Two leading health systems are taking markedly different approaches to cutting clinical variation, which can hinder care quality and drive up costs when left unchecked.
Variation in clinical care often stems from a lack of standardized processes, which can be difficult to diagnose and resolve. To address this, New York City-based Montefiore Health System opened a centralized command center, while Hartford (Conn.) HealthCare leaned into clinician-led standardization efforts.
Becker’s asked both systems: In the last 12 months, what is the most notable way your organization cut clinical variation?
Note: Responses have been lightly edited for length and clarity.
Raven Carter. Assistant Vice President of Operations at Montefiore Moses Campus (New York City): As Montefiore Health System has grown, one of our primary focuses has been reducing clinical variation by creating a more centralized process for patient transfers to our hospitals, from both within and outside of our 10-hospital healthcare system. On Sept. 12, we cut the ribbon on our new Command Center to ensure that we had one location where our admission and transfer center teams now work side by side to ensure consistency in communications and processes, streamlining case reviews and enhancing patient transfer processes across the Bronx and Westchester.
To support this initiative, three ambulances were also dedicated to the Command Center from St. John’s Riverside, Montefiore Nyack and the Bronx, enabling our Command Center to be a hub for streamlined referrals and admissions, as well as a strategic vehicle to drive inpatient, tertiary and quaternary growth.
Today, Montefiore fields upward of 6,000 calls per year, about a 50% increase since 2018. The time from when we are first contacted by physicians to when patients physically arrive for care, has improved by approximately 33% since 2023. Recently, we’ve also shaved eight minutes off the time it takes to provide care for people with time-sensitive, life-threatening conditions — such as stroke, cardiac arrest, major trauma, or other acute medical emergencies — where every minute can significantly impact patient outcomes.
Having a dedicated team working together for our high-priority, emergency ambulance transfers, ensures the fastest possible response and arrival time to maximize survival and decrease potential complications, including reducing neurological damage and side effects related to conditions like strokes or cardiac arrest.
Megan Panico, MD. System Director Clinical Care Redesign and Medical Director Supply Chain at Hartford (Conn.) HealthCare: Clinical Care Redesign is now deeply embedded in Hartford HealthCare’s culture. We prioritize this effort at every level of the organization with a shared goal of providing the highest quality care and improving healthcare outcomes while we work to make healthcare more affordable. This is top of mind across the system, from frontline clinicians to administration to support services.
Key to our success has been our Clinical Care Redesign team working in tandem with supply chain leaders to identify standardization opportunities, yielding a significant reduction in clinical variation. Specific attention is given to demonstrate that decreasing variation will elevate our quality of care across the organization, and keep a focus on value.
The cornerstone of our success is clinician engagement and a shared commitment to delivering the highest value and highest quality care for every patient. This level of commitment is shared by our supply chain department, which prioritizes the patient in every decision made. Physicians, advanced practice providers and nursing partners continually generate innovative ideas to reduce waste and elevate care through standardized practices.
By giving clinicians transparent insight into the true cost of care, and aligning this with an integrated supply chain, we’ve driven systemwide standardization and secured optimal value from our vendors, benefiting the patients we serve as well as the system.
Key initiatives over the past year that have driven meaningful change include:
- Standardizing endomechanical products
- Implementing reprocessing programs in surgical and electrophysiology areas
- Deploying feedback systems to minimize blood product waste
- Reducing medication variation through clinician education and EHR decision support
- Launching a robust surgical receipts program that provides real-time cost feedback and fuels clinician-led standardization discussions
Led by clinicians and underpinned by our integrated supply chain strategy, these efforts have generated quality improvements as well as multimillion-dollar savings in the past year. What truly sets our Clinical Care Redesign program apart is its cultural footprint — Clinical Care Redesign is a regular agenda item at every level and meeting across Hartford HealthCare.