performance improvement, is proud to announce their latest endorsement – that of TORCH Management Services, Inc.

“Over the past 12 years, Prista has successfully deployed ActionCue CI to many hospitals in 33 states – including 25 in Texas alone. Gaining this important endorsement from TMSI further validates the key role ActionCue CI plays in facilitating continuous performance improvement in patient care and safety by providing actionable insights in real-time to healthcare leaders and their staffs. We look forward to working with TMSI/TORCH members to bring ActionCue CI to bear on solving their challenges,” said Don Jarrell, President of Prista Corporation.

“TMSI is pleased to welcome Prista Corporation as an Endorsed Partner,” said Vicki Pascasio, FACHE, President of TMSI.  Ms. Pascasio continued, “This endorsement recognizes that Prista’s ActionCue CI platform can assist our TORCH member hospitals in achieving their goals while adhering to excellent standards.  Like all our Endorsed Partners, Prista has gone through a thorough vetting process.”

About Prista Corporation: Prista’s mission is to help healthcare providers create and sustain a “Culture of Quality” in their organizations. In other words, an environment that drives continuous performance improvement in patient care and safety. Prista does this by developing innovative, intuitive, easy-to-use software that goes beyond traditional reporting to provide actionable insights in real-time. With Prista’s ActionCue CI platform, information is more readily available, more meaningful, and more actionably insightful for healthcare executives, managers, and clinical staff.

About TMSI: TORCH Management Services, Inc. is a subsidiary of the Texas Organization of Rural & Community Hospitals (TORCH) created for the purpose of having an organization that could engage with services on behalf of the TORCH membership.  TMSI provides value-added services to rural healthcare organizations, thereby enhancing their opportunities for success.

About TORCH: The Texas Organization of Rural and Community Hospitals envisions rural Texas as having access to the highest quality health care.  To accomplish this, TORCH’s mission is to be the voice and principal advocate for rural and community hospitals in Texas and to provide leadership in addressing the special needs and issues of these hospitals. For more information, visit torchnet.org.

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Prista Corporation’s ActionCue® Clinical Intelligence Endorsed by Georgia Hospital Health Services

ActionCue® Clinical Intelligence, a software platform for healthcare quality-safety and performance improvement from Prista Corporation, has been endorsed by Georgia Hospital Health Services.

Prista Corporation, an industry leader in clinical intelligence software for healthcare quality-safety and performance improvement, is proud to announce that their flagship product, ActionCue® Clinical Intelligence, has been endorsed by Georgia Hospital Health Services (GHHS), a subsidiary of the Georgia Hospital Association (GHA).

“Over the past 12 years, Prista has successfully deployed ActionCue CI to many hospitals in 33 states. Gaining this important endorsement from GHHS further validates the key role ActionCue CI plays in facilitating continuous performance improvement in patient care and safety by providing actionable insights in real-time to healthcare leaders and their staffs. We look forward to working with GHHS/GHA members to bring ActionCue CI to bear on solving their challenges,” said Don Jarrell, President of Prista Corporation.

“GHHS is pleased to endorse Prista’s ActionCue as a premier data-driven platform that can facilitate improvement and advance the health of individuals and communities in Georgia,” said Bill Wylie, Sr. VP of Business Operations for the Georgia Hospital Association. Wylie continued, “ActionCue has passed GHHS’s rigorous due diligence process, and this endorsement signifies GHHS believes the platform to be of high quality, that it can provide a benefit to our members, and that it fits within GHA’s strategic plan.”

About Prista Corporation: Prista’s mission is to help healthcare providers create and sustain a “Culture of Quality” in their organizations. In other words, an environment that drives continuous performance improvement in patient care and safety. Prista does this by developing innovative, intuitive, easy-to-use software that goes beyond traditional reporting to provide actionable insights in real-time. With Prista’s ActionCue CI platform, information is more readily available, more meaningful, and more actionably insightful for healthcare executives, managers, and clinical staff.

About GHHS: GHHS, Inc. is a for-profit subsidiary of the Georgia Hospital Association. Founded in 1989, GHHS serves member hospitals by offering various types of programs. GHHS may either create a program to serve a membership need, exclusively market a program for GHA members, or endorse services and assist in creating awareness plans.

About GHA: Founded in 1929, GHA serves more than 170 hospitals in Georgia and promotes the health and welfare of the public through the development of better hospital care for all Georgia’s citizens. The mission of GHA is to advance the health of individuals and communities by serving as the leading advocate for all Georgia hospitals and health care systems. GHA represents its members before the General Assembly and Congress, as well as state and federal regulatory agencies, and is an allied member of the American Hospital Association. For more information, visit gha.org.

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Leadership Contest, Culture and collaboration.

Leadership is Personal – Innovating Improvements is a Team Effort

In his recent article “Leadership is Personal” published on LinkedIn’s Pulse, Keith Thurgood (also a member of Prista’s Board of Directors) notes that, “Despite spending billions on leadership development programs, [these programs] have not achieved their intended outcomes.”

Keith then goes on to say that “leadership is really about influence” and “Leaders understand that context, culture and collaboration matter when it comes to influence.” He then discusses the importance of self-awareness and how effective leaders must work on their personal development from the inside-out.

I always appreciate Keith’s insights, and reflecting on his article took me through ‘leadership’ as a thought exercise and into leadership as a learned set of behaviors – leadership becomes a habit, if you will. Some might call this ‘second nature’ because effective leaders make it appear so natural, but that’s not right, either.

By its very nature, leadership is not a solo practice. If leadership skills are not embodied in certain key collaborative work practices, their effectiveness will fade over time. What are those key collaborative practices, and how can they be facilitated?

At Prista, our experience with clients has made it very clear that the ongoing information work regarding the primary purposes and functions of an organization needs to directly serve the leadership function of that organization. This means the information work needs to deliver leveraged, actionable insights to leaders, not mass data, and these insights need to come from the work process itself, not from quarterly reports.

Leaders give direction and feedback that must be communicated directly and used in the collaborative process, not watered-down nor delayed by coming through side-channel briefings or bulletins. When this happens, real-time accountability becomes “built-in” to the way teams operate.

To be effective and efficient, the flow of information needs to leverage Information Technology and not be a massive human effort. Speaking of Healthcare IT design, Ted Melnick, Director of the Yale Clinical Informatics Fellowship, advised “Relentlessly question why things are done a certain way to ensure health IT doesn't get stuck in a cycle of ‘we do it this way because that’s how we've always done it.’”

Chris Coburn, Chief Innovation Officer at Mass General Brigham (Boston) had this to say about innovation: “Know your organization. Its people and culture will be the source, enablers and, at times, obstacles to innovation.” Leadership is personal, but leading requires a team and being an effective leader involves enabling the team’s success and removing obstacles.

In speaking about innovation teams at Houston Methodist, Michelle Stansbury, VP of Information Technology, takes steps to “ensure that we are focused on the right problems and we can quickly operationalize the transformational solutions.” That’s the key – it’s not information for information sake, or work for work sake, but rather developing solutions that lead to positive changes.

In other words, demanding, seeking and choosing fundamentally innovative design in the tools that equip the business is required, but so is end-user buy-in and participation. When this all comes together, leaders' relationship with information and its use in the organization changes dramatically to the benefit of all.


Prista’s ActionCue CI is an innovative, intuitive, easy-to-use platform that goes beyond traditional reporting to provide actionable insights in real-time. With ActionCue CI, information is more readily available, more meaningful, and more actionably insightful for healthcare executives, managers, and clinical staff. Contact us today if you’d like to learn more.

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Nurses Week Thank You

National Nursing Week 2020

As we prepare to celebrate National Nurses Week during the Covid-19 pandemic, it’s difficult to find words that adequately express the thanks and gratitude that each of us feels for America’s brave, dedicated, and heroic nurses during this crisis. And the truth is that even a week of honoring our nurses simply doesn’t cut it, because they deserve our respect, thanks, and admiration every day of the year.

For many folks, it’s hard to understand why anyone would want to work in such a physically and emotionally demanding profession, but the truth is that many nurses don’t think of it as a profession, but rather as a calling. That was certainly the case for Florence Nightingale, the British nurse whose experiences on the frontlines and advocacy work back home helped reform medical care and established nursing as an essential position in society.

Each year, National Nurses Week begins on May 6th to celebrate America’s nursing professionals and concludes on May 12th–a date that was symbolically chosen because it is also Florence Nightingale’s birthdate. To celebrate the 200th anniversary of Nightingale’s birth, the World Health Organization declared 2020 the year of the nurse, which is especially appropriate in this time of global health crisis.

Nursing in the modern era

While supportive care roles have always existed in some form throughout recorded history, nursing as we know it today only came into existence in the second half of the 19th century, as Nightingale and others began to recognize the dire need for skilled healthcare providers, both on the war front and at home.

Nightingale, who cared for wounded British soldiers during the Crimean War, witnessed firsthand the pain and suffering her patients experienced due to a lack of proper medical care and trained nurses. Upon returning to Britain, Nightingale embarked on a campaign of reform, publishing training manuals for nurses and advocating for the establishment of nursing schools and standardized care. In 1860, Nightingale and a group of influential benefactors established a nursing school at St. Thomas’ Hospital, where they began training future generations of nurses to implement their vision of increased care, better patient outcomes, and less global suffering.

Through tireless advocacy work, Nightingale and her supporters revolutionized nursing and helped establish the modern system of care. Politicians and citizens alike began to see that nurses are essential to a functional healthcare system. Working in warzones, hospitals, rural clinics, and family offices around the world, nurses provide critically needed care to patients day in and day out.

Today, Covid-19 provides a somber reminder of how crucial nurses and other frontline workers really are.

Ways to show your support

During the Covid-19 Pandemic, there are many ways that you can show your support–not only during National Nurses Week but also year-round.

  • Show you care and are thinking of them – As natural caretakers, many nurses and providers feel pressure to shield their friends and families from the stress and trauma that accompanies their work, shouldering the burden alone. During this crisis, reach out to the nurse in your life to let them know you’re thinking of them. Offer to make yourself available if they need someone to listen, and check-in with them weekly or bi-weekly. If they do want to talk about their experiences, remember to listen actively and show them you’re there, especially during hard times.
  • Donate PPE – If you or your business have a stockpile of personal protective equipment (PPE) such as N-95 masks, respirators, or face shields, consider donating it to a local hospital or through an online donation portal. By helping provide essential PPE, we can help keep our nurses and other frontline workers healthy.
  • FLATTEN THE CURVE! – One of the biggest ways we can thank our nurses is by following the guidance of trusted public health officials. Social distancing, frequent hand washing, and minimizing unnecessary trips outside of your home will help slow the spread of the virus and prevent the healthcare system from becoming overwhelmed. By abiding by the CDC-recommended best practices, every one of us can help save the lives of patients as well as healthcare workers.
  • Donate to the American Nurses Foundation Coronavirus Response Fund– If you would like to give a financial gift, considering donating to the Covid Response Fund for Nurses, which is run by the American Nurses Foundation, an official partner of the American Nurses Association. This fund benefits nurses in a variety of ways, from offering direct financial relief to funding access to mental health care professionals during this time of crisis.

Today, nurses and other healthcare workers are more united than ever in the face of Covid-19. Simply put, never in our lifetime has there been a greater unified effort to confront an illness on frontlines around the world. Together, let’s thank our nursing professionals and continue the crucial advocacy work needed to ensure that our frontline workers have the resources they need to stay safe.

 

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