Achieving long lasting Healthcare Value is the balance between the clinical excellence and the sustained operational profitability.

Succeeding at the major undertaking that is a long term plan to achieve the balance of these two distinct objectives requires active collaboration between multiple functions within the healthcare value chain. Healthcare Value can be seen as the convergence of four forces:

• Patient Experience
• Operational Performance
• Clinical Excellence and
• Technology Maturity

We examined in a previous brief how Operational Performance and Clinical Excellence can generate improvements and contribute to an even greater performance when working together. Below is the second part of the analysis, considering the Patient Experience and the Information Technology Maturity forces. Each hospital, clinical or clinical care center would experience these drivers with varying degrees of acuity and relevance.

Most might find that the following resonates with their experience and enjoy the quick read.

Patient Experience

The ongoing transformation of the healthcare landscape has in many cases sent patients into confusion, with Plans changing constantly, reimbursement rules linked to ICD10 creating uncertainty when a preventive procedure can change its designation based on its outcome, and the rapid concentration and redistribution of networks making it sometimes harder to find an adequate treatment center. Adding to the landscape the disparity of rules and regulations between states and the political black hole post 2016 Elections would be already cause for patients to complain about headaches.

Admission processes kick the headache to another level in many cases, with the requirement that the patient fills and signs paperwork including in some cases repeated requests for the same information. The labor intensive and error prone process which requires a staff member to type in the data just written down by the patient is both antiquated and a waste of time and money.

A new reality is that the patients are simultaneously under constraint by their Healthcare provider to choose an in-network practitioner, and are free to pick one that they like, even if this means going outside of the network. The recent rise of patient direct costs through deductible or out of pocket rules shifted more costs to the patients, which in a twisted way made going out of network a more comparable option.

Putting the Patient at the Center.

Patients are at the center of a care workflow, which gives them a unique end-to-end perception of the care process. The gap between two departments in a care center, or the difficulty managing a referral can easily go unnoticed by hospital managers.

From a patient’s perspective, the entire care value chain is front and center, and their perception of a care center or a practitioner is rarely in insulation. Although feedback ratings are not yet as mainstream as in other public servicing industries, they become more standard. It only is a question of time before full scale rating systems will help patients decide where and who they will seek care, in a competitive landscape.

Easy and dependable access to diagnostic or treatment can be a key criterion for patients who are shopping for the best care solution. Narrow networks can be a good option in cities and when proximity care is available. In other cases, they might be a deterrent to patients who want to access the adequate care center without complications.

Better Management of Referrals

The management of referrals can be a differentiator for Care Centers as they provide a care solution more complete, while increasing the patient base for practitioners. Maintaining an online, automated referrals management system linked to the overall care system puts a positive spin on the up-front part of the process with a patient.
Extending the first impression with an easy and paperless admission, including a pre-admission or appointment exchange that reduces the data acquisition on the scheduled date saves time, reduces errors and gives the patient a positive perception that might last throughout the entire process. Engaging the patients in optimizing the entire workflow offers many benefits; designing the process in such way that the patient becomes engaged with the process from the start is a greater, longer lasting benefit.

Quality of Care, always

Once early stages are over, the primary focus for a patient is the quality of care and the clarity of the outcomes. Continuous care models, exchanging information and updates throughout the entire workflow both reduce the cycle time and simplify the process.

If the visit with a clinician triggers lab work or imaging, the patient can be automatically checked-in and simply goes to the appropriate location in the center. Not only can most steps be automated and paperless, but the simplicity of the transition from a department to another creates a sense of integration in the eyes of the patient. The patient’s perception is based on all successive steps of the care workflow; the feedback will reflect the 360 view, even if a department only sees a fraction of this view.

Understanding Billing

The final step, often upsetting for patients, is the billing and payment phase. Although there is no doubt in a patient’s mind that there will be a summary bill at the end, surprises and lack of clarity upon the check-out or discharge can create animosity or rejection. Incomplete statements, future complementary bills, opacity of the billing rationale and codes create confusion, which turns rapidly into distrust. Asking out of pocket payment for anesthesiology services when the procedure was executed in an in-network center with in-network staff creates an instant feeling of being coerced into grayish payments. This is augmented by the psychological standing of a discharged patient, which inevitably sees the world as expected to be gentle and caring, based on their most recent experience.

Transparency and clarity on costs and payments, reimbursement by the Network and possible extra costs can greatly reduce the potential for contentious discussions. Staff training on how to handle this event in the care process can also make a difference in how the exchange will be perceived by the patient.

The final exchange between the care center and the patient carries a high weight in the overall customer satisfaction; a solid care performance can be ruined with an acrimonious exchange upon payment.

Information and Technology Maturity

Information technology is involved at various stages of healthcare operations. Although IT is often considered as a single entity, its role actually covers a great span of functions.

Technology as a clinical enabler. Many clinical acts rely on a set of machines, software and infrastructure that help with diagnostic or treatment. Radiology, hematology, spectrometers but also bedside monitors and telemetry systems are in fact solutions which comprise a computing technology at their core. Such technology based solutions are now the standard in hospitals and clinics, as well as in the office of doctors and practitioners.

If it beeps, it needs maintenance

As other equipment carrying a computing core, medical, clinical and patient systems require maintenance to update their software and possibly their hardware on a regular base. They also need specific security and regulatory compliance updates such as HIPAA compliance and reduction of information access vulnerabilities.

Wireless monitors or mobile hematology stations for instance require a Wi-Fi connection to operate, granting them access to the broader hospital network. From this moment, they become both at risk for a networked malware spread or be a risk if such malware originated with them.

Either way, the connected devices become part of a larger technology ensemble, which requires continuous maintenance, care and monitoring.

Interoperability

A second aspect of the connected devices is the interoperability. A clinical pathway can involve multiple systems either in a certain sequence or simultaneously (e.g.: Operating Room and ER systems). Others “collaborate” through an integration system, adding a layer to the technology architecture. Some medical devices and systems can have a lifespan of decades (e.g.: heavy radiation or radiosurgery systems) and then comes the issue of systems that become obsolete as new generations of systems are brought to service. Over time, the servicing of older systems is not just keeping them operationally viable, but also maintaining or expanding their capacity to exchange data with other inter-related systems.

System-to-system electronic exchange only covers a part of the needs for interoperability, as solutions often carry historical ad’ hoc uses, such as the use of special fields and codes to reflect a particular decision or patient outcome.

Electronic Records too

Converting this information into a standardized data field that all use the same way with the same understanding can me a major overhaul of the practices and processes, possibly requiring in-depth training of the entire staff. A benefit can be for instance the ease of capturing information on a mobile station and having it uploaded immediately instead of waiting to do a mass upload back to the nurse’s station. The capacity of those systems to exchange feedback information enabling reporting on their use is key to comply with Meaningful Use requirements and reap all the financial incentives tagged with this recommendation.

Continuous Care and Technology

The emergence of the Continuous Care model has brought new challenges to the care center: the need for an additional layer of integration, exchanging both medical and patient information, but also synching up with events as they unfold. Pre-admission exchanges before patients walk in, monitoring and treatment information while in ambulatory care, dynamic scheduling while on premises including inter-departmental coordination and real-time updates on the outcomes are examples of the level on integration required in the continuous care model.

Continuous care can also involve patient information exchange, such as updates to their schedule, confirmations and other data points. The infrastructure requirements to support such open-ended networking are both complex and sensitive. Complexity comes from the multiple and rapidly evolving devices that need to be interconnected. Sensitivity arises from the multiple accesses from users with all kind of authorities and access rights, especially regarding patient privacy and security.

Preventing unauthorized access, providing immediate access within specific classes and protecting against hostile penetration or sharing of information in a heterogeneous architecture can be a nightmare for technology specialists. The benefits of such headache are huge however: improved cycle times and care, reduction in costs, reduction of errors and misinterpretations, patient experience, better utilization…

Finally, Technology helps manage the entire process, records procedures, creates the invoices and claims and helps manage the entire operations and facilities. As an operational and administrative backbone, technology helps streamline processes and ensures that all details of a process, all patient outcomes and statistical analysis happen in quasi real time.

One IT Function might hide another

The roles of technology in clinical care, patient management, administration and claims management for instance are completely different, as should be reflected in their respective charters. Effective IT performance in a medical environment requires a recognition of the role and optimal performance of the architecture for each function.
Using the same approach, the contribution of information technology and architecture in improvement efforts and innovation projects can vary greatly based on the context. Successful optimization programs combine process improvements, training, information exchange and some sort of historical analysis. Each of these stages should include a technology component, but also consider how using technology differently could accelerate the program benefits.

In a more pro-active move, technology department leaders should propose innovative ideas and changes, not just based on new technical capabilities, but on the goal to achieve superior healthcare value. The natural distaste of technology staff regarding open access to the clinical network (based on legitimate fears of weakening security) should not prevent exploring a connected architecture; the continuous care transformation will mandate an open network regardless the fears of security experts, and finding acceptable solutions is always better than fighting a lost battle.

Technology as an Innovation leader

Technology leadership should actually be at the forefront of new models and new architectures, proposing new capabilities and new architectures that could improve the care of the operations of the care center. Taking the point of view of the patient (patient and evidence based models), the angle of the clinicians (e.g.: clinical excellence or clinical integration) or the charter of operations (e.g.: Hospital Manager, CFO or Medical Director) starts the dialog with other leaders of the care center on terms they can relate to and understand.

Many IT organizations in hospitals and clinics struggle to play a more active role in the overall performance of the clinical center, but adopt the position of gate-keepers of architecture and security instead of analyzing issues from the angle of their constituencies. A typical result includes a breakage of communication and reciprocal second guessing. A more collaborative approach would propose departments and functions with innovative ways of using technology, striking the creative sparks that might trigger a cross-over innovative project benefiting all.

The Four Forces combined

Healthcare value is at the convergence of Patient Experience, Information Management, Clinical Excellence and Operational Performance.

The synergies built combining those forces to achieve Clinical and Operational Excellence is much more than the addition of isolated benefits. Novel ideas and improvement efforts can carry well beyond the boundaries of their launch, but they also can be undermined with other initiatives which unknowingly, could cancel off earlier progress.

Let’s imagine that all clinicians agree on a shared codification of patient outcomes, but the patient integration system does not adjust to capture this information, and a new generation of reporting systems reformat the repurposed field capturing the data. Clinicians might benefit from their shared knowledge, until they find out that the data is no longer available in other systems and that the claims do not carry this information properly.

A more complete Integration

Associating clinical integration patient system and administration of claims to the joint effort would prevent such scenario to unfold. Cross-team collaboration could also enable nurses to bring in their main daily issues with treatment integration and claims management could raise issues with the codification of cases. Over a few cycles of brainstorming, the final scope of the project would encompass some of the grievances from the effort constituencies, and all participants would be aware and in support of the effort.

Business process reengineering best practices recommend expanding the optimization effort across the entire organization, as historical data shows that end-to-end improvements achieve almost twice the benefits of partial stand-alone projects taken altogether. The same happens with the complex landscape of an acute care center. In effect, all departments and functions are inter-dependent of each other, and contribute to the same ultimate goal, which is to deliver patient care in an efficient and sustainable way.

Launching an Improvement Program

The Four Forces model can be used as a rallying banner for all departments and functions, provided that each Force is chartered with specific objectives and mandates. All clinicians for instance can rally behind the “Clinical Excellence” banner, which is likely going to include clinical innovations. What does this mean to a specific hospital? Problems and objectives declared by the Brigham and Women’s Hospital in Boston, MA might share some issues but are predictably going to be different than the concerns raised by a regional hospital center in Louisiana or the Mayo Clinic in Arizona.

Using a matrix model modeled after strategic planning best practices allows defining overall targets and milestones over time. The matrixed representation helps map each effort or team idea to all the key drivers (the Forces) described above, allowing ongoing monitoring of the efforts as they get launched and executed. The first benefit of invoking this model however is that a team working on a business case for an innovation or improvement know from the start how much their idea is aligned with the overall charter, hence how much support they might get when presented for funding.

The second benefit resides in teams which are aiming at the same targets might want to share ideas and integrate, bringing a higher potential for benefits at once.

Manage the Transformation to generate lasting Healthcare Value

Launching a long term effort to improve Healthcare Value is a demanding effort; much less energy, resources and attention might be given to other projects once started. It is therefore important that the overall initiative remains flexible in its guidance, making room along the way for the inevitable regulatory, security and other mandatory projects that might arise. Supporting these new projects which are not necessarily aligned naturally with the Four Forces does not mean giving up on the alignment either: exploring how each project could be combined or expanded to achieve progress against the targets minimizes disruption from the main efforts and help added projects “blend” into the overall improvement portfolio.

Achieving long lasting healthcare value will remain a goal after the main initiatives have been completed and achieved their intended benefits. New obstacles will come up, medical science and technology will make progress in new areas that will require adoption and integration. The merits of keeping the initiative alive is to capture new ideas and new ways to improve the workflows and operations. At some point, the potential for improvement might become too small to justify a large programmatic effort, and might need to be combined to have a sufficient “critical mass” of benefits.

But the collaboration, cross-departmental synergies, and overall alignment with the future healthcare value of the care center will remain, providing daily benefits.

These benefits will better prepare for future challenges, more than trainings or mandates.