Learning faster than the competition
Healthcare is well behind many industries in capturing, managing, and using data. Even with huge investments in EHR (Electronic Health Records) systems, organizations are still in the infancy stage of information.
As an organization that has helped companies across many industries improve their performance by leveraging data, Evolve has developed insights on the integration of processes, systems and behaviors to manage change in service of results. The top-performing companies in these industries have had to change, either to survive, compete, or comply. They are all trying to adapt and learn faster than the competition. What separates them is how they use information.
In our experience, successful companies take an integrated approach to change of which data systems are only one part. The Evolve Organizational Space ™ is a useful model for working through all the necessary elements for successful improvement:
Using the Organizational Space model, there are seven practical steps leaders can take to improve performance:
Be clear about the results you want. In our experience companies make changes like acquiring an EHR and expect great things to happen, but they don’t define the results they are targeting and let those results drive the changes in the organization. There are tradeoffs between cost, customer service, quality, and market share, so it is important to be clear about the results and let those drive the change.
Redesign processes. A new EHR system is a perfect time to revisit your workflows, from patient check-ins, to pre-authorizations, to collections, to exam protocols. The worst thing you can do is overlay your new system on top of your old, antiquated processes. Lean concepts such as Process Mapping, Mistake-Proofing, Pareto Analysis, FMEA, and Kaizen Events are critical tools and skills to use and all are designed with one purpose in mind – to eliminate waste in your processes. These process improvement tools need accurate, timely information to confirm that what you think is happening in a given process actually is (or isn’t). As one of our colleagues is fond of saying, “Don’t tell me what you think…show me what you know!”
Identify Key Performance Indicators (KPIs) and assign an owner to each. This is the first step to enhance accountability, up and down the organization. The KPIs should align with the business objectives and be relevant to the owner’s level of responsibility. For example, KPI’s for executive-level managers (e.g., Length-of-Stay, Days in Collections, and Readmission Rate) have been around for some time. However, front-line managers, who’ve not always had good information with which to manage, are in the best position to benefit from the improved data access. Generating KPI’s such as Average Check-In Time, OR Turnaround Time, Cancellation %, Provider Productivity, or Transcription Backlog is now possible.
Create a management system. Once you’ve identified who owns which KPI’s, a structured cadence must be implemented to manage it. This may take different forms, but the objective is to drive home ownership. The KPI owner’s thinking will often evolve through a series of mental stages:
• If I can measure it, I can track it
• If I can track it, I can report it
• If I can report it, I can explain it
• If I can explain it, I can predict it
• If I can predict it, I can prevent it
“Sue” was frustrated with providers cancelling their clinics at the last minute. This impacted not only the clinics daily productivity, but it was very poor customer service to the dozens of patients a day who had to be rescheduled. She was given responsibility for the following KPI:
• Number of cancelled appointments per month
As she began reporting it at the monthly manager’s meeting, she discovered that her team had not been consistently using reason codes for cancellations and even when they did, the categories were not consistent. She updated the reason codes and was able to explain that 65% of the cancelled appointments were due to 2 reasons:
• Planned vacation not scheduled
• Last minute surgery coverage
Knowing that, Sue could look ahead and see what scheduling conflicts might be forthcoming and proactively change schedules instead of waiting to hear from the providers. As a result, the number of cancelled appointments declined 60%.
Use the KPIs to promote organization-wide behavior change. A basic premise in performance management is to show people their scores. Especially in the beginning, it’s important to show staff the data without making judgements or decisions based on it. Much as a speedometer gives feedback on the driver’s speed, KPIs should give staff objective, unbiased feedback. Then, people will often make their own changes. For example, the front-desk team at a clinic had not been diligent about collecting all biographical information from patients at check-in. The supervisor reminded all of them at her staff meetings how important it was to complete all the information, but after a few months of no improvement, she took a different approach. With the help of the IT manager, she extracted information pertaining to open fields by each receptionist. She started to post this each month and in just a few months, the number of open fields decreased by 91%. All of this was done without the supervisor having to say anything.
Once the team is accustomed to seeing their scores, the next step is for the leader to reinforce the desired behaviors. For example, when the x-ray department broke a record for the fastest average x-ray time for a single day, the supervisor not only circled it with a note on the daily report, but also handed out new water bottles for the team. Simple, right? Yet, in most healthcare facilities we’ve been in, it is not common. Study after study shows that employees want a boss who cares how they’re doing, knows what they’re doing, and lets them know when they’ve done a good job.
Be clear about the culture you want. The volatility and uncertainty in healthcare will continue as reporting requirements, payment methods, and market forces evolve. The key for today’s healthcare leader is to create a culture that adapts quickly to these changes. How do you foster such a culture? Create learning experiences for all your employees by encouraging people to test their ideas and theories. Some ideas will work…some won’t. But getting employees in the habit of trying new things is a skill that needs to be practiced and reinforced. The organization that learns the fastest will be the one best able to deal with this ever-changing landscape.
As an aside, we’ve used the previous examples to demonstrate how simple and straightforward improvements can be. It is the leader’s responsibility to ensure the management systems and culture help cultivate hundreds of small success stories like these each year. After all, each one is important to the people involved and taken together, significantly impact performance.
Manage the change. There are many ways in which companies underestimate how the change process requires active leadership and management. You are asking people to work differently, so do they have a clear vision of where the organization is heading? Can they personally buy into in? What is the case for change and what is changing in the marketplace to compel these changes? It is very easy to take for granted answers to these questions or think that you’ve told everyone once, so it should be clear. You are asking people to work differently and develop new skills and that takes repetition, reinforcement and support over an extended period of time.
As Big Data enters the realm of healthcare, organizations may feel overwhelmed by the sheer volume, detail, and complexity of it all. Many will add resources to try to cope with it. However, those leaders and organizations that are truly in the Relentless Pursuit of Performance will view their EHR investments, technology, and new information as an opportunity to break away from the pack and build organizational capability to create long-term, sustainable change.
Jay Hammerquist is a Client Partner with Evolve Partners. He has extensive experience helping businesses achieve operational excellence in manufacturing, aerospace, oil and gas, and healthcare. Prior to joining Evolve, Jay was CEO of Black Hills Orthopedic and Spine Center and a Board Member at Black Hills Surgical Hospital. Jay can be reached by email at jay.hammerquist@evolve.cc.
Evolve works with leading companies who recognize that learning faster than the competition is critical to their success. Evolve supports implementation programs that create a culture for the relentless pursuit of performance. We enable our clients to deliver significant value in terms of Capital, Production, Cost, Risk and Growth that continues to improve long term.
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