Many organizations start their CVR effort by going after the most contentious conditions, where there is not a clear standard of care nor clinical consensus. At first blush, standardizing conditions for which there is a lot of debate can seem like a good tactic to drum up clinical interest.

However, the bigger—and better—opportunity is to pursue standards where clinical consensus exists, but clinician adherence is lacking. In these cases, most clinicians agree with the widely-accepted clinical guidelines and want to comply, but simply forget the standard or find that the standard too hard to follow. By starting with care standards clinicians already agree on—i.e. the path of least resistance—you can more easily win buy-in for CVR.

Starting with the path of least resistance can also mean standardizing care in an area where there are clear physician champions to help you get quick wins to build organizational momentum for CVR.

To reduce unwarranted care variation at scale, there are certain decisions that have to be held at the system-level—not in siloed pockets across the organization.

The most successful organizations stand up a dedicated system-level oversight committee for CVR that is responsible for ensuring a coordinated approach to CVR across the system, including:

• Setting system-level cost savings and quality goals attributable to CVR
• Prioritizing among CVR opportunities and selecting which to pursue
• Convening clinical working groups to develop care standards
• Allocating centralized resources to working groups
• Evaluating and approving care standards ahead of rollout

Oversight committee membership

The system-level oversight committee should be executive-led and include both clinical and non-clinical executives in order to ensure alignment around CVR goals and resource allocation decisions.

Clinical executives include: the system-level Chief Physician Executive and the system-level Chief Nursing Executive (or senior-most CNO). Non-clinical executives include: CEO, CFO, and CIO or CMIO.

The key is that the system-wide oversight committee stays focused on governance, including setting strategy, prioritizing vision, monitoring key indicators of success, and guiding decision-making for CVR.

To learn more about effective CVR governance structures, access How to build a governance structure to support CVR at scale.

Creating an implementation-ready care standard means ensuring that every step of the care standard is feasible for clinicians to follow. Often, CVR task forces consider their work done once they’ve reviewed internal and external evidence and come to clinical consensus. However, care standards that only include clinical requirements are incomplete, and lack the functional requirements, or “workflow enablers,” needed to implement the standard at the frontline. A comprehensive care standard includes the workflow enablers that clinicians will need to complete each step of the care standard successfully. Common workflow enablers include:

• EHR supports such as alerts, order sets, and fields to document the step
• Equipment and supplies that are both available in the relevant facilities or units, and readily accessible to clinicians at the point of care
• Requisite information to complete the step, such as job aids or checklists to perform the step effectively, or clinical information, such as required lab results
• Care team members or other people who are required to sign-off on the step, supervise the step, or actually perform it

For customizable templates and examples of care standards, access our Toolkit for building implementation-ready care standards.

Clinical expertise is necessary, but not sufficient, to scale CVR. While clinicians are well-versed in clinical evidence and have first-hand experience of workflow realities, they often do not have the non-clinical design skills required to operationalize a care standard. Once clinical consensus has been reached among clinicians, the bulk of the actual design work should be done by internal process experts that have the requisite skills to create implementation-ready care standards.

Five skillsets needed to design care standards

Project management

• Project plan management
• Logistics coordination
• Resource management

Process engineering

• Clinical workflow analysis
• Impact forecasting
• Implementation planning

Data analytics

• Data extraction
• Performance evaluation
• Dashboard management

Clinical informatics

• Electronic health record optimization
• Clinical decision support creation

Clinical education

• Education plan development
• Communication strategy guidance

The good news is that most hospitals and health systems already have this talent internally in project management offices, finance departments, and IT departments. Considering prioritizing internal expertise as you build or expand your design team.

Hospitals and health systems that accomplish the first four imperatives often run into a new challenge: the number of care standards they create far outpaces what their clinicians can feasibly implement into daily practice at any one time.

From an operational perspective, the system-level oversight committees can help prevent this bottleneck by sequencing and scheduling care standard rollouts centrally—taking into account not just other CVR efforts, but all major change initiatives that impact clinicians. Organizing changes on a single, system-wide change calendar allows leaders to identify ‘hot spots’ where frontline clinicians are being asked to absorb too many changes at one time. In turn, leaders can shift rollout dates to accommodate clinician capacity, as well as re-prioritize which new care standards are in development across the system.

But there is also a larger strategic question that leaders need to address when thinking about the pace of CVR efforts: how fast can your organization go after CVR at scale?

Whether you’re starting CVR from scratch or transitioning from an initiative-byinitiative approach to a scaled approach, it’s important to consider whether the timeline for reaching your system-level CVR cost savings and quality goals actually aligns with the resources your organization is willing to dedicate to the effort. Based on our conversations with progressive organizations, the types of organizational resources that determine how quickly organizations can scale CVR include:

• Clearly defined, system-level vision for CVR
• Executive-level engagement
• Frontline clinician engagement
• Dedicated clinical governance
• Functional order set capabilities
• Effective supply chain management

Whether your organization is in a position to sprint towards your CVR goal or needs to extends your CVR timeline to match the resource commitment, the key to successfully scaling CVR system-wide is ensuring the pace matches your organizational commitment to the effort.

To determine whether you have the level of organizational commitment to scale CVR, see Assess your organization�s commitment to care variation reduction.