Blog Post

3 surprising ways health systems are scaling care variation reduction

October 2, 2017

    As Advisory Board's Senior Director for Care Variation Reduction (CVR), I interact with a national cross-section of CMOs on a weekly basis. Many are now being held squarely accountable for generating 3-year cost savings of up to $300M by minimizing unwarranted variation in clinical practice. As a result, my time is increasingly dedicated to helping member organizations across all stages of this journey, from those just beginning to put CVR governance in place, to others in full flight rapidly implementing new clinical standards every quarter. Despite varying backgrounds and approaches, there is one challenge they all have in common—figuring out how to scale and sustain this process year over year.

    We recently invited 11 health systems that are at the leading edge of CVR to reflect on what has worked so far, what hasn't, and what emerging challenges they foresee. Here are three noteworthy insights from their discussion on CVR success that all leaders should apply at their organizations:

    1. Add process design and finance experts to your clinical leadership team.

    When assembling a clinical consensus group or council, most typically look for skilled clinical leaders with a proven trusted advisor status among their peers. While this is the right starting point, leading organizations go one step further by urging these committees to think beyond 'consensus' and expand their scope to 'implementation' of new clinical standards into day-to-day practices. For example, Memorial Hermann Health System breaks down siloes that typically exist between clinical, financial, and process management functions by formally bringing experts from the latter groups into the previously exclusively clinical leadership groups.

    Recommended Leadership Triad for Reducing Care Variation

    2. Minimize physician involvement in designing standards for routine care.

    There is no denying that physicians must play a central role in care standardization. Yet, their time and mindshare are at a great premium as evidenced by a mere 14% of physicians reporting they have enough time to provide a high standard of care, according to The Physician Foundation's 2016 survey. This poses very real constraints on how much time organizations can ask physicians to dedicate to CVR efforts without risking disengagement—or worse, burnout. Texas Health Resources has found an elegantly simple solution to strike this fine balance. They have divided all of their care standardization efforts into three tiers based on their clinical complexity and level of clinician intervention needed. Physician time is preferentially reserved for the most complex tier, which focuses on condition-specific care such as designing a congestive heart failure (CHF) pathway. Physicians are not involved in routine care process standardization such as vital signs capture.

    Laddering Physician Involvement in Standard Setting at Texas Health Resources

    3. Account for frontline workflow realities early in the design process.

    I repeatedly hear how organizations have spent months, even years, developing certain care standards with the highest possible clinical rigor, yet still struggle with adherence when the guidelines reach the frontlines. Upon digging deeper, we almost always find that the design team did not factor in the existing clinical practice impacted by the new standard. Unless the new standard maps accounts for existing hardwired behaviors and practices, it serves only to confuse the frontline staff, which leads to the all too familiar end result of further frustrating and alienating clinicians. Banner Health System includes frontline representatives from various care team roles as well as staff from informatics and data teams early in the design process in order to account for operational aspects of frontline realities before the clinical standard is set in stone. This helps them 'go-to-market' with a much more frontline-ready standard than most organizations do.

    Leading Health Systems Frontload Workflow Mapping in Standard Design

    Get more CVR insights from leading health systems

    Whether you are early in your care standardization journey or a veteran of many years, these considerations can help scale your processes and hardwire sustainable practice change across your organization.

    For a deeper look at these and additional insights that emerged from this dialogue, read our Executive Briefing, "Ten Insights on Reducing Care Variation from Leading Health Systems."

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