Consistent Improvement Methodology Accelerates Healthcare Outcomes

对于医疗保健组织来说，分析问题并及时实施有效改进的能力是保持竞争优势所必需的。成功的、持久的改进的一个重要组成部分是使用一致的、系统的方法在组织内引入和实施变革。

社区卫生网络(CHNw)已投资培训护理人员若干改进科学模型。然而，CHNw的改进工作往往是孤立的，没有在整个组织中广泛传播，导致缺乏可持续性。通过开发一个专注于统一采用、教育和持续监督的新战略，组织旨在改变它向前推进所有组织改进努力的方式。CHNw很早就采用了系统化的改进方法，新的结构已经为公司带来了价值。

CONSISTENCY IS KEY TO SUSTAINABLE IMPROVEMENTS

The ability of healthcare organizations to change, adapt, and evolve is a competitive advantage.¹More than half of health IT leaders report that it is difficult to consider new technologies that require substantial changes across disciplines, even when the technology has the potential to improve patient care and satisfaction.²成功和持续的改进需要在组织内采用一致的方法来引入和实施变化。³Single improvement approaches are not meant to replace change methodologies or tools used by organizations, but rather to provide a framework for analytics, organizational collaboration, and feedback to remove barriers and accelerate outcomes.⁴

CHNw is a non-profit healthcare organization, serving central Indiana. It is consistently ranked among the nation’s most integrated healthcare systems. Based in Indianapolis, CHNw serves more than 539,000 patients and employs over 15,000 caregivers, providing access to exceptional healthcare services, where and when patients need them—in hospitals, health pavilions, and doctor’s offices, as well as workplaces, schools, and homes. CHNw values patients first and is committed to providing patient-centered care and outstanding service, delivered with respect and compassion.

SILOED IMPROVEMENT EFFORTS HINDER WIDESPREAD CHANGE

此前，CHNw曾投资培训护理人员几种改进科学模型，如精益生产、六西格玛和改变加速战略。然而，改进工作通常是竖井式的，并没有在组织中广泛传播。如果没有一个共同的改进方法，组织就会有许多意图良好的项目，但是缺乏治理和低效的资源利用降低了改进工作的潜在有效性。

由于CHNw缺乏可操作的数据，组织很难识别和优先考虑改进工作。为了促进可持续的改进，CHNw需要改变并更好地组织其改进工作，以确保在整个组织中广泛采用。

NEW STRATEGY ENABLES SYSTEMATIC IMPROVEMENT APPROACH

CHNw leadership established a vision for quality, aiming to deliver an exceptional experience to every life it touches. The organization describes quality as defined by its individual patients, based upon outcomes, experience, cost, and the appropriateness of care. CHNw partnered with Health Catalyst, implementing improvement functions in three systems to achieve systematic, organization-wide change.

1. Best practice system:The tools, processes, and evidence that defines what the organization should be doing.
2. Analytics and feedback loop:Using the Health Catalyst^®数据操作系统(DOS™)平台，CHNw能够分析可用数据来评世界杯厄瓜多尔vs塞内加尔波胆预测估优先级和监控目标的进展。
3. Adoption:支持和维持变更所需的治理结构。

With this support, CHNw was able to adopt a consistent, systematic improvement methodology across the organization. This consistency in problem-solving and improvement provides a common language and sequence of steps for reaching goals, effectively establishing best practices across CHNw.

CHNw选择的改进方法与多种改进方法兼容，包括六西格玛、PDCA、DMAIC和设计思维。策略的敏捷性和适应性是很重要的，它允许团队通过快速通过一些阶段，或者根据需要重新访问早期的步骤，以确保一个积极的结果，在迭代的方式中导航改进。

With the improvement approach in hand, leadership established a governance structure and commissioned permanent improvement teams to help achieve key organizational priorities and goals. CHNw’s governance structure integrates several important principles, including:

• Stakeholder engagement:利益相关者的参与从组织的最高层开始。CHNw的执行领导围绕着质量的共同愿景展开工作。
• Shared understanding:对于组织的需求、能力和准备情况有一个共同的理解。
• Alignment:除了采用一致的改进方法，CHNw还调整激励措施，并努力平衡组织内部的两极分化。
• Focus:The organization practices disciplined decision-making to prioritize, fund, organize, and sustain initiatives.

永久的改进团队拥有充足的资源，并且由于他们与战略目标的一致性，他们带头的主动性工作优先于其他改进工作。The permanent improvement teams also support ongoing efforts with representation from the necessary organizational functions, including outcome performance managers, financial analysts, clinician champions, and executive sponsors, to ensure organizational changes are widely adopted (see Figure 1).

数据分析师、CHNw结果和性能经理促进数据驱动的改进，利用Health Catalyst数据操作系统(DOS™)平台的数据产生新的见解。世界杯葡萄牙vs加纳即时走地世界杯厄瓜多尔vs塞内加尔波胆预测临床领导将数据和分析视为战略资产，帮助推动采用和加速改进。When facing challenging organizational problems, CHNw asks and answers seven critical questions:

• Do we understand the problem?
• 我们知道我们想去哪里吗?
• Do we know the cause?
• 我们知道要改变什么吗?
• Have we applied and measured the change?
• 改变是否带来了改进?
• 我们是否保持了这些成果?

通过面对面的会议和书面材料，为整个系统的领导人提供了协调培训。鼓励领导者在其服务范围内使用该框架进行改进和创新。一旦确定了优先级和选择，项目就被部署到永久改进团队中，开始改进过程。

这种持续的、系统的、广泛的改进方法为CHNw领导者提供了一个全网项目的全面资源库，能够进行状态报告和持续的资源分配，从而使所有未来的计划都有很大的成功机会。

RESULTS

The consistent, systematic improvement approach has begun to accelerate improvement at CHNw. The health system has experienced impressive early adoption of its improvement approach, and the new structures are already bringing value to the organization. In just two years, CHNw has:

• Trained more than 800 leaders in its new improvement approach.
• Resourced eight permanent improvement teams.
• Thirty-five active improvement projects in process.

The improvement teams are delivering impressive results. For example:

• $15.5 million in savings, including:
  • 节省了820万美元的败血症费用，改善了败血症的识别、诊断和治疗，并减少了每个病例的平均可变成本和平均住院时间(ALOS)。
    • 34.5 percent relative reduction in mortality for patients with sepsis prior to admission, saving 124 lives.
    • 1,047 emergency department (ED) bed days saved, the result of decrease ED ALOS for patients with sepsis prior to admission, and 147 inpatient bed days saved, the result of a decreased inpatient ALOS.
  • $3.2 million orthopedic service line savings.
    • $1 million in additional revenue from a newly designed outpatient total joint arthroplasty program.
    • 100万美元的LOS reduction。
  • $2.32 million integrated primary care savings.
    • 为老年评估管理病人节省100万元。
      • 407 lives impacted. Patients receiving care from the GEM have a mortality rate that is 1.45 percent less than that of non-GEM patients.
    • 8.8 percent relative increase in overall screening rate for colorectal cancer—74,889 patients were screened for colorectal cancer between January and September of 2018—7,221 more patients than the number of patients screened in all of 2017.
  • 心血管服务专线节省98.6万美元。
    • $161,000 in additional revenue through improved management of atrial fibrillation.
    • $541,000 in readmission cost avoidance, the result of a 21 percent relative reduction in heart failure 30-day readmission rates.
  • 母婴服务可节省66万美元。
    • $403,000 savings by reducing the variable cost per case across the CHNw system in just one year by implementing a standard medication-assisted treatment program for pregnant women with opioid misuse during pregnancy.
    • 64.3 percent relative increase in long-acting reversible contraception.
    • 实施外阴切开术的数量相对减少39%，避免了127例外阴切开术。

“Rather than rushing to a solution, leaders are now applying the improvement framework to both small and large problems, pausing to be certain we know the problem we need to solve, and focusing their improvement efforts on the processes associated with the problem.”

–Patrick McGill, MD
EVP, Chief Analytics Officer

WHAT’S NEXT

Having established a consistent improvement approach supported with data and analytics, CHNw intends to further expand its data literacy and expand its use of analytics to drive improvement, and plans to further reduce clinical variation, improving the quality of care delivered to patients.

REFERENCES

1. Al-Abri r(2007)。Managing change in healthcare.Oman Medical Journal, 22(3), 9-10.
2. Spok. (n.d.).医疗技术人员正在适应生存。
3. The Health Foundation. (2016).Quality improvement made simple – What everyone should know about health care quality improvement.
4. Institute for Healthcare Improvement. (n.d.).Science of improvement: How to improve.