In a recent post, we talked about the value of applying the quality improvement principles of Lean to today’s value-based care environment. As hospitals work toward achieving the Triple Aim—enhancing the patient experience, improving population health and reducing the cost of care—Lean is helping them remove waste, achieve quality and efficiency, and develop a culture dedicated to continuous improvement. But not every hospital or physician practice that adheres to the Lean approach is successful in achieving those goals. And it’s usually because they’re making one or all of these mistakes.
Mistake: Not sticking to the strategic plan
Who hasn’t gone to a conference and gotten fired up about a new idea? But resist the urge to come back home ready to implement it, says Faith Jones, MSN, RN, NEA-BC, director of care coordination and Lean consulting for HealthTechS3.
“There are all kinds of new concepts out there and new ideas to implement,” she says. “But it’s important not to get distracted. If you have a thoughtful strategic plan and stick to it, quality improvement will happen continuously, one step at a time.”
Mistake: Not staying on top of technology
That sales pitch to clinicians that EHRs wouldn’t have to change how they work? “That was a lie,” Jones says. What’s more, she says, the initial implementation and the many headaches that accompanied it caused many users to have a case of the sour grapes—even today. The issue is exacerbated every time an EHR vendor releases an update. “Instead of understanding how the update can improve their workflow and get them closer to their goals, their main concern is, ‘Did anything break? Can I keep doing what I’m doing?’”
But one of the central tenets of the Lean approach is workflow improvement, and that’s exactly what these updates are designed for. By ignoring the new capabilities, organizations will stay stuck in the past, using outdated methods that take too long and don’t give them the data needed to make clinical QI a reality.
“Even if your hospital doesn’t have a full IT department, it’s important for someone to spend some time with the update and understand how it can improve your processes.”
Mistake: Not forging the right partnerships
Whether it’s an internal relationship that needs to be strengthened or one between care partners, Jones says the right partnerships can go a long way toward achieving a specific clinical QI initiative. For reducing readmissions, for example, Jones says she sees too many hospitals trying to tackle the problem on their own. “There’s no reason hospitals should be attempting to coordinate a patient’s care days and months after discharge,” she says. “Primary care providers have the infrastructure for care coordination and they can be reimbursed for it. Instead of duplicating their efforts, hospitals need to be making a greater effort at building relationship with the care coordinators at physicians’ offices.” For more on this topic, check out the HealthTechS3 webinar, Implementing Care Coordination: Partner to Remove the Barriers.
Mistake: Thinking too much about the numbers (and not enough about patients)
With any quality improvement initiative, it’s easy to see success through the lens of key performance indicators, but it’s important to strike the right balance between metrics and the actual patients.
In CMS’ proposed rules for 2020, which Jones was reviewing when we interrupted her for this interview, the agency draws attention to care coordination and its ability to reduce the overall cost of care and improve patient satisfaction. But, CMS also points out that only 9% of eligible patients have received this important benefit.
For hospitals looking to improve their HCAHPS scores, making sure their patients are receiving care coordination services after discharge should be a priority. This is just one way that hospitals can be more patient-centered, Jones says. “Looking at things from the eyes of the patients can help not just with patient satisfaction, but also patient outcomes.”
Jones recommends assembling a patient advisory council, composed of past patients who can occasionally give the hospital input on various topics. “It’s not enough to just pay attention to the complaints,” she says.
Mistake: Not connecting the dots
Focus groups are a great place to find qualified candidates for patient advisory councils, but conveners of these groups don’t need to reinvent the wheel. “Focus groups are already a requirement of the Community Health Needs Assessment,” Jones points out. “We get so busy that we do all of these things separately or see them as regulatory boxes to be checked off. But by not connecting the dots, we’re not able to see the bigger picture of how all of these different pieces fit together to improve care.” Need help identifying and implementing clinical QI initiatives for your healthcare organization? For more information or to get started, email Jones at faith.jones@HealthTechS3.com.