My favorite philosopher, Yogi Berra, once said, “If you don’t know where you are going, you’ll end up somewhere else.” It’s an easy argument to show that we continually end up somewhere else in our current health care performance improvement efforts, and most times that somewhere else is the land of no change. No matter the laudable efforts of many people, we seemed to get derailed in our improvement efforts by everything from unengaged clinicians to a lack of accountability. Not having the right data is often cited as the reason; however, I would like to suggest that it’s a scapegoat rather than the reason. The real reason is that we don’t know exactly where we are going.
The role of data in performance improvement is to get us to the right destination and then to tell us if the change that was implemented has led to the improvement we wanted. If it’s that simple, then why do we find it so hard to get beyond data? The answer is that without three extremely important attributes – appropriate comparisons, transparency and the ability to substantially drill down – hospital leaders are forced to make assumptions about where change needs to occur. In many cases, when those leaders approach clinicians about a performance improvement opportunity, attacking the data has become the favorite pastime.
The first step needed to brush back challenges to the data is to leverage scorecards. Virtually all hospitals have monthly leadership balanced scorecards and they can serve as the GPS for where an organization is today and where they need to go. No matter how big or how small a provider, trying to manage without a leadership dashboard is like driving at night in a heavy storm without mirrors or headlights. You may get to your destination, but only if it’s in your very familiar neighborhood.
However, a common issue with dashboards is that health care systems spend too much time, energy and money determining which metrics to include and how to display them. Among the hundreds of hospitals that I’ve visited, almost all use the same metrics in finance, operations and quality/safety/patient satisfaction, yet they all look similar, regardless of how much money has been spent on business intelligence. Many hospital leaders are surprised to hear that there are other hospitals that achieved greater improvements with the use of a comparative database and Excel. We try to be innovative in our dashboards and don’t realize that the dashboard doesn’t motivate change. Instead, it’s the story built from the dashboard that eventually moves us to change.
I believe that the hospital’s dashboard needs to be presented every month at a leadership meeting by an expert – a data scientist – who has drilled into the opportunities in a comparative manner such that they can point the organization toward the right change. This is common practice in other industries, but in health care we have relied on the super human powers of our leaders to make the right assumptions.
Improvement in health care is not easy, and the sustainability of the American health care system depends upon our ability to get much better at change. In my experience, I have seen a very high correlation between a hospital’s improvement efforts and their engagement in both the data and with the organization providing the comparative data. Without that engagement, hospitals lose out on opportunities to connect with like organizations, gain valuable insights from the data and benefit from the guidance only the most experienced industry experts can provide. Working with a company like Vizient, diving deeply into world-class comparative data in finance, operations, quality and safety, and using their experts as trusted advisors, will lead to improvement.
Ideally, we’d all have a favorite philosopher like Yogi riding shotgun. But since we can’t, then we should at least follow his sage advice and have an idea of where we are going.
