Operating Room Efficiency: driving improvements with the use ...

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OperatingRoomExcellence:HowOneHospitalSystemisDrivingImprovementswiththeUseofAdvancedAnalytics April16,2015 Postedin Leadership,Culture,Governance,andEquity ArticleSummary MissionHealthinNorthCarolinahasalwaysbeendedicatedtoexpandingaccesstocare.Topreservethiscommitmentinaneraofdecliningreimbursementrates,Missionneededbetteraccesstodataforquickandflexibledecision-making.Asatmosthospitals,operatingroomsareMission’sbiggestrevenuegenerator,buttheyalsorepresentasignificantcostcenter.So,leveragingtheirnewanalyticscapabilitiestodriveoperationalimprovementsacrosstheirsystemofoperatingroomswasastrategicopportunity.MissionnowhasimprovedabilitytodrivecareandoperationalimprovementswithintegrateddataandanalytictoolsliketheirORDashboard—resultingindramaticimprovementsincludinga20%increaseinfirst-caseon-timesurgicalstarts. Jumpto: THEOPERATINGROOM:ACLEAROPPORTUNITYFORQUALITYIMPROVEMENT THEDATA-DRIVENSOLUTIONFOROPERATINGROOMEFFICIENCY Downloads OperatingRoomEfficiencyDrivingImprovementsWithAdvancedAnalyticsDownload Upnext: UsingAdvancedAnalyticstoManagePopulationHealthinPrimaryCareClinics Improvedabilitytodrivecareandoperationalimprovementswithintegrateddataandanalytics20percentage-pointincreaseinfirst-caseon-timesurgicalstarts85percentreductioninstaffhoursrequiredfordatapreparationandreportingDroveculturaltransformationthroughengagementatalllevelswithintheorganization Whetherprovidingschool-basedhealthcaretohelpstudentsbehealthierandbetterlearners,orextendingprimarycarehoursatareapracticestorelievehospitalemergencydepartmentwaitingtimes,MissionHealthinNorthCarolinahasalwaysbeendedicatedtoexpandingaccesstocare.Topreservethiscommitmentinaneraofdecliningreimbursementrates,Missionembarkedonastrategicjourneyitcalls“Missionre:DESIGN.”Thehealthsystem’sgoalwas(andremains)nothinglessthanaradicalredesignofclinicalprogramsandprocessessothatpatientsreceivethebestpossiblecareandexperiencewithzerowasteandharm. Toachievesuchexcellence,Missionneededbetteraccesstodatatoenablequickandinformeddecision-making.Andforthat,thehealthsystemwouldneedanintegrated,singlesourceoftruthtosupplytimelyandreliabledata. THEOPERATINGROOM:ACLEAROPPORTUNITYFORQUALITYIMPROVEMENT MissionHealth’s47operatingroomsarethehealthsystem’sbiggestrevenuegenerators,accountingforasubstantialshareofrevenueandcost.Thus,knowingthatimprovedaccesstodata-driveninsightintobaselinemeasurementandopportunitiesforclinicalandoperationalimprovementscouldaffectrealchangefortheorganization,Missionidentifiedsurgeryasanearlyprioritytoleverageanalytics. Aswithmosthospitals1,theefficientuseofMission’soperatingrooms(ORs)wasparamounttotheentireorganization’sfinancialsustainability.Inareviewofpotentialefficiencyimprovementopportunities,Missionidentifiedschedulinganddelegatingresourcesasthecriticalfirstareasoffocus. AlthoughMissionhadautomatednumerousprocessesovertheyears,adailysurgicalworkflowdashboardwasnotyetoneofthem.Instead,thehealthsystemreliedonamanualdata-preparationprocessfrommultipledisparatesystems—whichwasinefficientfromatimingperspectiveandcarriedtheriskofpotentialdataqualityissues.Pullingdatafromdifferentsystems—aboutfiveintotal,includingtheEHRandrawbudgetfile—andgeneratingoperationalreportsforMission’ssystemofORsconsumednearlyhalfafull-timeemployee(FTE). Despiteallofthisdedicatedtimeandeffort,manydatagapsexisted.Itwasdifficult,ifnotimpossible,tomakequality,financial,andoperationalimprovementdecisions—especiallywithlimitedabilitytoquicklymakechangestoqueries,suchasdrillingdownintothedata.Forexample,Missionwasunabletofocusinonspecifictimeperiodstoseewhichcasesweredrivingdelaysandotherissueswithscheduledsurgeries. Newtoolsfordecision-makingintheOR Anemergingbestpracticeamongleadinghospitalsismakinguseofanoperatingroomdashboard,adata-richtoolthathelpscliniciansandadministratorsmaketherightcallonallocatingvaluableresources. Italsohelpsidentifyareasforefficiencyimprovements—and,notsurprisingly,oneofthemostprofitableareastostartimprovingiswithfirst-caseon-timestarts.AsmostwhohaveworkedintheORknow,whenthefirstsurgicalcaseofthedayisdelayed,therestofthedayistypicallyimpactedwithaseriesoflatestarts,aswell.Amongthechiefreasonsforthefirst(andsubsequent)delaysislackoftimelyandcomprehensivedataabouteachofthesurgeriesscheduled.AnautomatedworkflowdashboardcouldimprovevisibilitytothisinformationinandoutofMission’soperatingrooms. Ofcourse,technologyalonewouldnotfullydriveimprovementtomeetqualitygoals.Inthetypicalhospitalenvironment,manydifferentemployeesanddepartmentshaveastakeintheOR’slimitedresources,andtoembracetheuseofananalyticalORdashboard,allmustbecommittedtodata-drivendecision-making.Forthattohappen,Missionneededtodriveaparadigmshiftthroughouttheorganizationtoembraceanevidence-basedculture.Thehealthsystemwouldneedtoeducateandencouragepeople,atalllevels,ontheuseandvalueofdataautomationandactionableinformationtomakebettercareandoperationaldecisions. THEDATA-DRIVENSOLUTIONFOROPERATINGROOMEFFICIENCY Todeployanalyticsthatwouldhelpmakelastingimprovementsintheoperatingroom,MissionimplementedtheSurgeryWorkflowOperationsDashboardandLate-BindingEnterpriseDataWarehouse(EDW)platformbyHealthCatalyst.TheEDWaggregatesdatafromsourcesystemsthroughouttheorganizationtocreateasinglesourceoftruththatfeedstheORdashboardandotheranalyticalapplicationsbeingdeveloped. Mission’sSurgeryWorkflowOperationsDashboardwascustomizedtomeetthehealthsystem’sneeds.Itstopfeaturesinclude: Clearmetricsthatalignwiththeorganization’sgoalsandobjectivesIntuitivelydisplayedinformationforquickexplorationandinsightSummaryviews,trends,anddrill-downcapabilitiestofilterintogreaterdetailonindividualmetric Figure1.SampleORDashboardsummaryvisualization Withnewanalyticalcapabilities,stakeholdersacrossthehospitalcanmoreconfidentlymakesounderdecisionsaboutoneofthehospital’sbiggestrevenuegeneratorsandcostcenters,theoperatingroom. Figure2.SampleORDashboardfirst-caseon-timestartdrill-downvisualization Topromoteadoptionofthistechnologyandrealizethevalueofself-serviceanalytics,thehealthsystemassignedasmallworkteamtocollaborateoncustomizingtheapplicationandeducatingendusers.Thisdesignatedworkteamcontainedrepresentationfromkeystakeholders,includingseniorandmid-leveladministrativestaff,andfront-lineemployeesdirectlyengagedindrivingqualityimprovementsintheOR.AstheteamrollsouttheORdashboardtoadditionalhospitalsintheirorganization,theirobjectiveswillinclude: ProvideuserswithadeepunderstandingandofthevalueofthedataPresentinformationfromaclinician’sperspectivetodemonstratehowthedatacouldbeusedtoimproveprocessesforbetteroutcomesShowhowself-serviceanalyticaltoolsreplacetediousandinefficientmanualprocesseswithmoremeaningfulinformation—andmoremeaningfulwork RESULTS Atlast,Missionhadvaluableanalyticsathandtodrivemajorqualityimprovementsincriticalareas.Theresultsweresignificant: Improvedabilitytodrivecareandoperationalimprovementswithintegrateddataandanalytics QuickimplementationoftheEDW—whichaggregateddatafromsixdatasourcesinjustninemonths—providedasinglesourceoftruthtoguideimprovementefforts.TheORDashboardrunningontheEDWplatformdeliversdrill-downanddatavisualizationcapabilitiesthathelptheORteamidentifyimportanttrendsandpotentialgaps.ThissinglesourceoftruthnotonlyresolvespreviousconcernsaboutthecompletenessandqualityofthedatausedforORanalytics,italsodeliversdataupdateswithoutrequiringsomanyvaluableresourcestocollectandreportout.Thistimelyprocesssupportsquickandflexibledecision-making. 20percentage-pointincreaseinfirst-caseon-timesurgicalstarts Increasedaccesstocompleteanddetailedinformationprovidedunprecedentedvisibilityintothekeydriversforfirst-caseon-timesurgicalstarts.InsightfromtheORDashboardenabledmonitoringoftwokeyareastoaddressinordertoimprovethisimportantmetric:doctoron-timearrivalandreadinessofORequipment.Effortstoaddressthesetwoareashaveresultedindramaticimprovement—20percenttodate.Theteamreviewsthisdatadailytoassessimpactofinitiativesandidentifyopportunitiesforcontinuousimprovement. 85percentreductioninstaffhoursrequiredfordatapreparationandreporting ThepreviousmanualdatapreparationandreportingprocessrequirednearlyhalfanFTEtomaintainandaccommodate-offreportrequests.And,inmanycases,reportingrequestscouldnotbemetatallbasedonthetimerequiredtomeettherequestortheinabilitytoaccessthedataneeded. Now,dataautomation,poweredbytheEDWandanalyticalapplications,hasreducedstafftimesignificantly.LessthanatenthofanFTEfromadataarchitectisneededtosustaintheautomatedreportingprocess.Teammemberscannowfocusonanalysisandenhancingtheanalyticalplatform,benefittingboththeorganizationandtheemployees. Droveculturaltransformationthroughengagementatalllevelswithintheorganization Staffquicklyrecognizedthepotentialofthenewanalyticalapplication,thankstodedicatededucationandtrainingfromtheimplementationteam.Inadditiontodetailedtraining,internalsocializationofORdashboardsuccessestodatehashelpeddriveacceptanceandadoptionofthenew,data-drivenprocesses.Staffhave,infact,madetheORdashboardanessentialcomponentoftheireverydaywork. Thefactthatthesolutionpresentsinformationfromaclinician’sperspective—showinghowthedataimprovesprocesses,whichthentranslatestoimprovedoutcomes—hasbeenkeytoengagingcliniciansandestablishingadata-drivenculture.Self-serviceanalyticaltoolsmadeavailabletoalllevels,fromleadershiptocliniciansonthefrontlinesofsurgicalcare,alsoincreaseengagement.Suchdatatransparencyandeaseofaccessempowersuserstoidentifyimprovementopportunitiesandmakedecisionsthatenhanceclinicalandoperationaleffectiveness. “Becauseofthegrowingcomplexityanddemandsofthehealthcareenvironment(e.g.,clinicalcare,operations,regulatoryenvironment,decliningreimbursement,andtheneedtocontrolcosts),everyhealthcareorganizationneedsaccesstogooddata.WiththeimplementationofourEDWwenowhaveatrulyintegrated,singlesourceoftruthtosupportthebestpractices,careprocessmodels,andpopulationhealthmanagementthathealthcarewillonlyrequireevenmoreinthefuture.”–JillHoggardGreen,Ph.D.,RNChiefOperatingOfficer WHAT’SNEXT “Missionanticipatesa$5-7millionsavingsopportunityintheirORsupplychain,withtheORdashboarddeliveringtheinsightneededtodrivethesesavings,”saysJonBrown,VicePresident&AssociateChiefInformationOfficer.Withaneyeonremovingsimilarwasteandredundancyinotherdepartments,thehealthsystemhasestablishedteamstoleverageadvancedanalyticstoimprovecareinkeyareasincludingC-section,heartfailure,sepsis,andnewborn.Permanentworkteamsarebeingputinplacetodriveengagementindata-drivenimprovementinitiatives,aculturalshiftthatisprovingbeneficialtoMission.Additionally,workisunderwaytostandardizedatadefinitionsandtheframeworkforconsumption. As“Mission:reDESIGN”marchesintothefuturewithenhancedprocesses,qualityimprovementswillalsomoveforward,ablyassistedbyanalyticsandadata-drivenculture. References Park,KyungW.M.D.,M.B.A.,Smalzt,Detley,Ph.D.,McFadden,David,M.D.,Souba,Wiley,M.D.,Sc.D.,Ph.D.(2010).TheOperatingRoomDashboard{Abstract}.JournalofSurgicalResearch.164(2),294-300. ABOUTHEALTHCATALYST HealthCatalystisamission-drivendatawarehousingandanalyticscompanythathelpshealthcareorganizationsofallsizesperformtheclinical,financial,andoperationalreportingandanalysisneededforpopulationhealthandaccountablecare.Ourprovenenterprisedatawarehouse(EDW)andanalyticsplatformhelpsimprovequality,addefficiencyandlowercostsinsupportofmorethan50millionpatientsfororganizationsrangingfromthelargestUShealthsystemtoforward-thinkingphysicianpractices.Formoreinformation,visit healthcatalyst.com,andfollowuson Twitter, LinkedIn, and Facebook. 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