Category Archives for Helping Hospital CEOs

How Excellent Patient Care Saves Costs

Patient Safety is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.”  Every hospital in America has a stated mission to prioritize Patient Safety above all else.  “First, do no harm” is the most fundamental principle of any health care service.  Every healthcare organization says it, but are they really doing everything they can to prioritize patient safety?

The first step to solving a problem is admitting that you have one.  But what if you aren’t aware that you have a problem?  Especially in the Critical Access and Community Hospital space, where staff is stretched to non-optimal lengths, how can a facility, not only stay on top of patient safety, but take the time necessary to rigorously evaluate processes and policies to improve their quality of care?

Beyond the moral and ethical obligation to provide the best health care possible, there are clear financial benefits, although often unrecognized, unknown, or undervalued, to doing no harm.  When was the last time you truly evaluated your facilities process of minimizing risk events, and optimizing quality outcomes? Could it be improved upon? Can it make your facility more profitable? The answer is a resounding yes.

Look at your patient fall data to see how much you’ve paid for Cost of Harm falls last year – what else could your hospital have used that money for? Next time you need to tighten your budget, remember cost cuts don’t just come from lowering staffing or standards. You can also save by minimizing how much quality and risk incidents are costing your hospital.

We’ve found this is true amongst our customers. Using ActionCue© CI’s Performance Improvement Plans and the guidance of our Implementation & Support team, one of our customer hospitals reduced falls at their facility by 25% over three years. Based on the Center of Disease Dynamic’s Cost of Harm figures, this saved them almost a million dollars in additional costs.

Another hospital saved more than a million dollars over three years as their CLASBI cases reduced by almost 47%. A third hospital saved more than $80,000 by cutting their rate of VAP cases by 66% in three years of using ActionCue CI.

Improving the quality of care, through proactively tracking and tackling risk and quality incidents can lead to significant savings from the cost of harm avoided – money that can fund additional staff, equipment upgrades and other improvements.

This positive cycle can multiply – every dollar saved by avoiding a Cost of Harm event can be spent on further eliminating Cost of Harm events, leading to more savings from the cost of harm avoided. As the cycle continues, avoidable costs decrease while the quality of care – and your reputation – increases.

This article first appeared in the March 2024 edition of Marketplace, the monthly newsletter of TORCH Management Services, Inc.

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.

Leadership is Personal – Innovating Improvements is a Team Effort

Losing Focus on Value in Value-Based Purchasing

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.

Reducing Preventable Errors Requires a Sustained Shift in Processes and Culture

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.