Session 12

From the Boardroom to the Bedside:Using Analytics to Drive a Culture of

Continuous Improvement

Chris DeRienzo, MD, MPP, FAAPChief Quality OfficerMission Health System

Mike Creech, BSEE, LSSBB, LSSMBBVP Process Engineering & Applied AnalyticsMission Health System

Jon BrownChief Information OfficerMission Health System

Learning Objectives

• Describe how Mission Health is building the foundation for a continuous improvement culture firmly grounded in analytics.

• Explain how to engage physicians in driving analytics to the bedside.

• Clearly articulate one methodology of achieving widespread adoption of an analytics toolbox from bedside caregivers to administrative leaders.

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Poll Question #1

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Where does your organization spend most of its time RIGHT NOW?

a) Ab) Bc) Cd) De) Ef) Fg) Gh) Hi) Unsure or

not applicable

Standard Reports

Ad hoc Reports

Query Drill-down

Alerts & Triggers

Statistical Analysis

Forecasting

Predictive What-if Analysis

Optimization

Analytics

What happened?

How many? How often? Where?

What action is needed?

What exactly is the problem?

What is the best course of action?

How can I influence the future?

What are likely future outcomes?

Why did this occur?

B

F

E

D

C

G

A

H

Poll Question #2

4

Forecast ahead 18 months…Where do you want your organization spending most of its time?

a) Ab) Bc) Cd) De) Ef) Fg) Gh) Hi) Unsure or

not applicable

Standard Reports

Ad hoc Reports

Query Drill-down

Alerts & Triggers

Statistical Analysis

Forecasting

Predictive What-if Analysis

Optimization

Analytics

What happened?

How many? How often? Where?

What action is needed?

What exactly is the problem?

What is the best course of action?

How can I influence the future?

What are likely future outcomes?

Why did this occur?

B

F

E

D

C

G

A

H

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We are dead in the water without a culture of continuous improvement grounded in analytics that permeates everything we do and all that we are.

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The U.S. health system ranks last among 11 industrialized

countries on measures of access,

equity, quality, efficiency, and healthy

lives.

Wasteful spending in the health

system has been calculated at up to

$1.2 trillion.

70% of hospital strategic initiatives

fail.

Only 32% of healthcare IT projects

meet their objectives,

while 24% totally fail, and 44% have

difficulties in meeting their goals.

About Mission Health

Tracing its roots back nearly 120 years and based in Asheville, Mission Health iswestern North Carolina’s only not-for-profit, independent community healthcare system. Mission Health, through its vision to provide world-class care to westernNorth Carolina and beyond, is the tertiary care regional referral center for the western part of the state and the adjoining region.

Employing nearly 11,000 dedicated professionals, the system includes sevenhospitals with some 1,145 licensed beds; some 400 employed medical providers; andmore than 1,200 total physicians on its medical staff.

Mission Health is dedicated to improving the health and wellness of the people ofwestern North Carolina. For more information, please visit mission-health.org.

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MAP OF MISSION HEALTH SYSTEM

Western North Carolina 18-County AreaPopulation (2016): 882,581Percent over 65: 22%

Mission’s BIG(GER) AIM —To get every person to their desired outcome, first without harm, also without waste, and always with an exceptional experience for each person, family, and team member.

The Situation at Mission Health

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Increasing need to focus on continuous quality improvement.

• Ever-increasing benchmarks for greatness.

• Pay-for-Value incentives in public/private programs.

• To deliver on our BIG(GER) Aim!

Process activities launched broadly beginning in 2012.

• Lean transformation across several service lines.

• Clinical programs with standard algorithms of care.

• Data needed both for analysis and real time operational control.

Access to data was difficult due to many unintegrated systems.

• 13 EMRs, including ambulatory and hospitals.

• 12 billing / finance systems.

• 350 IT applications.

The Need at Mission Health

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Major process improvement was facilitated through the centralized performance improvement team—a highly skilled team of process engineering professionals.• Created internal dependency on the centralized team for complex projects.• Access to data only through IT and Informatics.• Difficult to provide real-time operational data or management roll-up data.

The Need:1. Provide health systemwide data in a way that allows broad access for analysis as well

as operational uses ranging from daily unit management to board-level discussion.

2. Create a culture of continuous improvement by outfitting key clinical / operational roles with skills, tools, and a sense of ownership for improving their own processes.

The Turning Point

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Process transformation after “low hanging fruit.”• Early wins always lead to

more difficult and complex follow-up projects.

• Requires higher level of leadership, particularly from physicians.

Clinical program development.• Simply not possible

without strong physician leadership.

• Requires sensitive project facilitation.

Both require a great degree of empirical data-driven evidence to compel difficult and complex process changes.

Results

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Achieved with Data Infrastructure in Concert with Process Improvement Efforts

EDW and Analytics

30 Care Process Models

Advanced Analytics Teams

• Simulation of new building projects.• Hospital census prediction (under

development).• Regional transport optimization.• Risk modeling and stratification.

• 65 systems integrated.• 41 applications.• Broad adoption.

• Severe sepsis: 20% improvement in compliance; 32% reduction in mortality rates; 58% increase in sepsis detection.

• 7% reduction in LOS for bowel surgery patients.

• 34% improvement in heart failure LVEF assessment rates.

• 20% increase in “on time” starts as result of OR dashboard.

Instilling Culture Change

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Culture of Data-Driven Continuous Improvement

= f Desire (and expectation) to drive improvement in

areas aligned with strategic objectives.

Having the right tools.

Ability to use the tools to drive improvement.

Leadership to provide ongoing support and a sense of accountability

and ownership.

How Mission Health Is Achieving Results

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Create “pull” for tools and methodology by connecting

accountabilities with strategic objectives

Empower leaders…special focus on physicians

Deploy effective tools

Provide a variety of training options

Honor accountabilities

Lessons Learned

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• Tools without purpose will not be adopted; link analytics deployment with work for which people will be held accountable.

• Physician leadership is essential.• Tailor analytics tools to levels of the organization—the board doesn’t need to

see detailed operational dashboards.• Clear ownership of processes will minimize ambiguity and “spin.”• Measure both clinical and operational success to ensure impact.

Future Plans

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1. Carefully integrating EDW application development skills to roles outside of the IT analytics team to allow transition to continuous improvement mode.

2. Integration of advanced analytics into our operational dashboards, to include predictive and prescriptive controls.

3. Continued evolution of CPM rollout.4. Integration of analytics applications into the provider workflow.

Analytic Insights

AQuestions &

Answers

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What You Learned…

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Write down the key things you’ve learned related to each of the learning objectives

after attending this session

Thank You

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