How NYU Langone Health improved operations using a tactic from Amazon, Google

NYU Langone Health in New York City successfully used randomized quality improvement projects to evaluate the effectiveness of routine patient care processes.

The team that implemented the projects reported their findings in The New England Journal of Medicine.

Companies in the private sector, such as Google and Amazon, often use randomized continuous quality improvement methods in their workflow; however, it is not yet common in the healthcare sector yet.

At NYU Langone, randomized quality improvement projects were implemented across its inpatient units, outpatient offices and the emergency department, focusing on improving care after hospital stays and capturing patient-reported outcomes, among others.

The randomized quality improvement projects tested many processes, allowing NYU Langone to make tweaks as needed. For example, one of the projects tested the effectiveness of post-discharge phone calls to patients. It showed that the phone calls were ineffective because patients who received the calls came back to the hospital at the same rate as those who didn't get the calls.

The findings allowed the team to explore other options for more effective post-discharge follow-up, such as changing the call script or only calling high-risk patients.

The randomized quality improvement projects were designed to be easy to implement, said Leora Horwitz, MD, an associate professor at NYU Langone's departments of population health and medicine, director of the Center for Healthcare Innovation and Delivery Science and leader of the projects. The projects do not require specialized tools or databases.

"I believe we have an ethical responsibility to rigorously assess whether our operational interventions are effective, even when they may seem trivial, such as scripts for calls or mailings that we send to people to get them to get their colonoscopy," Dr. Horwitz said. "If we don't, we can't be sure we are doing the best by our patients."

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