Table Of ContentHealth Care Management / Quality & Patient Safety J
o
s Leading Health Care
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i
Leading Health Care Transformation provides a handbook of essential tools •
E
for defining transformational opportunities, leading high-functioning teams, r
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being a good team player, and using evidence, measurement, and narrative •
Z Transformation
for effectively communicating and fostering a change agenda. The book is h
a
punctuated by salient case studies that offer valuable insight into deploying n
g
change tools in real-world situations, illustrating not only technique, but the •
S
context of their application. In that regard, this is really much more than a i
k
k
“primer”; it offers both expert knowledge, as well as the wisdom borne of a
A Primer for
colleagues’ experience and lessons learned.
—From the Foreword, Jonathan B. Perlin, MD, PhD, MSHA, FACP,
FACMI, President, Clinical Services and Chief Medical Officer, L Clinical Leaders
Hospital Corporation of America e
a
d
A succinct and practical primer on health care transformation, this book is
i
n
a key resource for all clinicians in leadership positions. It summarizes high-
g
profile health care topics and includes a synopsis of the evidence, examples,
H
lessons learned, and key action steps for each topic covered.
e
a
Providing cutting-edge insights from the quality and physician perspectives,
l
the book focuses on the most critical topics in the field today, including the t
h
issues of quality, cost, value, and new models of care.
C
The book includes discussions on various quality improvement processes a
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including Lean and Six Sigma. Detailing specific strategies and tools to help e
you achieve and sustain improvement, it explains how to build a culture T
of safety and identifies proven principles and practices for creating a high- r
a
reliability organization.
n
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Blending the perspectives of administrators, nurses, and physicians, this f
o
insightful and practical resource provides the understanding you need to r
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leverage health information technology for clinical improvement and to
improve care coordination to reduce readmissions. a
t Maulik Joshi, DrPH • Natalie Erb, MPH
i
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n Sonia Zhang, MPH • Rishi Sikka, MD
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K24509 cvr mech.indd 1 6/9/15 12:36 PM
Leading Health Care
Transformation
A Primer for
Clinical Leaders
Maulik Joshi, DrPH • Natalie Erb, MPH
Sonia Zhang, MPH • Rishi Sikka, MD
Foreword by
Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2016 by Health Research & Educational Trust and Advocate Health Care
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20150609
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Contents
Foreword .............................................................................................................ix
Acknowledgments ..............................................................................................xi
About the Authors ............................................................................................xiii
1 The Health Care Landscape ...................................................................1
Introduction ................................................................................................1
First Curve to Second Curve ...................................................................1
Leading Transformation ..........................................................................3
Key Factors Driving Transformation ...........................................................4
High Cost of Care ...................................................................................4
Shifting Demographics: Patients and Workforce .....................................5
Transition to Value-Based Reimbursement ..............................................6
Variable Quality Outcomes .....................................................................7
Expansion of Coverage under the Affordable Care Act ............................8
Advances in Health Information Technology ..........................................9
Shift from Defined Benefit to Defined Contribution Health Plans .......10
The Role of a Clinical Leader .....................................................................10
Conclusion .................................................................................................12
References ..................................................................................................12
2 Effectively Implementing Quality and Safety Improvement ................15
The Evidence ..............................................................................................16
The Model for Improvement .................................................................16
Lean ......................................................................................................16
Six Sigma ..............................................................................................20
International Standards Organization 9001 ..........................................21
Lessons Learned .........................................................................................22
Case Studies ...............................................................................................24
NCH Healthcare System: Improving Medication Communication
with Patients ..........................................................................................24
Memorial Health System: Hourly Nurse Rounds Reduce Patient
Harm and Improve Patient Satisfaction .................................................25
iii
iv ◾ Contents
Action Steps to Lead ..................................................................................25
References ..................................................................................................27
3 Spreading Improvement .......................................................................29
Evidence ....................................................................................................29
Preparing for Spread ..............................................................................30
Establishing an Aim for Spread .............................................................31
Developing a Spread Plan ......................................................................32
Effective Strategies for Executing and Monitoring Spread ........................34
Case Study: On the CUSP ....................................................................35
Lessons Learned .........................................................................................39
Action Steps ..............................................................................................40
References ..................................................................................................41
4 Physician Champions ...........................................................................43
The Evidence ..............................................................................................43
Case Study ................................................................................................46
Lessons Learned .........................................................................................48
Action Steps and Strategies to Lead ...........................................................49
References ..................................................................................................49
5 Building a Culture of Safety .................................................................51
The Evidence ..............................................................................................51
Transparency around Safety Events .......................................................54
AHRQ Surveys on Patient Safety Culture .............................................55
Safety Attitudes Questionnaire .............................................................56
Case Study .................................................................................................56
Lessons Learned .........................................................................................58
Action Steps and Strategies to Lead ...........................................................59
References ..................................................................................................60
6 Principles and Practices of High Reliability Organizations ................61
The Evidence ..............................................................................................61
Preoccupation with Failure ....................................................................62
Reluctance to Simplify ..........................................................................62
Sensitivity to Operations .......................................................................63
Commitment to Resilience ....................................................................63
Deference to Expertise ..........................................................................63
Case Study ................................................................................................64
Preoccupation with Failure: Investigating Near Misses and Good
Saves .....................................................................................................64
Reluctance to Simplify: Thorough Root Cause Analysis and Event
Investigation ..........................................................................................65
Sensitivity to Operations: Daily Organization Huddle .........................66
Contents ◾ v
Commitment to Resilience: Simulation.................................................67
Deference to Expertise: Executive Rounding .........................................68
Lessons Learned .........................................................................................68
Action Steps and Strategies to Lead ...........................................................69
References ..................................................................................................69
7 Key Quality and Safety Measures ........................................................71
The Evidence ..............................................................................................71
Data for Performance Measurement: The Basics....................................73
Types and Dimensions of Measures ..................................................73
Criteria and Standards...........................................................................74
Data Sources .........................................................................................74
Metrics of the Future .............................................................................76
Effective Strategies: Using Data to Drive Performance Improvement ........77
Selecting Measures ...............................................................................77
Lessons Learned .........................................................................................79
Case Study: Tracking Total Harm .............................................................80
Action Steps to Lead ..................................................................................81
References ..................................................................................................82
8 Using Data for Feedback and Improvement .........................................85
Evidence ....................................................................................................85
Step 1: Data Collection: Objectives, Sources, and Methods .......................86
Step 2: Displaying the Data .......................................................................89
Physician Profiling ................................................................................89
Dashboards ...........................................................................................89
Run Charts ..........................................................................................90
Step 3: Analyzing the Data ........................................................................91
Step 4: Implementing Improvement Cycles ................................................92
Lessons Learned .........................................................................................92
Interview: Tina Esposito, Vice President, Center for Health
Information Services at Advocate Health Care ..........................................93
Action Steps and Strategies to Lead ...........................................................97
References ..................................................................................................98
9 Leading Effective Teams: For Clinical Care and for Performance
Improvement ......................................................................................103
Evidence ..................................................................................................103
Clinical Care Teams ............................................................................104
Performance Improvement Teams .......................................................105
Strategies for Success ................................................................................106
Effective Strategy: TeamSTEPPS ........................................................106
Effective Strategy: Patient and Family Engagement.............................107
Case Study: Building an Improvement Team ...........................................108
vi ◾ Contents
Voice from the Field: Ken Anderson, MD, Chief Operating Officer,
Health Research & Educational Trust .....................................................109
Lessons Learned .......................................................................................111
Action Steps to Lead ................................................................................112
References ................................................................................................113
10 Engaging Patients and Families .........................................................115
The Evidence ............................................................................................115
Prevalence of Patient and Family Engagement Practices ......................116
Effective Strategies for Patient and Family Engagement ...........................117
Strategies at the Direct Care Level ......................................................117
Strategies to Engage Patients in Organizational Design and
Governance .........................................................................................118
Working with Patients/FamilyAdvisors ...............................................119
Case Studies .............................................................................................121
Developing a Patient and Family Advisory Council ............................121
Partnering with Patients and Families to Achieve High Reliability .....121
Lessons Learned .......................................................................................122
Beyond the Bedside .............................................................................123
Engage Patients as Partners .................................................................123
Provide Meaningful Opportunities for Patients and Families to
Contribute ...........................................................................................124
Patient and Family Engagement as a Strategy to Eliminate Harm.......124
Barriers to Engagement ............................................................................124
Action Steps and Strategies to Lead .........................................................125
References ................................................................................................127
11 Improving Care Coordination and Reducing Readmissions .............129
Evidence ..................................................................................................129
Boston Medical Center Re-Engineered Discharge ...................................130
Care Transitions Program ........................................................................131
Evercare™ Care Model ............................................................................132
Transitional Care Model (TCM) .............................................................133
Strategies for Success ................................................................................133
Identify Patients at High Risk for Readmission .......................................134
Build Self-Management Skills ..................................................................134
Discharge Planning..................................................................................135
Follow-Up and Community Resources ....................................................135
Case Study—Collaborative Effort to Reduce Readmissions at Griffin
Hospital ...................................................................................................136
Lessons Learned .......................................................................................137
Action Steps to Lead ................................................................................137
References ................................................................................................139
Contents ◾ vii
12 Addressing Variation in Utilization ...................................................141
Evidence ..................................................................................................141
Understanding Warranted vs. Unwarranted Variation ........................142
Choosing Wisely® ...................................................................................143
American Hospital Association: Appropriate Use of Medical
Resources ............................................................................................144
Strategies for Success ................................................................................144
Interview: Dr. Debra O’Connor, Vice President of Clinical
Effectiveness, Advocate Health Care ........................................................146
Lessons Learned .......................................................................................151
Action Steps and Strategies to Lead .........................................................152
References ................................................................................................153
13 Physician Alignment and Clinical Integration ...................................155
The Evidence ............................................................................................155
Case Study ...............................................................................................158
Physician Hospital Organization Field Support Team .........................159
Clinical Programs ...............................................................................159
IT Solutions ........................................................................................160
Lessons Learned .......................................................................................161
Action Steps and Strategies to Lead .........................................................162
14 New Payment Models .........................................................................165
The Evidence ............................................................................................165
Pay-for-Performance ............................................................................166
Accountable Care Organizations and Shared Savings ..........................167
Identifying an Attributed Patient Population ......................................168
Structure of Risk Sharing ....................................................................168
Bundled Payments ...............................................................................169
Capitation ...........................................................................................170
Case Study—Advocate Health Care ........................................................171
Lessons Learned .......................................................................................172
Information Technology......................................................................173
Data and Analytics ..............................................................................173
Care Management ...............................................................................173
Action Steps and Strategies to Lead .........................................................174
References ................................................................................................175
15 The Clinical Leader Role in Emerging Models of Care ......................177
Retail Medicine ...................................................................................177
Population Health ...............................................................................179
Mobile Health .....................................................................................180
Case Study ...............................................................................................182
Lessons Learned .......................................................................................184
viii ◾ Contents
Action Steps and Strategies to Lead .........................................................185
References ................................................................................................187
16 Compendium of Action Steps .............................................................189
Chapter 1: The Health Care Landscape ...................................................190
Chapter 2: Effectively Implementing Quality and Safety Improvement ...191
Chapter 3: Spreading Improvement .........................................................192
Chapter 4: Physician Champions .............................................................193
Chapter 5: Building a Culture of Safety ...................................................194
Chapter 6: Principles and Practices of High Reliability Organizations ....195
Chapter 7: Key Quality and Safety Measures ...........................................196
Chapter 8: Using Data for Feedback and Improvement ...........................197
Chapter 9: Leading Effective Teams: For Clinical Care and for
Performance Improvement .......................................................................198
Chapter 10: Engaging Patients and Families ............................................199
Chapter 11: Improving Care Coordination and Reducing
Readmissions .......................................................................................200
Chapter 12: Addressing Variation in Utilization ......................................201
Chapter 13: Physician Alignment and Clinical Integration ......................202
Chapter 14: New Payment Models ...........................................................203
Chapter 15: The Clinical Leader Role in Emerging Models of Care ........204
