Improving surgical value: driving change through clinical intelligence & surgeon engagement

SCL Health and Olive have partnered to use clinical intelligence to improve surgical value. The goal is to reduce the unwarranted variation in surgical supply costs by leveraging advanced AI and data analytics. 

At the Becker's Clinical Leadership + Pharmacy Virtual Forum, during a session sponsored by Olive, Simon Payne, MD, chief medical officer of clinical and operational transformation at Broomfield, Colo.-based SCL Health, and Chris Smith, vice president of customer enablement at Olive, discussed this partnership and the steps these organizations have followed to accomplish cultural change at SCL Health.

Four key insights: 

  1. Segmenting data into clinically meaningful comparisons — cohorts — forms a critical foundation to reducing surgical variations. All stakeholders need a shared basis of understanding. "Olive solves for this by applying natural language processing, machine learning and other artificial intelligence techniques to the operative note, as well as the EMR fields, to aggregate that information, create cohorts and enable clinically meaningful comparisons," Mr. Smith said. This single view of the data helps overcome initial hurdles to successful conversations. Cohorts, clinically meaningful comparisons, allow for granular analysis at the regional, facility, and surgeon level for surgical supplies and equipment. Cohorts overcome differences in patient populations and other factors to enable meaningful analysis of variation reduction opportunities.

  2. Collaboration with stakeholders is a key to success. "Organization-wide collaboration is a key for successful change," Mr. Smith explained. The structured process begins by identifying variation opportunities that can be validated with the care-site team and confirmed with supply chain and clinical and nonclinical stakeholders. Only after this vetting is the data reviewed with surgeons to work toward a documented consensus that can guide future analysis.

    It is vital to engage all stakeholders, and do so upfront, with a broad view of who is in those conversations. A multidisciplinary governance structure guides the work; setting clear expectations of roles and accountability at the outset is crucial. Cultivating champions, including front-line staff, facilitates the process. As in all change management, the final step is ongoing monitoring to track implementation.

  3. Early and ongoing communication with surgeons can overcome resistance to change. Physicians, in particular, must be engaged. Olive's partnership seeks to overcome physician resistance through proven change management techniques: data integrity, transparency, change request, acceptance and monitoring performance. Building momentum for change with surgeons relies on these steps to create trust upfront.

    Before the cohorting of data, surgeons weren't accustomed to seeing individual-level data compared to their peers. But because the process is based on engagement and the data has been transparently vetted prior to the discussion, physicians are more open to the clinical conversation among peers.

    Success starts with relatively straightforward opportunities to build early momentum. A final element is the thoughtful clinical conversation, when the physician feels heard and the entire team is open to discussing variation opportunities, coming to consensus for change, or identifying a valid clinical reason to maintain current practice. 

  4. Leading with a clinically centered conversation to approach clinical variation is vital to building trust. As set forth, this process enables a vastly different conversation about surgical supplies and devices, using analytics to understand variation and true comparative performance and outcomes.

    At SCL, conversations begin with quality outcomes, then operational efficiencies. Cost analysis comes last. "It doesn't feel like we're just trying to cut costs; we're actually having a clinical conversation," Dr. Payne said. This clinically centered approach is vital to what is inherently the messy, challenging work. "Yes, there's a focus on the savings," Dr. Payne concluded, "but really this is about a cultural change that can make us successful in the future."

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