Perspectives from a CEO and Physician Executives: How Effective Governance Can Drive Sustained

Improvements

David Grauer Senior Vice President, Professional

Services Health Catalyst

Tim Hobbs, MD, MBA, EVP

Executive Vice President of Clinical Transformation, Community Health

Network

Session #36

Cate E. Ranheim, MD

Medical Director, Hospitalist Programs and MeriterAntithrombotic Service

UnityPoint Health

Learning Objectives• Learn from established leaders how to apply best practice principles in outcomes

improvement leadership and governance.

• Understand the definition of outcomes improvement governance, and how it differs from data governance.

• Understand how to drive change by successfully engaging board members and clinical leaders.

• Discuss how to align organizational and provider incentives to achieve your strategy.

• Determine how to achieve shared understanding and establish a vision for outcomes improvement.

• Learn how to effectively review and prioritize improvement opportunities.

Leadership, Culture, and Governance

Financial Alignment

What should we be doing?

How are we doing?

How do we change?

Where do we focus?

How are we financially compensated?

The Three Systems Framework…Requires GovernanceGood governance accelerates outcomes improvement.

Poll Question #1On a scale from 1–4, how would you describe your organization's culture and leadership as it relates to driving outcomes improvement initiatives?

1) Ineffective2) Effective3) Somewhat effective4) Extremely effective5) Unsure or not applicable

Outcomes Improvement GovernanceDefinition and connect the dots

“Well-designed and executed governance optimally allocates scarce resources, which

significantly accelerates the breadth and depth of outcomes improvement.”

—Tom Burton, Co-Founder and Executive Vice President, Health Catalyst

The leadership, structure, process, and organizational culture needed to support sustained, system-wide outcomes improvement.

Data GovernanceDefinition

The people, processes, and technology orchestrated to maximize the value of data to the organization.

etc.

Outcomes Improvement Executive Leadership Team

Content & Analytics Team(s)

Data Governance Committee

Domain Guidance TeamProvides domain oversight

and drives priorities

Outcomes Improvement Team(s)Drives innovation & adoption

Workgroup(s) as neededWorkgroup(s)

as neededInnovates

Domain 1

Domain 2

Outcomes Improvement Governance Structure How outcomes improvement governance is connected to data governance.

Governance Handbook

Outcomes Improvement Governance Principles

Stakeholder Engagement: Starting at the top, engage all stakeholders around a common vision.

Shared Understanding: Have a common understanding of organizational need, capabilities, and readiness.

Alignment: Adopt a consistent improvement methodology, align incentives, and balance polarities.

Focus: Practice disciplined decision making to prioritize, fund, organize, and sustain initiatives.

The governance must-haves that support the success of outcomes improvement in healthcare organizations, regardless of their structure:

Our emphasis is on principles, not prescriptions.

UnityPoint Health

UnityPoint Health is one of the nation’s most integrated health systems, providing care in nine regions throughout Iowa, western Illinois and southern Wisconsin.

In Nine Regions

Best Practices: UnityPoint Health

Principle: Stakeholder Engagement• Leadership structure and

committee composition• Physician engagement

Principle: Focus• Opportunity analysis and

prioritization of projects

Clinical Leadership Group (Provides Direction for Catalyst Priorities)

Catalyst Team (Oversight for Reducing Variation in Clinical Care Priorities)

CLG-delegated supervision of

Roadmap Priority

Accountable for coordinating

resourcing and implementation

of clinical opportunity strategies

Responsible for: Partnering with other Roadmap

Priorities & Reporting back to

CLG

Clinical Service Groups (Guidance Teams for each Domain)

Work Teams (Domain Specific Discovery Teams)

Regional Implementation Teams (Implementation & Execution)

Domain #1: Septicemia

Subject Matter Experts, Analytics, Process Excellence,

Informatics

Domain #2: Coronary Artery

Disease/Acute MISubject Matter

Experts, Analytics, Process Excellence,

Informatics

Ownership of Specific Catalyst

Clinical Initiatives (Domains)

Inpt Medicine ED

Cardiovascular Ambulatory

Etc.Regional

Implementation Team for each

Initiative

Multi-disciplinary team members per

initiative scope

Regional Executive Sponsor (e.g. CMO/VP MD)

2016 US Breakdown:Radial: 34%Femoral: 65%

53% System Radial average

Radial Compared with Femoral:All RegionsSTEMI 2016 Discharges Readmission Rate Mortality Rate Variable Direct Cost

Radial 326 4.13% 1.53% $6,490

Femoral 328 6.14% 6.1% $7,779

Exclusions:Balloon PumpCABGCABG + Balloon PumpCABG + Balloon Pump + ImpellaCABG + ImpellaImpella + Balloon PumpTherapeutic Hypothermia

Increased Risk Increased Risk

Poll Question #2Which of the following outcomes improvement governance best practices does your organization struggle with? (Select all that apply.)

a) Stakeholder engagement b) Focusc) Shared understanding d) Alignmente) Unsure or not applicable

About Community Health Network

More than 200 sites of care8 acute and specialty care hospitals

20 walk-in clinic locations(including Community MedCheck, KidsExpress, Community Clinic at Walgreens)

11 surgery and endoscopy centers

Community Physician Network(nearly 1,000 employed providers)

Community Home Health(110,000 visits in 2016)

Community Employer Health(provided care for more than 75,000 unique individuals in first half of 2017)

School nursing program(421,000 visits to 113 school nursing sites in first half of 2017)

Community Health Network Foundation($4.4 million to Community programs/services in 2016)

Best Practices – Community Health Network

Principle: Shared Understanding• Common definition and vision for

quality.

Principle: Alignment• Organizational readiness

assessment.• Aligned incentives.

Key Takeaways and Lessons Learned

Outcomes improvement governance is theleadership, structure, process, and organizational culture needed to support sustained, system-wide outcomes improvement.

The must-have principles of outcomes improvement are:• Stakeholder engagement.• Shared understanding.• Alignment.• Focus.

Incorporating best practices in your organization is about following principles, not prescriptions.

Thank You