Making it Sustainable: Clinical Variation Management
Fueling Growth with a Governance Structure That Drives Sustainable Clinical Performance Improvement
While care variation reduction projects offer numerous benefits — including reducing length of stay, improving quality of care and the patient experience, and reducing the cost of care — they can be difficult to sustain. To maximize these benefits and deliver sustainable, long-term results, a governance structure that provides relevant and timely data to the appropriate individuals is key.
Involve the Right People
Individuals involved with the project must have clearly defined responsibilities for managing the implementation and sustaining improvements. These individuals must be passionate champions of the work and believe in the overall mission behind it.
Provides oversight, vision and strategic direction, has decision-making authority, prioritizes and charters initiatives, and selects strong clinician champions to lead the work
Sets strategy and direction, removes barriers, recommends and enforces key policy decisions, and facilitates communication
Interdisciplinary Initiative Team
Designs a multidisciplinary standard of care and other cross-clinical workflow changes including reviewing policies, supporting communication of changes and escalating issues, and offers recommendations regarding key functional areas including clinical operations
Initiative Champions (Physician and Nurse)
Serve as the clinical content experts and work to lead change within their disciplines
Provides project management support, data analytics and meeting facilitation to initiative team
Analyze the Right Data
Initiatives should be designed around outcome and process metrics.
- Outcome metrics should be reported monthly to the Steering Committee to drive accountability for the initiative teams. Examples of outcome metrics include:
— Length of stay
— Cost per case
— Readmission rate
- Process Metrics are predictive of lagging outcome metrics and are measure the change in specific processes. They are unique to an initiative and are best reviewed both retrospectively and as close to real time as possible.
- Clear approval and accountability processes, including approval at clinical leadership meetings, that typically culminate with the Medical Executive committee
- Regular review of outcome metrics at executive and steering level meetings which incorporate unit, service line and physician level drill downs
- A real-time review of process metrics, with an associated escalation process for all disciplines, that aims to impact patients while they are still in house
- Regular review of process metrics at initiative team meetings as well as unit and service line meetings to keep driving forward day-to-day behavior change
Develop the Right Processes
Clear processes that provide the right data to the right people — those who are in roles to make change — are critical in sustaining care variation improvement and identifying needed changes.
Benefits of Sustainable Clinical Performance Improvement
- Improves quality
- Reduces length of stay
- Lowers readmission rate
- Increases patient satisfaction
- Cuts costs today to fund projects that support the business of tomorrow
- Reduces patient length of stay, thus increasing capacity or reducing labor costs
- Improves resource management for tests, treatments, blood products, drugs and supplies
By establishing a governance structure before beginning their journey to minimize care variation, organizations will create new delivery models that are not only innovative, but sustainable.