How Clinical Standardization Can Transform Your …...How Clinical Standardization Can Transform Your Organization Braden Lang Senior Consultant [email protected] ©2014 The Advisory

Pharmacy Executive Forum

How Clinical Standardization Can

Transform Your Organization

Braden Lang

Senior Consultant

[email protected]

©2014 The Advisory Board Company • advisory.com

6

2

3

1

Road Map

Beyond Evidence-Based Practice

Case Study: Banner Health’s Clinical Transformation

Applying the Banner Model at a Single Hospital

©2014 The Advisory Board Company • advisory.com • 30126F

7

Amidst Many Critical Priorities, Cost-Consciousness Rises to the Top

Source: Physician Executive Council Topic Poll,

2014; Physician Executive Council analysis.

Consensus: We Need Cost-Conscious Physicians

1) In response to the question, “How much of a priority is this topic likely to be for

you in 2014?”: A-This is one of my top priorities, B-This is a secondary priority

for me, C-This is not a priority for me, F-I will spend no time at all on this topic.

3.18

3.29

3.30

3.37

3.42

3.50

3.55 Cultivating a Cost-

Conscious Medical Staff

Effective Communication with

the Mixed Medical Staff

Engaging Physicians in the

Shift to Population Health

Leading Cross Continuum

Clinical Transformation

Keeping Up with

Industry Transformation

The Integrated

Quality Function

Overhauling Physician

Leadership Roles

Top Ranking by Priority, as Graded by System and Facility CMOs1

n=38

Out of 4.0


8

“Right Care” Engages Physicians in Tackling Clinical Overuse

Source: Physician Executive Council interviews and analysis.

1) Evidence-based practice.

A Cost-Conscious Role that Resonates with Physicians

Evidence-Based

Practice Right Care

Shared

Decision-Making

Self-Directed

Medicine

Physicians practice

according to own

training and

knowledge, yielding

dramatic variations

in care

Physicians practice

according to the most

up-to-date clinical

evidence, yielding

greater

standardization where

evidence exists

Physicians practice

EBP1, and even where

the evidence is unclear,

physicians identify and

weed out unwarranted

variation and excess

costs of care

Physicians

incorporate costs of

care into shared

decision-making

conversations with

patients

Cost-conscious physicians

practice at this end of

the spectrum

Desired Evolution of Physician Practice


9

Source: Yancy, Clyde, et al., “2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology

Foundation/American Heart Association Task Force on Practice Guidelines,” 2013, available at: https://circ.ahajournals.org/content/128/16/e240.full.pdf;

“Heart Failure Fact Sheet,” American Heart Association, available at: http://www.heart.org/idc/groups/heart-

public/@wcm/@private/@hcm/@gwtg/documents/downloadable/ucm_310967.pdf; Physician Executive Council interviews and analysis.

1) Left ventricular systolic dysfunction.

2) Angiotensin-converting enzyme inhibitor.

3) Angiotensin II receptor blockers.

Distinguishing Between EBP and Right Care

Evidence-Based

Practice Right Care

• Prescribe HF patients with

LVSD1 an ACEI2 or ARB3

• Prescribe patients evidence-

based specific beta blockers

Order an echocardiogram to

measure left ventricular function

and ejection fraction. Repeat

measurement only

recommended for patients with

significant change in clinical

status or device therapy.

Unclear guidelines

yield significant

variation

Clear guidelines yield

adherence to appropriate

standard of care

Group of cardiologists identifies

and addresses drivers of care

variability (e.g., ordering habits,

different definitions of “significant

change”); provides medical staff

with appropriateness criteria for

repeat echoes

Example 1

Example 2

Example Guidelines for

Heart Failure Patients


10


The Push to Right Care Requires Ample Investment

z

Sample Investments Along “Right Care” Development Workflow

Opportunity Assessment

Regularly assess cost,

outcome data to identify

variation, pinpoint greatest

opportunities

1

Consensus Groups

Physician-led groups

set care standards to

optimize quality and

resource stewardship

2

Roll-Out Communication

Leaders explain rationale

for new standards to

physicians, highlight their

role in adoption

3

z

Ongoing Monitoring

Track outcomes to

assess efficacy of

standards and identify

opportunities to improve

6

Accountability

Mechanisms

Set resource stewardship

goals; share performance

data with physicians

5

Practice Change Support

Use education, workflow

prompts and tools to

support adoption of clinical

standards

4

Iterative

process

repeated

to address

new

variation

hotspots


11

In Need of a Medical Staff Culture Shift

Does not view innovation as solely

additive services—helps figure out

when providing less care is optimal

Considers the impact of costs

on the affordability of

healthcare for patients

Aware of market imperative to increase

“value” of healthcare; embraces physician

role of reducing excess utilization

Uses data to identify opportunities to

reduce variation and compare the

effectiveness of different care paths

Resource Stewardship Not a Significant Departure from Core Values


Innovative

Patient Advocate

Data-Driven

Committed to

Health Care

Delivery

Core Physician Values Attributes of a Physician

Steward of Resources


12

Source: Chatman, Jennifer, “Leading by Leveraging Culture” California Management Review,

2003, available at:

http://faculty.haas.berkeley.edu/chatman/papers/18_LeadingLeveragingCulture.pdf

Talent Development, The Advisory Board Company; Physician Executive Council analysis.

Making an Amorphous Concept Concrete

Vision

Leadership

Commitment

Talent

Management Infrastructure

Four Tactical Elements of Cultural Change

Defining Culture

“Culture is a system of shared

values (defining what is important)

and norms (defining appropriate

attitudes and behaviors).”

Jennifer Chatman, PhD

Haas School of Business

UC Berkeley


13

2

3

1

Road Map





14

1) Through a merger between Lutheran Health Systems and

Samaritan Health System.

Case Study: Banner Health

Case in Brief: Banner Health

• 25-hospital, not-for-profit system headquartered

in Phoenix, Arizona, with facilities in Arizona,

Alaska, California, Colorado, Nevada, Nebraska,

and Wyoming

• Approximately 1,000 employed and 8,000

affiliated physicians system-wide

• Banner Health was created in 19991; in the early

2000s Banner committed to system-wide clinical

standardization as a means to improve quality

and reduce unnecessary care utilization

• To support this endeavor, Banner built “Care

Management,” an infrastructure with strong

clinical leadership committed to developing and

implementing system-wide standards of care

• This approach has contributed to improved

quality outcomes and financial growth (from $2B

to $5B in annual revenue) over the past 15 years

Source: Banner Health, Phoenix, AZ; Physician Executive Council interviews and analysis.

IMA

GE

CR

ED

IT: B

AN

NE

R H

EA

LT

H


15

Commitment to Reducing Variation Yields Returns

• As of 2012, 17 of 25 hospitals

achieved Stage 7 EMR Adoption

(HIMSS Analytics)

• 2013 Top 5 Large Health System for

Clinical Quality (Thomson Reuters)

Clinical Accolades Financial Growth

• Increased revenue from $2B in

1999 to $5B in 2014

• 2013: $13.7M reduction in

supply costs from strategic

initiative


A Sampling of Banner’s Achievements Across the Past Decade

Hallmarks of a Maturing Delivery System

Growth of Physician Leadership Team

• 1999: Three FTE physician leaders, 1 facility with a CMO

• 2014: 28 FTE physician leaders, 24 facilities with CMOs

Increased Reliability of Care

• System has matured to support monthly rollouts of multiple

system-wide clinical standards (e.g. six in September 2014)


16 ”

Physicians Feel Empowered as Clinical Innovators

“I am into utilitarian health care—providing the best care to the

largest group of patients. After practicing at Banner you can very

clearly see it’s the best thing for the patient.”

“I feel obligated to save the nation money. We can do that and

improve quality through standardization.”

“Is it a perfect system? Of course not. But it’s pretty good, and I

want to be a part of the solution—you’ve got to try, right?”


Quotes from Practicing Physicians at Banner Health

“I believe in the system—I am a big proponent of standardization.

It just works. Care Management saves lives and reduces costs.”

“Somebody, the government, the system, will make cuts based

on cost. At Banner that somebody can be us, the physicians. If we

want to advocate for the best patient care, we need to be involved.”


17

How Banner Rolls Out Care Standards System-wide

Care

Management

Council

A Quick Look at the Banner Model

25 Acute

Care Facilities


17 Clinical

Consensus Groups

Care Management Council consists

of clinical executives and retains

oversight of all care standard creation

and deployment

Clinical Consensus Groups include

multidisciplinary participants who

develop system-wide care standards

within a given clinical area

All 25 facilities “go live” with new care

standards on the same day, with the

help of system implementation experts


18


A Journey of a Thousand Miles…and Counting

Major Milestones in Banner Health’s Clinical Journey

1999

Merger between Samaritan

Health System and

Lutheran Health System

forms Banner Health

2001

CEO sets vision to become

a “clinical quality” company;

system CMO adopts

clinical standardization as

central tenet of that effort

2003

First Clinical

Consensus Group

develops system-wide

CV1 care standards

2004

Banner invests in

implementation

experts2 to support

local rollout of care

standards

2009

Expansion from six to

twelve CCGs3, led by

facility CMOs

Cultural and Clinical Transformation Does Not Happen Overnight

2013

Expansion to

17 CCGs

2014

Creating post-acute

care CCG to support

population health

strategy

1) Cardiovascular

2) Includes industrial process engineers, clinical informatics staff, and clinical educators.

3) Clinical Consensus Groups

“This is a journey that is not complete. You don’t make progress in six months.”

Dr. John Hensing, System CMO, Banner Health


19

Facing Real-World Challenges

System overseen by single

operating board; heavily

centralized leadership and

operating structure

Banner Health’s Starting Advantages Banner Health’s Headwinds

System financially strained

and culturally fragmented

post-merger

Multiple facilities widely

geographically dispersed

System CEO champions clinical

quality as organization’s primary

focus; committed to growing

bench of physician leaders

No shared culture among

physicians post-merger; even

now, only 15% of the medical

staff is employed

Early investment in system-wide

EMR supports standardized data

collection, order sets, and

electronic workflows across

the system



20

Towards the Practice and Culture of Reliable Care

1. A Defined Vision of

Reliable Care

2. Physician Value-

Vision Alignment

Adopting Care Reliability as

the Central Clinical Strategy

3. Clinician Defined

System-wide Standards

of Care

4. Physician Support

Structure

Building a Clinician-

Centered Infrastructure

5. Cultural Fit

Assessment

6. Physician Leader

Pipeline Development

7. Accountability for

Clinical Standard

Adoption

Aligning Medical Staff

Management


Seven Elements of Transformation at Banner Health


21

Defining What the Vision Means for Clinical Care

Evidence-Based

Practice (EBP):

Care standards based

on evidence from the

scientific literature • Most care variation is not addressed

by published clinical evidence

• Published evidence typically does not

account for variation in resource use,

costs of care

• Standardized care provides the ability

to monitor and assess the efficacy of

new care standards

Rationale for supplementing EBP

with “practice-based evidence”:

One, or both, of these methodologies underlie all of Banner’s care standards.

• In absence of published

evidence, clinicians

agree on care standards

• Standards implemented

and monitored to confirm

efficacy and identify any

needed changes


Banner Embraces Care Standardization, Even in Absence of Evidence

Practice-Based

Evidence:

Care standards based

on evidence from

Banner’s own practice

“Standardization is more important than evidence.”

Dr. John Hensing, System CMO, Banner Health

• When possible,

clinicians create and

implement standards

that reflect universally-

accepted clinical

evidence

1. A Defined Vision of Reliable Care


22

Clinical Strategy Appeals to Physician Motivators

Primary Components of the Reliable Care Strategy

Fix the System,

Not Physicians

Banner’s focus on

system design shifts

the “blame” away from

individual physician

performance

Grounded in Science

and Logic

The creation and

implementation of

clinical standards are

grounded in scientific

principles, specifically

the science of reliability

and outcomes

monitoring

Physicians at the

Center

Practicing physicians

are at the forefront of

developing system-

wide clinical strategy

and care standards

Commitment to

All Patients

Physicians embrace

concept of ensuring

every patient, even

those they do not see,

receive the best care

possible everywhere in

the system

To secure physician engagement, Banner ensures all efforts focus on

improving the quality of care. Cost reduction is NOT a goal of Banner’s

approach to clinical standardization, but it is a positive externality.


2. Physician Value-Vision Alignment

!


23



Reliable Care

2. Physician Value-

Vision Alignment



of Care


Structure

5. Cultural Fit

Assessment

6. Physician Leader



Clinical Standard

Adoption








Management


24

Who’s Responsible for Quality?

Oversee peer review,

credentialing, medical

staff by-laws

Medical Executive Committee

Responsibilities

Central “Care Management”1

Responsibilities

Banner and MEC Redefine Respective Quality Responsibilities

Manage system-wide

clinical data systems,

collection, and sharing

Define, design, and

implement system-wide

care standards

Identify areas of greatest

clinical variation across the

system; set quality agenda

Manage recalcitrant

physicians, medical

staff relations

Track qualifications and

provide recommendations

for department chair positions


3. Clinician Defined System-wide Standards of Care

1) At Banner, Care Management is the division that provides leadership for excellence in clinical

care and patient safety across the system. It is led by the Chief Medical Officer and includes

the physician leadership structure as well as the functions of clinical quality, informatics,

research, analytics, education, innovation, and health management.


25

Clinician-Centered Infrastructure Delivers the Vision

Banner’s Care Management Structure

Care Management Council

17 Clinical Consensus Groups

25 Acute Care Facilities

Care Management

Leadership

Clinical Consensus Groups:

• 17 CCGs2 (e.g., Critical Care,

Orthopedics, Oncology)

• Each co-led by physician and non-

physician (typically a nurse)

• Multidisciplinary membership3

representing the entire Banner system

• Define and lead implementation of

system-wide care standards

Care Management Council:

• Led by System CMO

• Includes all CCG1 leaders, CMOs,

and CNOs

• Sets quality strategy for system

• Approves all care standards


1) Clinical Consensus Group.

2) 17 CCGs: Perioperative, Behavioral Health, Critical Care, Cardiovascular Surgery, Women’s Health,

Neuroscience, Emergency Department, Pediatrics, Pharmacy and Therapeutics, Nephrology, Medical

Imaging, Cardiology, Hospital Medicine, Infectious Disease, Primary Care, Orthopedics, and Oncology.

3) Includes physicians, bedside nurses, clinical informatics, pharmacy, supply chain, and therapy

(occupational, respiratory, physical).


26

Clinical Structure Evolves with Strategic Priorities


Changes within Existing Structure Additions to Existing Structure

Need for Specialized Expertise,

Small-Group Efficiency

Support for Population Health

Management Strategy

Perioperative CCG1

Surgery CCG


2) In development as of August, 2014.

3) Post-acute care.

Anesthesia CCG

Identified need for

Post-Acute Care

CCG

Developing Post-

Acute Care CCG

Charter2

Challenges of Ambulatory Expansion

• CCG work largely limited to inpatient setting

• Do not own most PAC3 facilities

• Mostly non-employed physicians practice in

PAC facilities

!


27


2) Chief Medical Officer/Chief Nursing Officer.

3) If a standard is deemed “optional” due to lack of

evidence, the CCGs will not roll it out system-wide.

System Only Adopts High-Quality Standards


Adoption Expectation Built

Into Guidelines

Guideline Vetting Process

Cert

ain

ty o

f E

vid

ence

Lik

elih

ood o

f M

ajo

r R

evis

ion

Expected

Recommended

Optional3

CCG1 Workgroup

Other CCGs with Relevant Expertise

Care Management Council

Each Care Standard Assigned

A Level of Adoption:

CCGs largely work on

expected guidelines

Clinical Consensus Group

CMO/CNO2 Committees

1

2

3


28

Without System Support, Facilities Hit Implementation Hurdles


1) Cardiovascular.


But…Vetted, Trusted Standards Not a Silver Bullet

8-Month Implementation Period

CV CCG develops

clinical standard for

entire system

Facility leaders receive

standard and

independently manage

implementation

System provides

CV1 CCG2 with

data highlighting

clinical variation

opportunities

Facility Feedback:

“It’s really hard to do

this—we don’t have the

expertise or resources.”

“Can’t we figure this out

once, together, for the

whole system?”

Banner’s Initial System-Wide Clinical Standard Rollout

“The success of a clinical standard is based 30% on the

excellence of the product, and 70% on implementation.”

Dr. Marjorie Bessel

Regional Chief Medical Officer, Banner Health


29

Workflow Experts Ensure Usable Clinical Standards

• Dedicated to specific CCGs3

• Provide project management support:

craft meeting agendas, organize CCG

workgroups, circulate relevant

materials to CCG members, track

meeting attendance

Program Managers Industrial Process Engineers

• Work across multiple CCGs

• Integrate CCG clinical standards

into existing workflows with goal

of “zero defect” practice

Robust Team Helps Translate Standards into Practice

Program managers exclusively

dedicated to Care Management


1) Clinical Performance Assessment and Improvement Staff are largely involved in monitoring the adoption of

clinical standards at the facility-level. The other staff outlined in the box are largely involved at the system-

level, designing how the standards will be integrated into the frontline workflow.

2) This amounts to .6 FTEs per hospital, although they are a centralized resource rather than a facility resource.

3) Clinical consensus groups.

Industrial process engineers

across system2 6 15

Clinical

Informatics

Staff

Clinical

Educators

Clinical Performance

Assessment and

Improvement Staff1

4. Physician Support Structure


30

1) Computerized Physician Order Entry.

2) Includes checklists, criteria for medical necessity, etc.

Constellation of Supports Ease Clinician Adoption


CPOE1 Order Sets

EMR Prompts

Clinical Decision-Making Tools2

Education and Training

Talking Points for Leaders

Outcomes and Adherence Data

Supports to Facilitate Local Adoption of System-wide Clinical Standards

Clinician


31

Role of Implementation Experts3

Role of CCG1 Clinicians



2) Care Management Council.

3) Includes program managers, industrial process engineers, clinical informatics staff, and clinical educators.

Enabling Top-of-License Clinician Contributions

• Identify opportunities to

standardize practice, or update

a current standard

• Assess the evidence, define

standards

• Present standards for approval

from other CCGs, CMC2

• Incorporate new standards into

clinical workflow and develop plan

to monitor results, compliance

• Design facility support tools (e.g.,

talking points, EMR prompts,

clinician training, order sets)

• During system-wide “go live,”

act as local champions for

new standards

• Report colleague feedback to

CCG and decide on any

follow-up action

Banner’s Three-Step Process for Implementing Clinical Standards

Design Implement Define

• Provide input to implementation

experts on clinical workflow,

tools

• Conduct ongoing monitoring

to assess efficacy of

standards and identify

adoption barriers

• Provide project management

support (e.g., schedule

meetings and create agenda,

organize CCG working groups,

track attendance, etc.)


32



Reliable Care

2. Physician Value-

Vision Alignment



of Care


Structure

5. Cultural Fit

Assessment

6. Physician Leader



Clinical Standard

Adoption








Management


33

Physicians Only Hired if Compatible with the Banner Philosophy

5. Cultural Fit Assessment

Ensuring the Right Fit

Multiple stakeholders

interview physician

candidates and screen

for the “three Cs”


1

2

3

Is the candidate CRITICAL to achieving

Banner’s mission?

Is the candidate CAPABLE of practicing at

the Banner standard of performance?

Is the candidate culturally COMPATIBLE?

• Assess how this physician will

contribute to Banner’s population

health management strategy

• Review physician’s patient charts to

assess quality of care

• Identify any legal issues

• Assess physician’s opinion towards

Banner’s philosophy of developing and

adopting system-wide care standards

Banner Medical Group’s Interview Process


34 6. Physician Leader Pipeline Development

1) Clinical Consensus Groups.

CCGs1 an Incubator for New Leaders


Benefit from support

of project

management,

informatics, workflow

experts

Take leadership

courses focused on

stakeholder

management,

teamwork, analytic

problem-solving

High-Potential

Practicing Physicians

Senior Physician

Leaders

“Engage physicians around their value system, which is based in science, not in money.

As it turns out, money doesn’t matter—which is good, because there isn’t any.”

Dr. John Hensing, System Chief Medical Officer, Banner Health

Physician Participation on CCG

Intellectually engage

with care

standardization and

resource stewardship

principles

See the direct

impact of their

efforts on improving

patient care


35 7. Accountability for Clinical Standard Adoption

1) Ongoing Professional Practice Evaluation.

2) Varies by medical staff at local facilities.

Expecting a Commitment to Clinical Standards


• Take part in performance

conversation with regional or

system CMO

• May not get preferred block

scheduling or other privileges

• Adoption of clinical standards

included in OPPE1 and/or

peer review process2

• Medical group is starting

annual professional reviews,

including discussion of quality

• Take part in performance

conversation with physician

peer from Clinical Consensus

Group or facility leader

All Physicians

Outlier Physicians

Repeat Outlier Physicians

Tiered Approach to Accountability


36

2

3

1

Road Map





37

Empowering Physicians to Pursue “Right Care”

Source: Western Connecticut Health Network, Danbury, CT;

Physician Executive Council interviews and analysis.

Western Connecticut Health Network

IMA

GE

CR

ED

IT: D

AN

BU

RY

HO

SP

ITA

L.

Institution in Brief: Western

Connecticut Health Network

• Three-hospital system comprised of

Danbury Hospital, New Milford

Hospital, and Norwalk Hospital

• Based in Western Connecticut

• Medical staff comprised of 1,300

physicians, with 400 employed

• Physician-led Right Care initiative

reduces unwarranted clinical

variation and overutilization;

initiative started at Danbury and is

being scaled across the system

• Achieved $2.9 million in charge

reductions from FY 2009-2010


38

From Promoting Order Set Adoption to Rightsizing Utilization



A Maturing “Right Care” Strategy

Reduce Unnecessary

Utilization by DRG

Reduce Unnecessary

Utilization by Cost Driver

Standardize Order Sets

and Pathways

• In 2004, Danbury

completes CPOE

implementation

• Clinical executives focus

on promoting adherence

to evidence-based order

sets and care pathways

Three Phases to “Right Care” at Danbury

• In 2006, executives shift

attention to reducing

unnecessary utilization

• Physician-led initiatives

focus on reducing

unnecessary utilization

within specific DRGs—

these are classified as

“vertical” opportunities

• In 2009, Danbury leaders

complement DRG-focused

initiatives with initiatives

focused on cost drivers

(e.g., lab, imaging)—these

are classified as

“horizontal” opportunities

• In 2013, CMO classifies all

efforts to reduce

unnecessary variation as

“Right Care”

2004-Present

Like Banner, Danbury’s

transformation has been

a decade-long journey,

championed by the CMO

Focusing efforts on “right

care” delivery secures

physician support


39



1) Diagnosis Related Group.`

Physician-Led Groups Work Toward “Right Care”

• Now chaired by CMIO

(formerly CMO)

• Meets monthly with content team

leaders to assess progress

Steering Committee for Right Care

Dedicated Content Teams

• Led by physician leaders

• Each team dedicated to DRG1 or cost driver

(e.g., lab, imaging, pharmacy, etc.)

• Teams analyze data (e.g., contribution

margin, volumes, charges) to flag

unnecessary utilization and demonstrate

the negative patient impact of excess tests

“Right Care” Goals

Quantifiable Targets: Content teams

set annual utilization targets based on

medical literature and chart reviews

(e.g., reduce echo utilization for CHF

patients by 30%)

Financial Incentives: Department

Chairs are incented on relevant

utilization goals which account for

one-fifth of a 30% base pay

incentive potential

“Right Care” Structure

Responsive to Practice: Teams track

utilization throughout the year—if the

annual target over- or underestimates

appropriate utilization, they will alter

the target


40

Dedicated Content Teams Design and Implement Prompts



1) Computerized physician order entry.

Physician Choice Informed by Workflow Prompts

Education

Spectrum of Clinical Decision Supports

• “More is not better”

education

encourages, but

does not mandate

practice change

• Ex: explaining to

physicians why

they should curb

use of calcium tests

“Check the Box”

• Automated prompts in

CPOE1 require

physicians to select

pre-populated

indication for why

particular order is

clinically necessary

• Ex: physicians must

respond to dropdown

questions when

ordering a CT scan

Permission

• Hardwired hard-stops

require physicians to

request permission

before making certain

orders

• Ex: residents cannot

order high-cost tests

without attending

approval

Elimination

• Restrictions eliminate

certain orders

altogether when clear

evidence indicates

intervention offers no

additional value

• Ex: hospital removed a

continuous passive

motion machine for

orthopedic inpatients,

and eliminated multiple

inpatient lab tests

Underlying Evidence, and Necessity for Opt-Outs, Informs Degree of Prescription

Least Prescriptive Most Prescriptive


41

Adopting “Right Care” Strategy at a Single Hospital



Challenges Danbury Workarounds

Lack system executive mandate and/or

support to focus on reigning in unnecessary

variation

Hospital CMO and other respected physician leaders

champion this work and are the “face” of the initiative

Single facility does not have as large a pool

of potential physician participants as a

system

Encourage broad participation from department chairs

and other physician leaders by including utilization goals

as part of leader incentive

Lacks support from centralized engineering,

IT, and project management resources

Pair physician leaders with facility data analysts who

help unearth variation opportunities; secure support from

hospital IT to implement CPOE order sets, prompts

Do not have as large and diverse a patient

base to assess effectiveness of new care

standards

Rely heavily on published evidence for standards;

physicians also regularly conduct chart reviews to

ensure the impact of each initiative is to provide patients

with the right level of care

As facilities join or grow into systems, the

clinical variation work at one facility is

mismatched to that at another

Leaders identify best practices within the system and

consider replication across sites; leaders should also

consider incorporating representatives from the new site

into existing content teams

Lessons from Danbury


42


1) Dr. John Hensing, Banner’s System CMO, attributes the

organization’s success to the balance of these four elements.

Greater Than the Sum of Its Parts

Physician

Leadership

Physician

Engagement

Clinical IT

Investment

The Science

of Reliability

Banner Health’s

Four Keys

to Success1


43

November 7, Washington, DC

2016 Pharmacy Executive Forum Fall Meeting

A Unique Opportunity to…

Reflect on the future of health care and

pharmacy services

Pressure-test ideas for forward-looking

pharmacy strategy

Develop leadership and change

management skills

Exchange ideas and best practices

Network with other pharmacy leaders

Communicating Pharmacy’s

Strategic Value

Pharmacy System Strategy

Playbook

Advancing Retail Pharmacy

The New Era of Health Care

Reform

Tentative Agenda

Documents

How Clinical Standardization Can Transform Your …...How Clinical Standardization Can Transform Your Organization Braden Lang Senior Consultant [email protected] ©2014 The Advisory