Sustainability is Key to Healthcare Performance Improvement

By Amber Hanser, Vizient Senior Performance Improvement Program Director

Margaret Rudisill, Vizient Performance Improvement Program Director

Shannon Hale, Vizient Performance Improvement Program Director

A well-kept neighborhood is a collaborative effort. Outcomes are not the result of a single homeowner who worked alone on their well-tended yard; rather, it's a collective team effort involving time commitments and partnerships of the entire community. Likewise, sustainable improvements in healthcare are achieved through collaborative teamwork, time dedication and consistent effort.

Participating in Vizient's Performance Improvement (PI) Programs assist organizations in driving these improvements and sustaining them over time. Recently, a longitudinal analysis using Vizient's Clinical Data Base was conducted to examine PI Program members' performance and the impact their participation has on their organizations' patient outcomes and sustained improvement specific to mortality, readmissions and length of stay. As a result, the project groups compiled lessons learned that they not only attribute to their successes, but also serve as guides to better sustain and inform future improvement work.

Mortality

Mortality is an important concept and metric for all healthcare organizations. Participants in Vizient's Performance Improvement (PI) Programs recent mortality-focused projects showed tremendous outcomes, with 85% greater improvement in mortality rate for PI Program members over the 3.5-year timeframe versus non-PI Program members. Specifically, we followed seven projects from initiation to two years post project close with topics ranging from sepsis and workplace violence to maternal mortality and managing serious illness. We found 100% of the projects sustained a reduction in mortality rates averaging 2-22% improvement., equating to more than 9,800 lives saved and over $143 million dollars in costs avoided. Participants in the mortality domain projects identified the following lessons learned that they attribute to this improved performance:

• Engage with those doing the work you want to improve. Whether developing new protocols, workflows, policies or even seeing non-compliance with initiatives already in place, organizations that actively talk with, solicit feedback and observe those doing the work (physicians, nurses, front desk, etc.) can tell you what they need, help identify barriers and get to the root cause of any non-compliance issues you're seeing.
• Include representatives from cross-departments. It's key to have someone at the table from all departments who can help improve efforts. One provider we recently worked with was striving to decrease inpatient falls on their unit. They had worked on this issue before but had not seen a big decrease. The turning point for this organization was realizing certain roles such as transporters and nutrition services (two departments that have regular, important interactions with patients) were not included in their past discussions. After adding these departments to the collaborative team, they began to see a more significant decrease in their inpatient fall rate.
• Create topic-specific committees. It's important to form individual groups around topics such as maternal mortality and sepsis that meet regularly to review data and discuss areas of success and opportunity for the organization. A multidisciplinary committee can serve as a champion for the specific topic and help keep continuous improvement front of mind.
• Celebrate successes along the way. Having a goal is important but celebrating wins as you go will get team buy-in to help you reach that target. One provider recently spoke about how they complete monthly chart audits around topics such as falls, addressing patient educational needs and sepsis. When they find high performers, leaders send letters to those team members thanking them for their exemplary efforts. The recognition not only helps hardwire the efforts of the team, but those high-performing team members become role models for other staff and can serve as “peer educators.” Celebrating small wins along the way encourages growth, performance and engagement. 

Readmissions

As a part of the same analysis, we analyzed how organizations' 30-day inpatient readmission rates have performed over time across our program membership. In the most recent four quarters of data, we found PI Program members avoided nearly 19,000 inpatient readmissions equating to $270 million dollars in cost savings. Additionally, 83% of readmission-focused PI projects, such as standardizing stroke care, COPD chronic care management and high utilizers sustained a reduction in readmission rates averaging 3-5%. Participants in the readmissions domain projects attribute their improved performance to the following:  

• Provide formal education training to providers: Educate chronic care providers (ex: COPD nurses, physicians, respiratory therapists and pharmacists) by developing education workshops or online modules to teach skills. Then audit and evaluate their facilitation, confidence to correctly teach inhaler techniques, and identify needs and steps for additional training.
• Develop and test COPD hospital risk scores: Standardize metrics used to identify potential risk factors for hospital readmissions or emergency department revisits among patients experiencing COPD exacerbations.
• Develop care transition support and materials: Develop a guide for patients to help them understand what to expect after discharge. Items could include: readiness assessment tools, discharge checklist and utilize care transition nurse to conduct follow-up calls within one to three days post discharge.
• Establish a multi-visit patient (MVP) registry: Develop a registry or dashboard to build the program and measure improvement and review daily MVPs with key cross-continuum partners.
• Create emergency department care alert: ensure “care alert” is visible to emergency department staff and providers to increase awareness of MVP return and care plan.

Length of stay

Due to recent workforce and financial challenges, length of stay (LOS) in hospitals has been especially hard to improve and maintain. Vizient continues to support providers by offering LOS improvement programs. For example, 53 healthcare organizations that participated in the recent Reducing LOS to Improve Capacity collaborative implemented tactics and impactful practices to improve outcomes. While final results will come later this year, the collaborative's initial outcomes look promising, with nearly 60% of the participant organizations showing positive momentum in reducing their LOS. They have identified the following practices as key to their success:

• Building consensus: Garnering support from senior leadership is paramount with any project. To gain provider support, consider identifying a physician champion. Physician champions are respected and trusted by their colleagues and their endorsement can foster buy-in and engagement from others. Doing so will increase the likelihood of success as well as sustainability over time.
• Early discharge planning: Many organizations have implemented programs to designate certain patients for early discharge to reduce hospitals stays and create more capacity. Utilizing an algorithm to identify these patients is a common approach used by healthcare organizations. This helps providers identify patients that are not at high risk for readmissions or complications and can be safely discharged earlier.
• Real-time capacity planning: Standardized multidisciplinary rounding can lead to a decrease in LOS. By improving communication and coordination among the care team, patients can receive more efficient and effective care.
• Eliminating delays: By establishing an escalation process, discharge delays can be addressed more efficiently, leading to a decrease in LOS.
• Use of advanced analytics: Creating one source of truth is critical when driving improvement with the use of data. Vizient's Clinical Data Base (CDB) is utilized by our members as their data source and to create dashboards for frontline data visualization.
• Use of performance improvement (PI) methodologies: Use of PI methods such as process mapping, improvement sprints, data visualization, Root Cause Analysis (RCA), and holding kaizen events helped participants in the LOS collaborative improve more quickly and establish plans for sustainability.

These longitudinal analyses not only identified successes across these integral topic areas for healthcare organizations but provided important benchmarks and leading practices. Much like a well-kept neighborhood, sustainable improvements in healthcare are achieved through collaborative teamwork, time dedication and an eye on consistent, ongoing improvement. As such, Vizient Performance Improvement (PI) programs provide an ideal setting for providers to work together on initiatives to tackle tough issues across clinical, operational and financial performance to achieve future performance improvements and sustained results for a well-maintained healthcare yard.