Setting the Standard For Patient Care

Overview of the clinical standardization opportunity for hospital executives and board

Read this brief to get a conceptual overview of the challenges and opportunities of clinical standardization at provider organizations.

Most organizations have made significant gains over the last decade on the quality front. But continuing on the conventional “quality” path is not sufficient for delivering optimal patient care and capturing share in a market that increasingly values outcomes.

Even organizations that rate high on external measures of quality have opportunities to improve consistency in care delivery across their own facilities, service lines, and providers—improving quality of care for patients and capturing millions of dollars in cost-avoidance ROI. To move forward, organizations need to adopt clinical standardization as their front-and-center quality strategy.

Use this report to educate board members and executives about the pressing need to evolve to a clinical standardization mindset, where organizations can get started, and what they will need to do to create and sustain a consistent level of quality across the enterprise.

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15 insights on clinical standardization

Adopt a clinical standardization mindset

1. By focusing primarily on external measurements of quality, and also considering quality performance separately from strategy and margin, senior executives and board members are underestimating the importance and urgency of reducing performance variation within their organizations.

2. All hospital organizations, including those that already rate high on quality, have opportunities to improve by increasing consistency across facilities, service lines, and providers.

3. Using one’s own best performers to set an organization-wide performance floor will not only raise absolute performance on conventional quality metrics, but also protect margins and secure market share.

Don’t "standardize"—set a standard of care

4. The goal of clinical standardization is not to produce rigid guidelines. It is to establish an evidence- and consensus-based approach that will change and evolve.

5. Nor is the goal to enforce perfect adherence. Providers should be supported in customizing for individual patient needs and innovating in ways that will end up raising the care standard over time.

6. Leaders should be aware that there are two types of variability reduction opportunities: “Vertical,” which focuses on the standard of care for a particular clinical condition or patient population, and “horizontal,” which aims to rationalize use of costly resources that cut across conditions and patient types.

7. Rationalizing resource use (horizontally) is challenging because our understanding of value is often limited; also, a cost-focused approach risks alienating physicians.

8. Creating a standard of care by condition or patient population (vertically) is a more effective way to engage clinicians.

9. Unwarranted variability exists in all clinical areas. But within the realm of acute care services, research has identified a shortlist of high-volume, high-variation conditions—particularly sepsis, heart failure, joint replacement, and labor and delivery (L&D)—that merit particular focus.

Learn from organizations with strong clinical "systemness"

10. Beyond any given clinical area, it is necessary to invest in a strong and credible improvement platform that can accelerate (and keep) gains across clinical areas.

11. Virtually all organizations already have an improvement platform—but few have found a way to ensure that all sites, services, and providers are equally supported (and held to a uniformly high quality standard).

12. The challenge of achieving performance consistency increases with organizational size and complexity—making the multi-facility systems that lead the market on consistency the ones to watch for best practices.

13. Even stand-alone hospitals can learn from the elements of success at highly consistent systems.

14. Replicating best practices from high performers will require rewriting the organization’s DNA. Many diverse organizational components—including strategic goals, leadership structures, and resource allocation—must all be aligned in the same direction to succeed.

15. Only C-suite executives and boards have the power to put in place all the changes needed to set a uniformly high standard of care enterprise-wide.

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