Six Steps Towards Meaningful, Ongoing Healthcare Performance Improvement

卫生系统主要将绩效改善举措集中在关键领域，包括临床结果、患者体验和组织成本。虽然这种高价值的改进方法有可能产生重大影响，但它的长期成功依赖于战略执行。

Performance improvement efforts fall short of their desired results when organizations approach improvement as a series of one-off projects. To achieve an effective and sustainable performance improvement, organizations must develop and perform their initiatives within anongoing performanceinfrastructure and program.

An Infrastructure for Ongoing Performance Improvement Initiatives

The ongoing performance improvement infrastructure comprises the following three systems-based elements:

1. An analytics system来衡量进步。A performance improvement analytics system (e.g., the Health CatalystData Operating System (DOS™)) integrates the organization’s data sources (e.g., clinical, claims, financial, operational, etc.) and facilitates quick, accessible data sharing.
2. An adoption system建立永久性的跨职能工作组，专注于识别、部署和监控质量改进的有效性。跨学科团队分析数据并发现模式，从而通过不同级别的医疗保健分析获得见解和进展Healthcare Analytics Adoption Model(Figure 1).
3. A best practice systemto deploy a data-driven approach to implementing evidence-based best practices.

Figure 1: The Healthcare Analytics Adoption Model.

Six Steps to Implementing a Sustainable and Impactful Performance Improvement Program

With the improvement infrastructure in place, healthcare organizations can follow six steps for a sustainable, impactful performance improvement program:

Step 1: Integrate Performance Improvement into Strategic Objectives

医疗保健是一个复杂的自适应系统，由不同组件之间的交互和关系组成。卫生系统必须将绩效改进纳入该组织的战略目标(例如，组成助理文书助理或集中于人口健康管理)。集成性能改进还可以提高效率，并将资源集中在最有可能产生有意义的整体效益的项目上。

Step 2: Use Analytics to Unlock Data and Identify Areas of Opportunity

An analytics application can help an organization identify opportunities for improvement efforts by uncovering variation. Variation points to a potential for standardizing processes because the existence of variation inherently means that some care practices are more efficient and produce higher-quality outcomes than others. There also is a greater likelihood that some practices are not achieving optimum outcomes. Hospitals and health systems will have a significant opportunity for care improvement if they can identify their highest-performing practices and begin to make those practices and evidence-based practices the standards for all caregivers.

Variation in cost can be a good surrogate for quality of care because the higher cost may result from the delivery of inefficient or unnecessary services. As the prescribers of care, clinicians are among the most significant influencers in managing variable cost, representing the direct cost. By focusing on variable cost (i.e., looking at the volume of procedures and cost per procedure, in particular), they can identify avoidable costs and begin working with clinicians, using evidence-based practices, to address them.

Step 3: Prioritize Programs Using a Combination of Analytics and an Adoption System

Successfully improving clinical outcomes and streamlining operations requires a strong organizational commitment and changes in culture, organizational structure, staff education, and workflow processes. Consequently, any organization that embarks on a performance improvement journey should first assess its readiness for change. Examples of criteria that an organizational readiness assessment evaluates include clinical leadership readiness, data availability, shared vision, and administrative support (e.g., data manager, outcomes analyst availability).

A readiness assessment helps the organization determine how ready the teams are to accept change, to estimate what, if any, impact there is on staffing and the potential implications for frontline caregivers. Understanding the strategic objectives and integrating results from a readiness assessment and analytics help the organization prioritize which care families (clinical services) can be starting points.

Step 4: Define the Performance Improvement Program’s Permanent Teams

The organization will require permanent performance improvement teams to review and analyze data, define evidence-based and best practices, and monitor ongoing results. Improvement teams should include the following components:

• A guidance teamshould have accountability for clinical quality across the continuum of care in a specific domain (such as women and children). The primary role of such a team is to select goals, prioritize work, allocate resources, and remove barriers. The guidance team then delegates accountability to clinical improvement teams to improve care.
• Clinical improvement teamstypically report to a physician and nurse and consist of frontline staff who understand the processes targeted for improvement. These teams define workgroup outputs and lead process improvement implementation. Whenever possible, clinical improvement teams should represent a broad range of departments, clinics, hospitals, and regions to help disseminate knowledge across the organization. These teams generally create workgroups to perform detailed work.
• Workgroupsgenerally report to a physician and nurse subject matter expert and include best practices, analytics, and technical experts. These teams frequently meet to analyze processes and data and look for trends and improvements. Their role is to develop aim statements, identify interventions, draft knowledge assets (e.g., order sets, patient safety protocols, etc.), define the analytic system, and provide ongoing feedback of the status of the care process improvement initiatives.

Step 5: Use a Best-Practice System to Define Program Outcomes and Interventions

The focus of performance improvement initiatives for many organizations tends to be on low-performance outliers—that is, identifying instances where costs are much higher and outcomes substantially poorer than averages among caregivers. However, a more effective approach is to identify those practices that consistently lead to the best outcomes and promote them, with evidence-based guidelines, to improve outcomes across the board—in other words, best practices.

Step 6: Estimate the ROI

As the guidance team sets priorities for performance improvement, the team may also estimate the potential ROI for each initiative based on available information. The team can start by identifying organizational costs and assessing benefits using industry benchmarks for similar projects, vendor case studies, and internal estimates. Most organizations will need to educate their clinicians, operations, and finance departments on the value of sharing data and working together on interdisciplinary teams rather than keeping everything in silos.

Next, the team should identify direct benefits and savings (either from enhanced efficiency and productivity) or from clinical improvement and waste reduction. Then, the team can identify indirect benefits, such as a reduction in future infections or an improvement in patient satisfaction.

团队还应该考虑收入机会，例如更高的市场份额和患者数量，合同合规性的增加，或者坏账的减少。

Building the Framework for Healthcare Performance Improvement Initiatives

Creating a foundation for sustainable improvement and prioritizing initiatives does not have to be overwhelming. By following these steps and establishing a framework for performance improvement based on analytics, the right teams, and evidence-based practices, an organization can obtain the right tools to achieve and sustain performance improvement gains into the future.