If you run any part of a hospital, clinic or healthcare provider, you’ve seen more change over the last three-to-five years than most business leaders see in a career.
It’s exciting to see advances in clinical techniques and processes deliver outcomes once thought impossible.
But it’s also daunting, when you consider how far the healthcare community seems from achieving its vision of an integrated, patient-centric system that:
- Is financially resilient
- Enables everyone to use resources better
- Gives clinicians more time to provide better care
The need to realize this vision has never been more pressing. But it still feels frustratingly out of reach. Just one data point:
Somewhere near 80% of your system’s data exists outside your EMR or ERP system. That means operational and clinical decisions are being made with only a fraction of the available data.
After 20 years of widespread investment in technology, we’re still bound by manual processes, data silos and legacy processes untouched (or even compromised) by all this new tech.
Ten process improvement mistakes
At Conduent, we’ve seen many, many healthcare process improvement programs. The ones that really make progress on clinical, operational and financial improvements are those that avoid these 10 mistakes:
Over-emphasizing the technology component
Technology is a huge part of better healthcare processes. But tech alone can never drive real change. Instead, you need a balanced orchestration of people, process and technology, based on a real understanding of how work flows.
“Providers, payers, and physician groups will be spending over $69 billion on healthcare related IT and telecommunications services over the next six years.” – Insight Research Corporation
If tech investment alone delivered change, we’d have the most efficient, effective healthcare system in the world.
It’s time to balance our approach. View IT as a means to an end, not an end in and of itself. Put your resources into understanding people and processes.
The Office of the National Coordinator recently identified the impact of new IT systems on clinical workflows as one of the biggest barriers to interoperability.
Ignoring unstructured data
Today, most clinical observations, from radiology reports and operative notes to discharge summaries, are recorded as unstructured text.
Structured data warehouses are optimized for structured data. But given that the majority of healthcare provider data is still unstructured and the volume of data is growing exponentially, hospitals need to find a way to bring unstructured data into their clinical and operational processes.
Increasingly, this means leaving data in its unstructured state instead of spending a lot of money trying to structure and ingest it. This means more data lakes (optimized for unstructured data) instead of the rigid data warehouses. It also means using natural language processing capabilities to extract meaning from written notes.
To limit your hospital processes to the data stored in structured databases or warehouses is to limit the accuracy, scope and potential of these processes. Your processes should capture and use both structured and unstructured data
Reinventing the wheel
Healthcare is a highly specialized world. So it’s not surprising that many providers think that everything they deploy must be domain-specific or even custom-built.
That means healthcare misses out on proven strategies, tactics, and technologies that have worked for years in other industries.
Yes, your hospital is unique in many ways. But that’s true of every business in every industry – and yet they still use proven, off-the-shelf software building blocks and tools.
Too many process improvement programs start from scratch as if no existing software could ever apply. In truth, there are many available technologies and techniques that can do the job.
Lancaster General Health needed to obtain reliable benchmark data to help reduce Length of Stay – and do it using existing IT platforms. Midas+ (a Conduent company) introduced the Comparative Performance Measurement System to benchmark against national thresholds. Lancaster General can now manage 100+ performance indicators and has reduced the gap between actual and expected Length of Stay by as much as 50% in certain populations.
Throwing out what’s working
Many hospitals have suffered from heavy-handed Business Process Re-engineering (BPR) projects that are expensive, hugely disruptive and high risk. Often this attacks the good and the bad.
It’s critical to identify what’s working well in any process and to retain these things first and foremost. Use a systematic methodology for evaluating a given process, visualizing the sub-processes and efficiently identifying where improvement or new technology is required.
It’s essential to build on what’s working well instead of ripping and replacing everything that moves.
“Define what’s over and what isn’t. . . treat the past with respect . . . let people take a piece of the old with them.”
William Bridges, Managing Transitions
Underestimating change management
Every process improvement is a change management challenge. But far too many hospitals dive in without considering how to manage change actively.
In fact, effective change management is probably the single most important factor in success.
Effective process improvement is change management – and successful programs are those that recognize this and manage it accordingly.
Engage all the right people in your change – including the leaders, the managers and the do-ers.
“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everybody gets busy on the proof.”
John Kenneth Galbraith
Providers and payers need a lot of support to manage value-based care contracts, in areas such as analytics (35%), technology (34%) and people-based issues (32%). – Conduent survey of U.S. adults, players and providers on how they see the state of health care.
Heather Haugen PhD, Managing Director and CEO and The Breakaway Group (a Conduent Company) covers this in her excellent article on Improving EHR Adoption.
Not being clear about the desired state (and road map)
Too many process projects start with: “Here’s what the software can do…let’s go!”
Successful process improvement programs are almost always front-loaded, with significant time spent prioritizing, mapping and documenting exactly what the destination will look like.
Just as importantly, successful programs take the time to get all stakeholders aligned around these decisions.
Below is a before-and-after look at a hospital’s vendor invoice management process – the result of intensive up-front work visualizing, mapping and aligning the team:
Vendor Invoice Management Process: Before
Vendor Invoice Management Process: After
Thinking that strategy and execution are the same thing.
Depending on which study you read, somewhere between 60% and 90% of strategies are never executed. In the healthcare world, that statistic is not surprising.
Healthcare services are run by smart people who tend to be comfortable in the world of strategy — but that’s not the same as execution and measurement. New ideas and approaches are exciting, but the business of implementation is hard work and may not come naturally.
When you’re planning your process improvement program, define your execution and metrics program up front. What are your milestones and how will you know you’ve hit them? How are responsibilities and accountability assigned and tracked?
80% of payers/providers are concerned about the inability of providers to make the journey to outcome-based care. – Conduent survey of U.S. adults, players and providers on how they see the state of health care.
Failing to align business and clinical sides
Every hospital and care facility combines two powerful cultures: the clinical and the operational. Many of the problems caused by process failures on either side are due to the “silo-ization” of the two sides.
In real life, clinical, operational and financial considerations are intertwined. To reflect this in your processes, it’s important not just to align but actually integrate the different sides of the hospital – and share data automatically, right in the workflow.
With an integrated view, analytics can actually evaluate the items that matter: outcomes, value and the real drivers (or inhibitors) of each.
Data Analytics is changing the way healthcare is delivered. Read our latest eBook on Data Analytics in Healthcare.
Forgetting the patient
Healthcare providers exist to care for patients. But far too often we see processes that take the patient for granted or approach them as inert recipients of care rather than active participants.
Successful healthcare processes are invariably those that factor in the preferences and behaviors of the patient.
When we’re called to evaluate a process, we often start with the patient experience and work backwards. This always provides revealing insights, even if it’s a back-office system (everything connects to the patient eventually).
87.7% of consumers wish their pharmacist, healthcare provider and insurance company were more connected on their personal health. – Conduent survey of U.S. adults, players and providers on how they see the state of health care.
Waiting for government to design change
Clearly, government drives a lot of the change in healthcare.
The rate and scale of regulatory change often puts providers on the back foot, always reacting to change instead of initiating it.
But actively managing and improving the core processes that define your entire organization can keep your hospital ahead of the regulations, with best practices already delivering the outcomes that government expects.
In truth, you know better than government what will generate better outcomes for your patients and more transparency and accountability for your hospital. Taking charge of your own processes is far better than waiting for government mandates to make these decisions for you.
The move to ICD-10 codes is actually or a major opportunity for healthcare providers – a chance to use the new data sets to improve the quality and cost of care. But only if you think beyond the mandate as a transformation driver instead of simply a compliance exercise. More about ICD-10
Our Bottom-Up Approach
Top-down change tends to falter somewhere in the execution stage.
At Conduent, we like to take a bottom-up approach that starts with patients, clinicians and users, and then work backwards. It’s a pragmatic approach to process change that follows these steps:
— Pick ‘low-hanging fruit’ processes – the easiest to identify and fix
— Listen to the front line
— Visualize change
— Align everyone around the journey
— Bring your people and your patients along
— Measure (and celebrate) success
Q&A with Stephen Smith
VP, Healthcare Provider Solutions at Conduent
Q: Healthcare is so innovative and progressive in clinical technology – why does it lag in improving clinical, operation and financial processes?
A: Healthcare is enormous in scope, complex, expensive, political and hugely emotive. That’s not an ideal recipe for pragmatic decision-making.
Fortunately, we are seeing much more systematic, business-like management across healthcare communities. The focus on outcomes really is driving change – in a really good way.
Q: Providers have seen so many waves of “process change:” Business Process Improvement, Continuous Quality Improvement, Service-Oriented Architectures, Business Process Re-engineering. Why haven’t they led to more progress?
A: All of these trends brought a lot of good things to the table. But the healthcare world underestimated just how big a change they all demanded.
There is no plug and play solution for something so complex. Software alone can never be the answer. We evangelize a balanced approach that looks at people, process and technology as a whole system, right from the beginning. That’s a big difference.
Q: Is ubiquitous information sharing just too unrealistic a vision?
A: Absolutely not. It’s very much within reach and healthcare providers are way further down the road than they think.
But healthcare leaders are getting frustrated – and rightly so. It feels like they’re running in quicksand, but actually a lot of the pieces are falling into place right now. We’re seeing more and more hospitals and clinics making major leaps forward with less disruption than they expected.
If you’re a healthcare provider, it’s a fantastic time to be looking hard at your processes and information flows.