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.
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.
When it comes to discussions about healthcare reimbursement and costs, “Value-Based Purchasing” is a term that gets thrown around quite a bit these days. In fact, many experts say it’s going to be the future for healthcare organizations.
Due to its growing use in hospitals and regional clinics, Value-Based Purchasing (VBP) has become a buzzword in healthcare. But as often happens with buzzwords, the original meaning becomes less salient to most people than their feelings and experiences with the subject. What exactly is the goal of value-based purchasing?
The Goal of Value-Based Purchasing
On paper, the methodology of VBP is simple: pay providers for quality and value, not just volume. Hold healthcare organizations accountable for both the quality and cost of the care they deliver and reward the best-performing providers.
The goal of VBP is to facilitate a high-level of care that is both safe and efficient. To reduce medical errors, lower the rate of accidents, achieve better patient outcomes, and maximize financial rewards. In an ideal world, clinics and hospitals will operate at optimal effectiveness and efficiency – resulting in lower prices for both patient and payor.
The Reality of Value-Based Purchasing
Organizations work hard, month after month, to achieve this noble “value proposition”. But the everyday reality of succeeding for their organization in a Value-Based Purchasing program is far from simple.
Value-based care goals come with their own elaborate set of rules, metrics, benchmarks, reimbursement adjustment tables, and a million other things. The delay between capturing data and applying benchmarks to a provider’s reimbursement is significant. It’s all too easy for care providers to become immersed in the administrative minutiae of VBP and lose track of the program’s highest goal – better value for patients.
Therefore, whether you’re a front-line staffer or a top-level executive, it’s important to circle back to one basic question: “Does what we’re doing truly improve value?”. If the answer is “No” or, (as is often the case), unclear – then it’s time to evaluate the effectiveness of the task, process or tool on a fundamental level.
Getting Back to the Value in VBP
In order to shift the focus back to “value” in a value-based purchasing system, major changes need to occur in how departments think and work together.
Of course, a VBP-participating provider organization cannot completely ignore the necessary mechanics of the program without losing the reimbursement boosts it can provide. However, when the staff and management can focus on actual performance across the majority of their care-delivery operation, on a real-time basis, VBP success becomes a byproduct of genuinely improved clinical performance across the board.
As we see it, there are some real opportunities for core value improvement in the fundamental way the quality improvement operation is executed. For example:
- Change the focus from reporting to insight, learning, and change. Lengthy and detailed reports do not improve anything. Make the improvement process the primary core function, make it effective and efficient, and reverse engineer the way the capture, processing, communication, and work on that related information is built to optimize improvement in Quality and Safety.
- Involve executives by giving them the right lens on the subject matter. ActionCue’s event reports capture the facts and circumstances surrounding each adverse event, while the performance measures and analytics capture a big, coherent picture of the operations. Only by replacing the “too many moving parts” nature of Quality-safety with a complete story can we hope to provide proper executive buy-in and leaders to improve evidence-based outcomes and quality measures.
- Get away from paper as inputs or outputs. Paper is static information that takes human effort to move, change and work on. ActionCue CI gives uses a workbench to support information work and receive actionable insights in a dynamic way.
- Don’t be afraid to re-invent the process. Stop throwing more human effort at things that aren’t getting results, just because it’s “the way we’ve always done it.” That includes classes and meetings, that soon fade and impact the work far less than equipping the staff to actually work differently.
- Think outside the box. The “mandated” way is not always the best way! Don’t let a mandated task, step or artifact chain the organization to an outdated, suboptimal overall process. Look for new and fundamentally more efficient processes that serve goal attainment, even if those small mandated tasks, that deliver less value, seem redundant.
Remember, the most precious things your team produces in running your operation and delivering care are actionable insights to improving value. If you’re working more and getting less of that, CHANGE. Because the goal, after all, is value. Value for patients and value for care providers.
Preventable medical errors are a serious issue in healthcare and are estimated to be the third leading cause of death in the US, behind cancer and heart disease. The issue has garnered more attention within recent years, and for good reason, as according to a Mayo Clinic study, 8.9% of surgeons reported they believe t have made a major medical error within the last three months. There are many causes for medical errors, including communication problems, organizational transfer of knowledge, staffing patterns/workflow, and more.
Hospital administrators have seen a certain level of improvement in the number of medical errors by taking action based upon the findings and recommendations of several private- and public-sector organizations aimed at increasing communication, information sharing and teamwork among providers. While these methods can be effective, healthcare leaders must take their efforts a step further to create impactful change. Perhaps first and foremost, healthcare executives must drive efficiency and a value proposition into the consideration of changes. Sadly, many of those recommendations coming from traditional experts and thought leaders in healthcare amount to a hospital’s staff doing more supportive and administrative work for the sake of improving the quality and safety of patient care. This cannot be a good way to lower costs and improve patient care on a sustainable basis.
Sustained improvement in quality of care requires a significant shift in culture, facilitated by the optimization of work processes for clinical staff, increased involvement and leadership by executives, and an unrelenting focus on patient safety and quality. A subtle, but very important, aspect of this shift in approach is to orient the changes and innovations around the goal, rather than the historical activities and artifacts used in previous decades in managing and improving quality-safety. While applying information technology can be a major contributor to optimizing these processes, success – including the streamlining, reduction or even elimination of some steps and artifacts – requires that the IT be very well designed around the capabilities of the technology, the human/user factors and a keen knowledge of the work environment and goals.
Achieving quality goals requires a commitment to creating a “Culture of Quality,” in which senior healthcare executives both lead and participate. It requires open, transparent and bi-directional communication at all levels, but in order to get true “buy in” from clinical staff, the processes and procedures that make up their day-to-day must be efficient, intuitive and sensible. Quality improvement must be woven into every facet of their daily actions, with a continuous reminder of shared goals, as well as updates on progress. Placing the improvement process itself at the center of the overall quality-safety effort leads to reverse engineering and optimizing the pathway to the goals of better patient care, lower costs and a sustainable culture around both.
We kept these guiding principles in mind when developing the ActionCue Clinical Intelligence quality and performance improvement platform. We designed the application to save time among users, by ensuring their day-to-day functions are not only easy to use and understand, but also intuitively match their natural tasks. Furthermore, the system works to effectively shape their behavior through the encouragement of effective quality improvement methodologies. When clinical staff are presented with quality improvement technology that is efficient and helpful, they are more likely to remain committed to improving quality of care.
Effective leadership is essential in creating a sustained culture shift. Executives must remain committed to improving patient safety through involvement in staff’s daily functions, and monitoring of clinical issues and what’s being done to resolve them. ActionCue’s reporting feature allows staff to prepare reports in minutes, making it easy to provide executives with insight into quality improvement progress. This not only saves time, it allows upper management to remain an active participant and leader in the achievement of quality improvement goals.
Reducing medical errors requires a commitment from both clinical staff and hospital management to a “Culture of Quality.” ActionCue CI can help hospitals achieve this sustained culture shift through one easy-to-use online platform. If you’d like to learn more about how ActionCue is using innovation to improve patient care, download our recent white paper.
Everyone knows time is money, and healthcare consumes too much money. Therefore, it stands to reason that a major objective for hospitals and healthcare systems should be to save time and resources at all levels of the organization and throughout the supply chain. There are several facets to the drive for efficiency, but we’ll focus on the three main levels that successful performance improvement tools can make a positive impact on productivity and cost.
One way to pass time savings onto organizations is to operate the SaaS model of delivery, in which software is licensed on a subscription basis and is centrally hosted. This eliminates the need for incremental infrastructure—or the maintenance of it—in order to obtain additional benefits. There are several additional benefits in operational cost by not offering the “package and deliver” approach as an option for the customer, as some companies do. A commitment to operating at high levels of efficiency means providers are able to make the acquisition and continued use of the platform remarkably inexpensive.
One of the most impactful ways Prista passes efficiency onto organizations is by reducing the amount of customization utilized within our business model. Although it’s important to be responsive to customers’ needs and requests, the vast majority of healthcare IT customization is based on personal preferences, rather than needs, especially those aimed at imitating paper forms, previous processes, or outdated mandates. The fact is, customization can be a very lucrative business model for vendors and a very large, ongoing expense for customers. This is detailed in our recent blog post “Customization: The Gift That Keeps On Costing.” Aside from the real-dollar costs of significant ongoing customization, there is the added investment of time for key hospital staff and management in creating detailed requirements, reviewing revised software and testing functionality throughout the customization process, not to mention the learning curve of healthcare professionals on the language, disciplines and processes of the software business.
In contrast to the customization-oriented model, successful providers should focus on the turnkey nature of their application. A great deal of healthcare and clinical domain expertise went into the design of the ActionCue CI platform, so that workflow processes, terminology, content selection, and styling are already present “out of the box.” This way, organizational leaders don’t need to spend time specifying what they need or expect in the application. Aside from the healthcare knowledge applied, UI/UX designers should deliver the application to the customer as a finished product useable by the customer within days of start-up, rather than as toolkit that takes six to nine months before the “go live” date.
To accommodate the variability of customer types, including short-term acute hospitals, ambulatory surgical centers, and home health and rehab, and to adapt to the evolution of the quality-safety efforts over time, we made ActionCue CI extremely configurable, so customers, sometimes with the assistance of support staff, can adapt the application, using plain English configuration selections, quickly, efficiently and usually without any cost.
The specific design of the application should save time among key users throughout the organization. By ensuring the routine and administrative functions of the application are easy to use and understand, organizations almost never have to hire data analysts or additional clerical staff to assist with workload or technical tasks.
ActionCue CI’s fast, intuitive event reporting reduces the time between an event being reported and getting resolved and allows users to easily and quickly prove they are monitoring quality within the organization. The systems’ workflows were designed to not only match the natural tasks and processes of users, but also shape their behavior by encouraging methodologies that produce targeted results, and increase efficiency and accountability. The design goes beyond ease-of-use to advance the way in which healthcare organizations engage with information in an application.
Using ActionCue, staff can create comprehensive, insightful and simple reports within minutes, which reduces the amount of time executives spend in meetings analyzing confusing or incomplete data sets. At a glance, healthcare professionals can see the real-time condition of their entire facility’s quality and performance initiatives.
SaaS-model companies, such as Prista, 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.
Additionally, Prista support staff, with whom customers first and regularly engage, have credentials in Quality Management and Safety. Those staff members also have input on the product design, so that content delivered is accurate, correctly applied, and easy to understand. The ongoing working relationships provide users with a sense of partnership in which they gain knowledge of how the application works, and how it can be best applied to their role.
Efficiency was a guiding principle for the Prista business model, and it’s incorporated into every facet of the ActionCue CI platform. We’re proud to pass our savings along to our customers and ensure ActionCue is driving efficiency at the larger organizational level, as well as making the day-to-day functions of key users more simple and enjoyable. If you’d like to learn more about driving efficiency within your healthcare organization, check out this recent blog post.
This post is part 1 of our 7 Innovation series. Interested in reading more? Download the 7 Innovations that Deliver Strategic Value in Healthcare White Paper