Category Archives for Leadership

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.

Share and Enjoy !

Shares
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.

Share and Enjoy !

Shares
ActionCue Clinical Intelligence Software

3 Reasons Why “Designed by Clinicians” is Not Going to Save Healthcare IT

A recent article in Medical Economics, “The Promise of Next Generation EHRs” was an interesting read.  It got me thinking, and there were a few parts of the article that left me uneasy, given the challenges in healthcare today.

First, the article cited reports that point to software as the primary administrative burden to physicians’ productivity. The article notes that inefficiencies in software lead to click fatigue and multitasking, which ultimately lead to mistakes.

Indeed, mistakes are very serious problems in healthcare. However, it’s not only physicians who suffer from inadequate software - nurses, clinicians and a host of administrative staff are spending most of their day using various software systems and applications.

Second, and perhaps more importantly, while stressing the need for flexibility and usability in information technology for healthcare orgs, the author specifically advocates that the best software is “designed by clinicians”. Ironically, this “designed by clinicians” paradigm is a major contributor to the dissatisfaction many users have with healthcare software products – including EHRs.

Of course, healthcare application vendors would be silly not to include significant input from current and former clinicians. Clinicians’ hands-on experience is invaluable to clinical in the form of environmental background, workflows, user scenarios, use cases, specific requirements and other types of content.

The much greater concern over healthcare institutions jumping onto the “designed by clinicians” bandwagon is that it quickly leads to the idea that software must be designed, not by just any clinicians, but by their own in-house team of clinicians.

Thus, when considering new software products, healthcare leaders are quick to ask the vendor, “Can we customize it?” (meaning a unique instance of a product, custom-developed for an organization) before they have seen much of the existing product.  That question is where the real trouble begins. It is far from the end of the story, however.

Challenges in Healthcare Software Design

Improving software in healthcare is a noble - and very necessary – goal. But when the rubber meets the road, software designed exclusively by clinicians leads to three major pain points that are already widespread in healthcare organizations.

Problem #1 – Clinicians and Developers working together: mismatched skills match lead to less than optimal products

 The best software vendors use highly trained with a wide breadth of expertise in fields like information engineering, perceptive science, psychology, user interface (UI) and user experience (UX), for starters.

It takes all these skills and more to shape an optimal UX for a software product. Unfortunately, not every software developer is also gifted with design skills. Similarly, clinicians are untrained in the various disciplines of UX employed by a design expert during the product development process. As end-users, clinicians are often better at describing the problem rather then envisioning “clean slate” solutions that could drive the desired results.

In other words, both sides may be operating outside their area of expertise. Thus, having clinicians tell programmers what they want can lead to problems such as:

  • Communication breakdown over terminology
  • Conflicting approaches to both the problem(s) and potential solutions
  • Extra time spent in design and review processes to educate clinicians on UX and design principles
  • Important design features are diminished or omitted

To avoid this scenario, I feel that the best outcomes result from software designed not by, but with clinicians at multiple points during the design, development and maintenance phases of the software lifecycle.

Problem #2 – Customized product development “branches” leads to higher cost, but not necessarily higher performance

In recent years, custom development of healthcare management platforms has become ever more common. Vendors are eager to offer customization because they can charge more for the end product, while simply passing on the additional development costs directly to the customer. For some, in fact, it’s become a major part of their business model.

The more vendors provide custom development, the more customers ask for it, and so begins a vicious cycle. But the ugly truth is, while custom development or “customization” of healthcare IT products is lucrative for the manufacturer, it doesn’t necessarily benefit the customer. Much of customization work amounts to simple personal preferences which have no effect on patient care outcomes. Custom-developed products

Problem #3 - People tend to lean on (and thus design based on) what they know

One of the most important skills professional software designers have is the applied fundamental of design thinking. Design thinking uses a set of defined principles and constructs, combined with a very intentional process, to realize a desirable end product. Design thinking helps product designers fight the (very human) urge to “go with what you know”.

Most of us, when asked how a new system or product should look or work, will describe something very much like what we have used in the past – regardless of how well that product met our needs. People tend to lean on familiarity (often without even realizing it) which results in a “that’s the way we’ve always done it” attitude. It is this attitude that holds back much-needed progress in hospitals, clinics, and other healthcare organizations.

The unintended consequences of this perpetual cycle are:

  • Unintuitive platforms that are difficult to use
  • Software that feels just like a digital version of outdated paper forms
  • Expensive cycles of customization
  • Wariness at trying new products and systems

After a few years and many thousands of dollars, too many healthcare organizations find themselves still encountering the same problems.

Taking steps toward meaningful and effective change in healthcare Performance Improvement Software

So what should healthcare organizations do? It will require a major attitude shift to get out of the rut that’s been dug over decades of stagnation and frustration at ineffective systems. Meaningful change requires buy-in, starting with management on down through all levels of the organization.

Here are some starting principles for effective change:

  • Commit to innovation in selecting, acquiring and using healthcare management software
  • Accept the idea that progress comes with a certain amount of pain
  • Seriously consider newer, smaller vendors because they are the ones best positioned to truly innovate
  • When evaluating a product, focus more on organizational goals and actionable insights needed and less on tasks, processes and reports used in the past
  • Give turnkey products a chance to demonstrate their full functionality before asking about what can be built
  • Focus on whether a product is intuitive, easy-to-use and even exciting to think about using. If it’s not, keep looking

Developing New Approaches in Healthcare Performance Improvement Platform Software

The takeaway here is that optimal product design “takes a village” – a multi-disciplinary team that includes, but is not controlled by, end users (clinicians, physicians, administrative staff).

ActionCue CI is built upon this principle. Our innovative solution was developed in partnership with clinicians, as well as highly trained UX/UI product designers, to address known problems in ways that go beyond what myopic visions of what so-called ”new” solutions can lead to. The dashboard is configurable to meet the unique needs of risk managers, clinicians, and healthcare executives while avoiding the pitfalls of full customization, resulting in a more cost-effective and intuitive product that end users love.  By providing configurability without customization, ActionCue CI delivers an affordable solution that still meets specific users’ needs.

Would youlike to learn more about ActionCue CI and how it can benefit your organization?

 While there, be sure to check out the “Watch It Work!” video and sign-up for brief walk-through of the platform from a Product Specialist.

Share and Enjoy !

Shares
ActionCue CI Solution for accurate reporting

Increasing Efficiency in 2018

It’s the beginning of a new year, and in 2018 the healthcare industry would greatly benefit from better utilization of resources. U.S. health care spending grew 4.3 percent in 2016, reaching $3.3 trillion, while an estimated $1 trillion is wasted each year on inefficiencies, redundancies and abuse. With an aging population, and chronic illnesses and obesity on the rise, emergency department staff will continue to be flooded with patients, while hospitals work to comply with new CMS mandates and rulings, and improve quality of patient care.

Hospitals are constantly working to increase productivity and reduce expenditures, while statistics continue to remind us that time is money. In 2017, EY conducted an advisory study  of the healthcare industry, and after analyzing the data, suggested a holistic approach to reducing inefficiencies and improving quality of care. Of the five points presented, we’ll focus on the three areas where our ActionCue CI platform can make a significant impact for healthcare organizations in 2018: transforming the culture, advancing with analytic insights, and increasing productivity

Transforming the Culture

In 2017, we presented a four-part series on innovation and the role of leadership in creating action that improves patient safety and quality. A recurring theme in the series, and a concept we work to continuously promote, is creating a “culture of quality.” Improving culture is the first step towards improving patient safety and reducing inefficiency, and it must begin at the top. Organizational leadership must be deeply involved and aware of the challenges clinical staff face daily. Executive engagement is crucial to improving overall culture, but it’s no secret that executives face substantial time constraints. According to Becker’s Hospital Review, the average CEO spends about 2.5 hours per day in meetings, and 21.2% of a CEO’s solitary workday is devoted to reading and analyzing reports.

ActionCue CI allows staff to create comprehensive, easy-to-read reports in minutes, not days, providing real-time access to insights and performance measures while reducing time spent in meetings or analyzing confusing data sets. This creates more time for leadership to engage with clinical staff and take a more involved approach to culture. Because 51% of EY respondents believe employee satisfaction in healthcare drives patient satisfaction, not only will this boost morale, it will positively impact patient care.

Advancing with Analytic Insights

Access to reliable, accurate and insightful data is imperative as hospitals work to improve performance and quality. There’s more focus on patient outcomes than ever before, and as CMS continues to impose regulations and mandates, the spotlight is on hospitals to perform or risk losing funding. Executives need immediate access to meaningful metrics on safety events, corrective actions, performance indicators, quality management, risk management and more.

With event reporting, quality management and performance improvement tracking in one easy-to-use online platform, ActionCue CI is your Fast Path to Insight™. Its robust, real-time reporting features give executives the data they need to be proactive, rather than reactive, and drive better clinical outcomes.

Increasing Productivity

Organizations’ leaders have historically accepted that quality and safety efforts require a large amount of time and effort, and lengthy processes. However, we believe applications should focus on collaboration and workflows that not only match the natural tasks and processes of users, but also shape the users’ behavior by encouraging methodologies that produce targeted results, and increase efficiency and accountability.

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. Executives hoping to cut costs in 2018 should place significant focus on improving productivity and efficiency. With low operation costs, no hardware or installation requirements, and month-to-month subscriptions, the impact of ActionCue CI on cost reductions is two-fold.

 

As the healthcare industry continues to place more emphasis on quality and performance improvement, and improved clinical outcomes, 2018 promises to be a year during which increased efficiency and better utilization of resources is a major focus, and rightly so. If you’d like to learn more about how ActionCue CI can help you reach your quality and performance improvement goals more efficiently, contact us today and start 2018 off on the right foot.

Share and Enjoy !

Shares

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.

Share and Enjoy !

Shares
×

Are you ready to deliver better patient care? Get Started Today!

Loading...