As hospitals and health systems face pressure to reduce costs while improving quality of care, clinical variation – the overuse, underuse, different use and waste of healthcare practices and services with varying outcomes – has become a hot topic. The reduction of clinical variation using care redesign strategies is seen by many industry analysts as the next frontier of performance improvement to help hospitals to meet their business goals while maintaining focus on what’s most important – delivering top quality patient care.
Nancy Lakier, CEO, founder and managing principal of Novia Strategies, recently commented on this topic in interviews with leading healthcare publications based on her background and work with hospitals to uncover and eliminate unnecessary clinical variation.
Recently Lakier has published two articles together with Lorraine Yehlen, Vice President of Patient Care Services and CNO, DCH Health System. In the article published in Becker’s Hospital Review, Lakier and Yehlen share how DCH Health System has implemented clinical redesign efforts that have reduced clinical variation. They go on to say, “These efforts have led to higher engagement among physicians and engaged leaders, revenue enhancement, reduced costs and, most importantly, improved quality and safety. As the industry shifts from volume- to value-based reimbursement models, these benefits are fundamental to thriving in a new healthcare era.”
Lakier and Yehlen published another article in the February 2017 issue of HFMA’s Healthcare Cost Containment (download link below). In it, they emphasize “accounting for one-third of total healthcare spending, acute care is still the leading frontier for cost reduction – and where reducing clinical variation can be especially effective.” They go on to share a case study of DCH Health System’s clinical variation initiatives.
In the January 2017 issue of Hospital Peer Review, Lakier points out that while the healthcare community has made strides in integrating their “silos” of care delivery, there is still significant variation in how the same type of patient might be treated by different physicians and that acute care is where hospitals have the greatest opportunity to reduce clinical variation. She also stresses that the clinical standardization must be approached as an interdisciplinary effort, with teams from different disciplines understanding and striving towards a common goal.
“Embedding standardized clinical process into an organization helps keep everyone on the same page,” Lakier says. “Routine protocols take the burden off of physicians to remember every single detail of care.”
She also emphasizes the importance of obtaining solid risk-adjusted data, such as readmission rates, morbidity and mortality rates, which hospitals can present to medical leadership to identify variation among physicians and to engage them in the common goal of standardizing practices to improve care.
Healthcare Informatics also examines the topic of clinical variation in a recent article, “One Expert’s Insights into Reducing Clinical Variation,” based on a Q&A with Lakier in which she provides insight into the role of CIOs and CMIOs in addressing clinical variation.
Ensuring access to a good data set upon which hospitals can draw conclusions about their clinical practices is among the biggest challenges she cites for executives seeking to reduce clinical variation, and that’s also where CIOs and CMIOs can be critical partners in the process. She says they are instrumental in evaluating and discerning systems and vendors that can provide the data analytics that are needed to make clinical redesign successful.
Furthermore, she emphasizes the key role of the IT department in operationalizing and executing the strategic plan of the hospital as a whole. The IT department can be a partner in driving meaningful change by ensuring they have flexibility in their operations and can be responsive to changing clinical needs. They also can take disparate data sets and put in “crosswalks” to link these systems for current needs and with the future in mind.
Above all, Lakier suggests that hospital executives and their IT departments simplify their processes and planning wherever possible and to be pragmatic about can be done with realistic, attainable goals.