Quality Improvement in Healthcare: Where is the Best Place to Start?

-Eric JustVP of Technology

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Quality Improvement Challenges

Where to start is the biggest challenge providers face when setting out on a quality improvement initiative.With so many processes across healthcare systems, determining where to get the most benefit can be difficult.Consider the following analogy:

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Quality Improvement Challenges

Fisherman rely on, and relish, intuition. Finding the best spot is part of the sport.

Charter Skippers must leverage their experience and data to find the most productive fishing spots for their paying customers.

Most skippers use the best fishing tool available to them—the fish finder.

So what’s the “Fish Finder” for healthcare providers?

Eric Just and brother on commercial expedition in Long Island Sound.

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Quality Improvement Challenges

Many providers overcome that “where do we begin?” factor by using an enterprise data warehouse to look for high-cost areas where large variations in health care is being experienced.

Using a Key Process Analysis (KPA) allows you to quickly zero in on the biggest opportunities for improve-ment and waste elimination.

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Why Variations Are Great Indicators

Variation found through the KPA is an indicator of opportunity.

The more avoidable variation is reflected in a particular care process, the more opportunity exists to reduce that variation and standardize the process.

Generally, standardization is an indicator of efficiency.

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Why Variations Are Great Indicators

Efficiency hinges on scale and repeatability. That’s why it’s more efficient to build complex products such as cars and appliances on an assembly line.

The more you have everyone following the same evidence-based procedures and processes, the more control you have – which translates into higher-quality outcomes.

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Practical Example

The chart below shows a fictional analysis of the cost per case of vascular procedures. As you can see, the bulk of the bubbles in the chart fall right around the $20,000 range. That is the established norm in this hospital.

With Dr. J’s surgical costs three times the $20,000 average, a substantial opportunity for improvement exists.

At 15 surgeries a year the cost savings would be $600,000.

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Impacts of Cost Variation

Wide variations in cost are usually associated with wide variations in health care quality. Reducing variations in cost will bring corresponding increases in quality.

Using KPA methodology, look at data from many different areas, such as heart failure, diabetes, obstetrics, and orthopedic surgery, to determine where first steps should be taken.

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Adjusting for Severity

While a KPA provides a valuable top-line view, you’ll want to avoid the temptation to use it as an excuse to punish individual providers. There may be a good reason those outliers are showing up where they are.

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Adjusting for Severity

Looking back at Dr. J from our example: Even though the cost for procedures was 3X the norm there may be valid reasons.He might be drawing the toughest and most complex cases from all over the world.He may be a world renowned surgeon and his international reputation brings much prestige to the hospital.

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Determining Where to Start

Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement?

The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however.Variation analysis is the voice of the data, but it must be balanced with the voice of the institution.

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Let Variation Be Your Map

You wouldn’t think of starting a commercial fishing company without a fish finder. The same thinking should apply to a process improvement initiative.A KPA designed to uncover significant variations can help you identify your greatest opportunities for improvement and serve as the map to help you get started.

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More about this topicDriving Out Waste: A Framework to Enhance Value in Clinical Care (HFMA)Dr. David Burton, Senior VP and Former CEO

How Clinical Analytics Will Improve the Cost and Quality of Healthcare DeliveryDan Burton, CEO

How Analytics Will Lower Waste and Reduce Costs for the Healthcare IndustryBobbi Brown, VP of Financial Engagement

3 Steps to Prioritize Clinical Quality Improvement in HealthcareBobbi Brown, VP of Financial Engagement

Key Steps that help Clinical Improvement Projects Reduce Waste Ann Tinker, VP for Customer Engagement

Link to original article for a more in-depth discussion.

Quality Improvement in Healthcare: Where is the Best Place to Start?

© 2014 Health Catalystwww.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.

For more information:

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Other Clinical Quality Improvement ResourcesClick to read additional information at www.healthcatalyst.com

Eric Just joined the Health Catalyst family in August of 2011 as Vice President of Technology, bringing over 10 years of biomedical informatics experience. Prior to Catalyst, he managed the research arm of the Northwestern Medical Data Warehouse at Northwestern University's Feinberg School of Medicine. In this role, he led the development of

technology, processes, and teams to leverage the clinical data warehouse. Previously, as a senior data architect, he helped create the data warehouse technical foundation and innovated new ways to extract and load medical data. In addition, he led the development effort for a genome database. Eric holds a Master of Science in Chemistry from Northwestern University and a Bachelors of Science in Chemistry from the College of William and Mary.