How continuous improvement and technology can produce better care
At Nemours Children’s Health System, clinical experts are engaged in the work of finding better clinical processes, and data helps power their decisions.
As the healthcare landscape continues to evolve in the push toward value-based care, hospitals and health systems are challenged more than ever by the need to continue improving patient care, while simultaneously finding ways to make the effort financially sustainable.
To improve care in the 1980s and 90s, healthcare providers adopted clinical pathways—regimented, task-oriented plans that provided clinicians with steps on how they should treat patients with a specific disease and what those patients should expect. Even early on, the use of pathways was not really successful because of lack of strong evidence, complexity and too many manual steps.
We now we have electronic medical records (EMRs), computerized decision support tools and more sharing of outcomes to potentially meet the aspirational goals we set in the 1980s. However, to make a bigger impact, we need to employ a continuous improvement approach that reduces care variation for patients, improves care quality and minimizes avoidable costs.
At Nemours, we partner with our clinical experts in each specialty area, such as gastroenterology, cardiology and others, to find opportunities for streamlining clinical processes—not just recommending the use of one device over another, but considering new treatment approaches to specific diseases. The specialty groups also identify potential areas of unnecessary variation that would not impact patient care but would improve margins.
The key to this process and these guidelines is that we empower clinicians to develop clinical standards while giving them the autonomy to treat their patients as they see fit. The onus is that if there are multiple ways to accomplish the same outcome, then cost is a major driver. Likewise, if the more expensive option leads to definitive better outcomes, then it should be adopted on a broader scale.
In the past, establishing an evidence base for these practices that were most effective and making these adjustments virtually in real-time would have been extremely difficult. But the adoption of EMRs and the availability of data coming from these medical records have changed everything. Now, we have instant access to data to pinpoint our 30-day readmission rates. We can see exactly how many patients are returning to the emergency room after surgery. All of this helps providers better understand the clinical outcomes of the care we provide. This analysis also gives us the ability to swiftly make adjustments to clinical standards to improve patient care and clinical outcomes while eliminating avoidable costs.
Technology is also helping Nemours Children’s Health System improve care through networks with other providers, such as the Delaware Health Information Network and the National Pediatric Learning Health System (PEDSnet). Specifically, we’re able to more efficiently serve patients whose treatment started at facilities outside of Nemours because we have access to their previous health records, saving patients the hassle of retelling their medical history, while enabling clinicians to focus on care instead of administrative redundancy. These networks also enable us to incorporate the lessons learned from other hospitals into our clinical standards.
All these steps toward continuous improvement would not be possible at Nemours without buy-in from our staff. To breed the necessary culture of change, we intentionally brought clinicians into the process, as we did in developing clinical standards. We also work with the staff to ensure that they are using our EMR system efficiently so that we can pull the data needed to determine that we were on track toward improving clinical care and reducing avoidable costs.
Examining clinical practice and setting care standards used to be taboo in the healthcare industry, but the current climate has made it not only acceptable but crucial to our success. The technologies available to us, as well as the systems for continuous improvement, have opened a door for hospital and health system leaders to drive patient care to the next level.
To improve care in the 1980s and 90s, healthcare providers adopted clinical pathways—regimented, task-oriented plans that provided clinicians with steps on how they should treat patients with a specific disease and what those patients should expect. Even early on, the use of pathways was not really successful because of lack of strong evidence, complexity and too many manual steps.
We now we have electronic medical records (EMRs), computerized decision support tools and more sharing of outcomes to potentially meet the aspirational goals we set in the 1980s. However, to make a bigger impact, we need to employ a continuous improvement approach that reduces care variation for patients, improves care quality and minimizes avoidable costs.
At Nemours, we partner with our clinical experts in each specialty area, such as gastroenterology, cardiology and others, to find opportunities for streamlining clinical processes—not just recommending the use of one device over another, but considering new treatment approaches to specific diseases. The specialty groups also identify potential areas of unnecessary variation that would not impact patient care but would improve margins.The key to this process and these guidelines is that we empower clinicians to develop clinical standards while giving them the autonomy to treat their patients as they see fit. The onus is that if there are multiple ways to accomplish the same outcome, then cost is a major driver. Likewise, if the more expensive option leads to definitive better outcomes, then it should be adopted on a broader scale.
In the past, establishing an evidence base for these practices that were most effective and making these adjustments virtually in real-time would have been extremely difficult. But the adoption of EMRs and the availability of data coming from these medical records have changed everything. Now, we have instant access to data to pinpoint our 30-day readmission rates. We can see exactly how many patients are returning to the emergency room after surgery. All of this helps providers better understand the clinical outcomes of the care we provide. This analysis also gives us the ability to swiftly make adjustments to clinical standards to improve patient care and clinical outcomes while eliminating avoidable costs.
Technology is also helping Nemours Children’s Health System improve care through networks with other providers, such as the Delaware Health Information Network and the National Pediatric Learning Health System (PEDSnet). Specifically, we’re able to more efficiently serve patients whose treatment started at facilities outside of Nemours because we have access to their previous health records, saving patients the hassle of retelling their medical history, while enabling clinicians to focus on care instead of administrative redundancy. These networks also enable us to incorporate the lessons learned from other hospitals into our clinical standards.
All these steps toward continuous improvement would not be possible at Nemours without buy-in from our staff. To breed the necessary culture of change, we intentionally brought clinicians into the process, as we did in developing clinical standards. We also work with the staff to ensure that they are using our EMR system efficiently so that we can pull the data needed to determine that we were on track toward improving clinical care and reducing avoidable costs.
Examining clinical practice and setting care standards used to be taboo in the healthcare industry, but the current climate has made it not only acceptable but crucial to our success. The technologies available to us, as well as the systems for continuous improvement, have opened a door for hospital and health system leaders to drive patient care to the next level.
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