It’s Not About The Box Improving Care at Group Health with People, Process and Technology

October 3, 2008

A change in Quality measures

Filed under: After Visit Summary,Lean,Measurement — Tags: , — Matt Handley @ 8:06 am

This fall GHC is considering a pretty big shift in how we plan for our quality work.  We have traditionally set targets for performance in  things like HEDIS measures, that are steps toward our goal of being in the top 10% of health plans in the US.  so – specific quantified targets for all of the HEDIS measures, or a defined subset are usually our focus for clinical targets.  The challenges with this approach are several:

  1. There are too many measures to keep track of – we end up with a collection of projects that are confusing to clinical teams
  2. The measures don’t change quickly, even with concerted actions.  Because of the rolling year data, even good work doesn’t bear fruit quickly.  This makes the measures difficult to use to improve our processes.
  3. The focus tends to be on a “get it done any way you want” approach, or as Al Davis (owner of the Oakland Raiders is famous for saying “Just win, baby”).  The problem with this approach is that it usually relies on heroism rather than systematic improvement, and is almost never transportable – so if one clinic does well, other clinics are unlikely to be able to replicate their success.

the other way to approach measurement for improvement is to define a standard process, and then measure how reliably you meet the standard.  we have one measure like this now – the printing of an AVS.  We have defined the printing of an AVS as a standard that should happen at all visits, and report how reliably we meet that standard (still room for improvement, but many departments at about 100% in both specialty and primary care).  Simple.  Actionable.

The next step is to invite operational leaders int he delivery system to define thier standard work that keeps patients at the center and addresses quality, the care experience and affordability simultaneously.  The starter set likely includes the things liek fulfillment of HEDIS activities at all visits, with defined roles for flow staff and clinicians, and AVS printing.  Some organizations have mroe detailed standard work that includes things like rooming within 5 minutes of the appointment atime, and clinician entry into the exam room on time.

The meausre then is a “defects measure” – what percentage of times did a patient fulfuill thier HEDIS activities within a month of a visit?  KP Southern California has done great work with this, and have rates of cancer screening that boggle the mind – their mammography rates and pap smear rates are over 90%.

Defining standard work and managing to it, with reports of process measures driving improvement across many clinical conditions sounds a lot like lean, and is a big step forward if we can swing it.

I will spend more time on the KP S Cal work (the proactive office encounter, or POE) in another post.

August 12, 2008

Getting back into the Delivery System

Filed under: Epic,Lean — Tags: , — Matt Handley @ 2:31 pm

In the past two years we learned an important lesson about how to build tools to improve the care we provide patients – do it best when we do it with front line clinical teams. As part of our learning about Lean we went to where the knowledge about care resides – with clinical teams and the patients that they serve (patient participated in many of the events). We learned as we went, and the clinical teams stepped up not just to help us address their favorite issues, but also to address big issues for the entire delivery system.

In 2008 we had to make some tough choices. As we invested in “Practice Management” (Epic products that do appointments, registration and billing – replacing our LastWord application) we did not have sufficient resources to continue to work in clinics to improve Epic. We have had just enough resource to maintain Epic (it does require care and feeding) and do a few small improvements.

But – GOOD NEWS – given the timeline for Practice Management (that isn’t good news – now stretching out into 2009), we recognized that we could not continue to delay our investments in improving Epic, and working in the clinics. So we have invested in one more cross functional team (a team that will go out into clinics to do work with clinical teams) that will start as soon as we have them hired and trained. It will be great to be back in clinics with our clinicians and patients.

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