Despite the promises of clinical standardization as "the next frontier" in reducing variation and unnecessary spending, progress has been slow. An industry survey found only a modest increase in the rate at which patients are treated according to guidelines, from 35% in 2006 to 50% in 2011.
To continue to reduce unwarranted variation and ultimately, unnecessary costs, hospitals and health systems must go beyond establishing clinical standards and create protocols that improve compliance.
Three common barriers to clinical standardization
Organizations attempting to establish and enforce clinical standards often run into three challenges:
- Lack of visibility into relevant clinical performance data
- Inefficient clinical processes
- Inadequate and unsophisticated enforcement mechanisms
While hospitals and health systems often attribute an enterprise-wide approach and physician collaboration as the keys to success in promoting clinical standards, we've found that the most successful strategies share three additional characteristics: performance transparency, protocol flexibility, and real-time clinical monitoring.
Using data to address non-compliance
To gain visibility into physician variation in LOS and costs, Robert Wood Johnson University Hospital partnered with Crimson Continuum of Care.
Using this data, Robert Wood Johnson's CMO started to meet regularly with providers whose practice patterns reflected unwarranted use of specific clinical services.
During the meetings, the CMO reviews the clinical and financial impact of the physician’s care decisions and discusses the physician’s practices in relation to a peer group. Then, to enable practice pattern changes, the CMO explains the proper use of protocols and coaches the physician at the point of care using a sophisticated analytical platform that monitors real-time performance.
These conversations required extensive preparation and analytic support, but taking the time to improve physician practice in person helped Robert Wood Johnson save nearly $2 million in one year.
Accounting for reasonable differences
Deviation from clinical standards isn’t always accidental. In some cases, providers disagree with—and knowingly violate—the standard.
The most successful clinical standardization programs develop standards that include enough flexibility to account for reasonable differences in patient conditions and how providers manage them.
IndiGO, a technology solution based on the Archimedes model, uses patient-specific health information and a proprietary algorithm to customize care plan recommendations at the point of care. The program accesses data from EMRs, disease registries, and data warehouses. As a result, IndiGO provides recommendations that are informed by care standards but sensitive to nuances of individual encounters, yielding a higher likelihood of physician compliance.
Ensuring compliance with real-time clinical monitoring
While performance transparency and protocol flexibility can help build a solid foundation for clinical standardization, real-time, technology-enabled clinical monitoring ensures the highest degree of compliance.
Sentara Norfolk General Hospital uses eICU technology that allows its most experienced clinicians to serve as coaches at the point of care. Clinicians using the eICU can seek advice from experienced specialists in real time; eICU specialists observe patient-provider interactions and make recommendations remotely at the point of care.
To learn more about clinical standardization, Health Care Advisory Board members can read our best practice, "Evidence-Driven Clinical Compliance," from our study, The Sustainable Acute Care Enterprise.