How to Make Meaningful Performance Improvement

February 14, 2014
iVantage Health
Araby Thornewill, Senior Vice President Clients Services

Araby Thornewill, Senior Vice President Clients Services

Recently I spent an afternoon with a cross-functional executive team at a community hospital.  They were reviewing metrics and benchmarks from a wide variety of areas to begin tackling much needed performance improvement. We benchmarked cost per case, and length of stay, we evaluated outmigration and leakage, we analyzed process of care and patient experience, and we reviewed staffing levels and contracted rates.  Occasionally, there were breakthroughs ” but as often as not the problem-solving hit a wall as defenses rose, frustration increased and the collaboration began to crack.

It occurred to me that so often in our current environment, with such tremendous pressures and the urgent need to solve complex problems quickly, that we do ourselves a disservice if we don’t take the time to context set and articulate a foundational set of principles upon which we base our performance improvement initiatives.

The most successful teams I’ve worked with in the past 14 years have shared an instinctive understanding of the cornerstones of effective process and lasting improvement.  I believe all Performance Improvement teams and Executive Leaders would benefit from thinking about how these few foundational principles play out in their own environments.

1. Where there is Variation, There is Opportunity 

In my experience, the most successful organizations are interested in and fascinated by variation. For others more time and energy is spent explaining away the variation than doing the analysis to evaluate its meaning. I’m sure we have all heard the common responses of: TM “Our patients are sicker, our population is more challenging, our wage structure is higher, and our hospital is different.”

If only that energy could be spent embracing, analyzing and investigating the variation.  What does it mean?  What can we learn from it?  Why are our patients staying longer?  Why are our supply costs higher?  What does the variation in practice patterns among our physicians mean?  And is there anything we can do to move the needle in a positive direction?

There is no perfect benchmark ” the best leaders understand the goal is to find a reasonable delta and investigate what it might mean.  The best and most effective teams are not defensive about nor dismissive of variation and don’t spend time assigning or avoiding blame.  Instead, they are interested in variation’s existence and eager to investigate its meaning.

2. The Patient Is at the Center of All Performance Improvement

This is both a moral and mathematical reality.  It is easy to forget that the patient’s experience creates the individual metrics that end up on the spreadsheets and reports we evaluate.  The patient had a length of stay, a cost of care, a diagnosis, procedures, supplies, payments, etc\”¦ Processes were followed or not, communication was effective or not. Arguing about statistical significance or low volumes distracts from the valuable insight a single teaching case can provide.  And as one chief medical officer said to me years ago as we reviewed a single outlier with a hospital acquired condition ” “Rest assured, it was statistically significant to the patient”.  And in the era of value-based purchasing, where a single encounter can impact organizational reimbursement, we can no longer dismiss low volume metrics simply as anomalies.  The most successful improvement teams embrace any opportunity to evaluate process and outcomes, in aggregate or one patient at a time.

3. Effective Collaboration requires Leadership

It may seem counterintuitive to assert that a collaborative process needs leadership ” but the best problem-solving and analysis comes from cross-functional teams who have been empowered to work together.  A CEO who demands problem solving across the organization understands that breakthrough thinking is ignited when each function brings insights to the exercise andTM is allowed to have a voice.  Just as leaders must ensure that their data is integrated and processes coordinated, the challenges of the new healthcare require teams to collaborate to solve their complex and urgent problems.

Whether in large health systems, community hospitals or small, rural environments, the challenges are great and the need for action self-evident. As leaders, our actions are much more impactful, lasting and valuable when they follow our principles. It’s a good and humbling exercise to evaluate our own leadership performance as it relates to these ideas.  Do we embrace variation?  Do we lean into the teaching case?  Do we actively encourage collaboration? And if we do, how well do we create a narrative for our performance improvement teams.  The best among us articulate the “why” and the “what we believe” making the “how” easier, more effective and longer lasting.

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