The Top Five Essentials For Outcomes Improvement

Continuous qualityimprovement is aboutsustaining and hardwiringthe right behaviors. Forexample, if a healthsystem reduces its heartfailure readmission rate, itshouldn’t just check thatitem off the “to do list”and move on tosomething else within itscardiovascular program. Itstill needs to dedicatevaluable resources to thereadmissions initiative toensure outcomes aresustained; to make surethe interventionscontinue to be effective.Healthcare professionals are challenged to constantly improveoutcomes, so how do systems continue to push for improvementwhen it seems like every improvement increment is harder to attain?Healthcare leaders need to put their combined clinical, operational,and business hat on and ask, “What quality improvement initiativesdo we prioritize based on the healthcare data we have?” They needto work with their finance teams and do a cost-benefit analysis todetermine if it makes more sense to pursue a small, incrementalpercent reduction in heart failure readmissions (if already betterthan national benchmarking measures) or do something else with abigger impact on patient outcomes and costs.Continuous quality improvement is about sustaining and hardwiringthe right behaviors. For example, if a health system reduces itsheart failure readmission rate, it shouldn’t just check that item off the“to do list” and move on to something else within its cardiovascularprogram. It still needs to dedicate valuable resources to thereadmissions initiative to ensure outcomes are sustained; to makesure the interventions continue to be effective. A great example ofsustainable quality improvement comes from Thibodaux RegionalMedical Center, with a sepsis mortality rate that is half the nationalaverage. Even though Thibodaux achieved its quality improvementgoal, it’s constantly measuring and ensuring it sustains or improvesits outcomes.QUALITY IMPROVEMENT PROGRAMS: FOUR KEYCOMPONENTSAll successful quality improvement programs include four keycomponents: the problem, goal, aim, and measures.#1: The ProblemAll successful quality improvement programs start with an in-depthunderstanding of the problem. But what’s equally important issystem-wide buy-in for the quality improvement initiative and theproblem it targets.#2: The GoalDetermining the appropriate quality improvement goal can be adaunting challenge for most health systems. While it’s oftentempting to pursue incremental improvement gains in the samefocus areas, healthcare leaders need to target improvements basedon a return on investment (ROI) and cost-benefit analyses. Healthsystems should ask several key questions when defining theirquality improvement goals:Copyright 2017 Health Catalyst6

How does this tie into our organization’s strategicimprovement objectives?Analytics make it possiblefor health systems toassess quality of care,cost, and patientexperience. Qualityimprovement can only beeffective if it marriesquality improvementteams andmethodologies withanalytics, but manyhealth systems are in aneither/or situation.What will have the biggest impact on patients?What areas have the largest variation?What will have the biggest impact on costs?#3: The AimAims break up the work of achieving the goal into manageablepieces.#4: The MeasuresThere’s a big difference between a quality improvement initiativewith a result and one with an improvement; a distinction that canonly be made by measuring baselines and actuals. Measuringbaselines is so critical because it enables health systems todetermine if there is an improvement; and if and how theimprovement is correlated to intervention.THE CRITICAL ROLE OF ANALYTICS IN QUALITY IMPROVEMENTIn the confusing world of quality improvement, analytics serve as thecompass pointing in the right direction. Analytics make it possible forhealth systems to assess quality of care, cost, and patientexperience. Quality improvement can only be effective if it marriesquality improvement teams and methodologies with analytics, butmany health systems are in an either/or situation.Either health systems have quality improvement teams but collectand integrate data manually or they have analytics platforms buttheir quality improvement teams aren’t aligned with the qualityimprovement initiatives (an abundance of data but no clearunderstanding of the quality improvement goal methodologies).Health systems need analytics to enable valid measurement, theability to correlate interventions and improvement, and external datasharing and benchmarking.Valid MeasurementAnalytics are necessary for efficiently establishing valid baselinesand measuring improvements.Correlating Interventions and ImprovementsHealth systems rely on analytics to test interventions—to determineif the selected intervention is positively impacting outcomes. Forexample, one large medical center had an improvement programfocused on reducing their heart failure readmission rate. AfterCopyright 2017 Health Catalyst7

implementing a typical bundle of follow-up appointments, dischargemedication reconciliation, and follow-up phone calls, it didn’tachieve its improvement goal. After an in-depth analysis of its data,the program pursued another intervention: teach-backinterventions. The teach-back intervention (combined with the firstthree interventions) achieved the program’s 30-day readmissiongoal. If initial interventions don’t work, don’t give up; analyze thedata and determine additional aims to achieve the goal.External Data SharingExternal data sharing is based on the premise of collaboration andpopulation health management. It provides valuable insights aboutwhat systems are doing; sharing this information creates the bestpractices learning culture that’s so important in qualityimprovement. In an industry that attracts professionals passionateabout helping people, benchmarking is another tool that helpsprovide the best care to patients.THE TOP FIVE ESSENTIALS FOR SUCCESSFUL QUALITYIMPROVEMENT IN HEALTHCAREHealth systems want to improve the quality of the care they deliver.But, according to Becker’s Hospital Review, approximately 60 to 80percent of strategic initiatives fail. Successful quality improvementis challenging, but it’s becoming less elusive as systems learn fromeach other’s efforts. As a result of conducting an integratedliterature review of healthcare quality improvement efforts over thelast five years, the top five broad categories of success emerged todrive and sustain quality improvement:Essential #1: Adaptive Leadership, Culture, and GovernanceIndividuals or teams within a health system may have the aptitudeand dedication required to make continuous improvements, butindividual efforts alone won’t result in prioritized, sustained qualityimprovement. Successful quality improvement initiatives requiresenior leadership support and an adaptive learning culturecommitted to data-driven quality improvement.Essential #2: AnalyticsAnalytics is an essential ingredient for sustained qualityimprovement and plays an important role in each phase of thequality improvement lifecycle (plan, do, study, and act), frommeasuring a baseline and understanding the problem, todetermining if the resulting change was an actual improvement.Some healthcare organizations mistakenly think they have analyticsCopyright 2017 Health Catalyst8

because they have measurements, which is often not the case.Essential #3: Evidence- and Consensus-Based Best PracticesEvidence- and consensus-based best practices are thefoundation upon which successful quality improvementinitiatives are built. Developing and integrating evidence- andconsensus-based best practices isn’t enough; healthcareorganizations also need to have automated ways to measurehow consistently the best practices are being used and theirimpact on outcomes.Essential #4: AdoptionHealth systems with the necessary adaptive leadership,analytics, and best practices won’t have successful qualityimprovement programs unless they dedicate resources toimplement outcomes initiatives. From training to performanceevaluations and organizational incentives tied to qualityimprovement goals, prioritizing widespread adoption meanssaying three things:“Here’s why we want you to use this best practice.”“We’re going to measure your use of this best practice.”“We’re going to share the correlation of this best practice tooutcomes with you so we can learn together andcontinuously deliver quality, affordable care.”Essential #5: Financial AlignmentHealth system financial incentives and payment models have toalign with its quality improvement initiatives. If it’s paying providersone way but measuring them another way, then its financialpayment approach doesn’t properly align with its qualityimprovement goals. For example, hospitals organized as asystem—managed and budgeted as departments and units withinseparate hospitals—frequently find that hospital/departmentstrategic priorities are not in alignment with overall systempriorities. This misalignment frequently leads to well-intentioneddecisions that inadvertently result in overall waste, unnecessaryclinical variation, and operational inefficiencies.THE MOST EFFECTIVE QUALITY IMPROVEMENT TOOLSThe Health Care Data Guide: Learning from Data forImprovement by Lloyd Provost and Sandra Murray is anextremely valuable quality improvement resource for healthsystems feeling overwhelmed by quality improvement goals.Copyright 2017 Health Catalyst9

By working together asan industry to sharequality improvementsuccess stories,strategies, and lessonslearned, we cansignificantly turn that 60to 80 percent strategicinitiative failure rate intoa success rate. We canturn qualityimprovement’s tall orderinto a manageable,achievable, continuous,and sustained reality.Designed to help professionals “build a skill set specific to usingdata for improvement of healthcare processes and systems” thebook is a practical, step-by-step guide with strategies andmethods for continuous improvement. The book outlines themost effective tools, assigned to one of six categories:1. Systems and processes (e.g., flow diagrams).2. Gathering information (e.g., forms for collecting data).3. Organizing information (e.g., cause and effect diagrams).4. Understanding variation (e.g., run charts to determine ifvariation is special cause or common cause).5. Understanding relationships (e.g., scatter plots).6. Project management (e.g., Gantt charts).Systems can’t reap the benefits of these tools without skilledresources (people who know how to use the tools), training, anda framework for establishing, approving, maintaining, andupdating evidence-based practices.QUALITY IMPORVEMENT WILL TRANSFORM HELATHCAREAlthough successful, sustained, continuous quality improvementin healthcare is a tall order to fill, health systems guided bypragmatic definitions, armed with the most effective tools, andwilling to integrate the five essentials—adaptive leadership,culture, and governance, best practices, analytics, adoption, andfinancial alignment—are more likely to achieve their goals andcontribute to the industry wide effort to transform healthcare. Byworking together as an industry to share quality improvementsuccess stories, strategies, and lessons learned, we cansignificantly turn that 60 to 80 percent strategic initiative failurerate into a success rate. We can turn quality improvement’s tallorder into a manageable, achievable, continuous, and sustainedreality.Healthcare professionals go into healthcare because we careabout people; we truly want to improve patient health andexperiences, and help make care affordable. So we need toconstantly keep the end goal in mind: the Triple Aim. We need tomake sure every quality improvement goal ties back toimproving the health of populations, reducing the per capita costof healthcare, and improving the patient experience. By focusingCopyright 2017 Health Catalyst10

on collaboration, sustainability, and the Triple Aim, healthsystems will do more than provide better care—they willtransform the industry into one unequivocally dedicated toquality.ABOUT THE AUTHORSLeslie Falk joined Health Catalyst in 2012 as both anExecutive Engagement Manager and in various marketingroles. Prior to joining Health Catalyst , Leslie worked forHewlett-Packard in sales, support, and marketing roles. Shealso worked for Kaiser Permanente as their first BiomedicalEngineer in the Northern Region and helped launch the firstPediatric ICU in the state of Nevada. Leslie holds a Masters inBusiness Administration,Masters in Community Counseling, and a Bachelor of Science Degree inEngineering. Leslie has also earned certifications as a Project ManagementProfessional (PMP), Green Belt Lean, and Information Privacy Professional(CIPP, CIPP/IT). She is also a Registered Nurse.Ann Tinker joined Health Catalyst 2012 as a Vice Presidentfor Customer Engagements. Prior to coming to HealthCatalyst , she worked for GE Healthcare IT on the GE/Intermountain Healthcare partnership product calledQualibria as a Product Manager and Customer liaison. Annworked PRN (on-call) for LDS Hospital in the PostAnesthesia Care Unit (PACU) as a staff RN for the past 6 years. Before GE Ann was employedat 3M HIS business based in Salt Lake City working in a variety of positionsfrom sales support, implementation, development, marketing and productmanagement for both US and International products and prior to then workedfor Intermountain Healthcare for 10 years in Critical Care and NursingAdministration. Ann has a bachelor’s degree in nursing from Brigham YoungUniversity and a Masters from University of Washington.Copyright 2017 Health Catalyst

quality improvement essentials—critical elements successful quality improvement programs have in common. This executive report defines quality improvement in healthcare, describes critical quality improvement considerations, components, and tools, and identifies the top five quality improvement essentials: 1.