WHITE PAPER How to Start a Clinical Optimization Program Amitav Hajra Director, Inpatient Services Hayes Management Consulting
Background Electronic medical record (EMR) implementations have skyrocketed. However, so has user frustration. When there are usability issues, it can lead to low return on investment, decreased productivity, and provider/staff/patient discontent. If this is happening in your organization, it s time for clinical optimization! My definition of clinical optimization is the process of improving patient care by streamlining access to data, facilitating clinician collaboration, refining processes and strengthening outcomes. This white paper will take you through the first critical steps to creating a clinical optimization program. Steps to Building a Clinical Optimization Program Decide to optimize as an organization. This is an organizational decision, not an IT project. The EMR, for example, is just one component. Optimization requires workflow improvement, strong management, and organizational transformation. It requires close collaboration between all divisions of your organization, including IT, clinicians, quality management, revenue cycle, patient access, operational management, and the business office. For this reason, senior leadership needs to be involved in the strategic decision to start a program of clinical optimization. Once senior leadership has made the decision to start, I highly recommend that a senior executive sends the message to all staff. I also recommend having an optimization kickoff party that includes attendees from all parts of your organization. Now, everyone will know and realize they are part of it. Create a governance structure: A good governance structure is the foundation for the clinical optimization project. All your EMR optimization efforts should fall under a single governing body, and this group should represent key stakeholders from various areas of your organization, including a senior management representative(s). Suggested members include representatives from nursing (med-surg, OR, and ICU areas), quality management, ancillary departments (lab, radiology, OT/PT), procedural areas (cath lab, GI), IT, HIM, and patient access. Superusers and physician champions are also critical team members. A good governance structure will help your optimization initiative by ensuring that it is: Aligned with your organization s mission, strategic objectives and other initiatives Not blocked by lack of decision-making power In the best interest of the entire enterprise, not just a few silos Define the mission and scope: It is important to hammer out your optimization goals. One of the reasons optimization efforts fail is that the team has tried to do too much and has spread itself too thin. This leaves everyone unhappy. The optimization team feels overworked and pulled in a dozen different directions. The clinicians feel that their specific optimizations are not receiving enough focus. Management is not seeing results. Without a clear mission and scope, optimization efforts can become unmanageable. To avoid this trap, you need an optimization mission statement. This mission statement should include the overall purpose of your optimization work and how it aligns with and supports your organization s strategic goals. It should also include metrics for quantifiable results. Page 2
The mission can vary between healthcare organizations. For example, one organization I worked with wanted to reduce variation but even those two words meant different things to different stakeholders, i.e., variation in patient wait times, quality measures, etc. Whatever your mission statement may be, it is critical have to have one, and have your actions and those of your senior leadership back it up. Will your optimization work be focused on increasing quality, enhancing revenue, supporting the organization s strategic goals, or something else? How big will its impact be to the organization? Identifying specific, objective metrics will help enormously to justify your mission and scope. Publicize your optimization mission statement throughout the organization so that your user community is aware of your priorities. Establish your work teams: Although not entirely an IT initiative, clinical optimization does require significant IT resources. These resources should be almost 100% dedicated to the optimization project and report to the optimization project manager. I am a strong proponent of creating an actual job position called Optimization Analyst. Dedicated resources will help you make measurable progress. It is very easy for IT issues to derail an optimization effort, which is ironic, since the optimization will usually mitigate many of the IT issues. Put the right people in the right roles. An analyst who is good at implementations may not be good at optimization. In a time of increasing IT specialization, particularly with EMR, clinical optimization still requires the skills of an experienced generalist. The ideal clinical optimization analyst should have both technical knowledge and clinical workflow experience and be able to deal with complexity and uncertainty. The person should have the patience and empathy to interact with (sometimes angry) clinicians and translate their requests/complaints into clear change requirements and specifications, and the initiative and drive to see these requests through to completion in the face of competing tasks and distractions. All of this takes analytical skills, enthusiasm, excellent judgment, curiosity, initiative, patience, and strong communication skills. The optimization analyst must be a strong advocate of the EMR as it currently exists, but at the same time envision how the system can be improved for the future. If this sounds like an exceptional set of skills to find in one person, that s because it is! The truth is, you will not find all of these traits in an individual. Instead, plan to create the optimization team from a diverse group of people whose strengths are complementary. Optimization is best played as a team game. Create a project plan with roles and deadlines: Your dedicated resources are probably needed for a dozen other projects. It is important to stick to deadlines so that others can use the resources and you can fully utilize your team s time. You don t want to lose your analysts in the 11 th hour or find they ve been doublebooked! To avoid any surprises, it is critical to have a documented project plan for your optimization work. The project plan should include four basic elements: 1) the project goal(s), 2) the resources, 3) the tasks needed to accomplish the goals, and 4) the time allotted to the tasks. Unfortunately, your EMR vendor probably will not have an optimization project plan that you can use as a starting point, so you will need to create this from scratch. Where should you begin? I use the three Ps to guide my thinking: priority, people, and process: Page 3
Priority: What goal must absolutely be met for the project to be considered a success? Your optimization project may have several goals, but you should determine which one is the priority. The project priority should be aligned with your overall optimization mission and scope and be consistent with the other project goals. Establishing the top priority for your project will set the direction for the rest of your project planning. For example, your optimization mission might be to improve clinical outcomes. The project goals might be, Within the next three months, create a provider dashboard that 1) is easy-to-use, 2) displays key quality metrics by individual provider and, 3) can be updated with future metrics. Of these three goals, you may decide that the project s priority is easy to use. The reasoning behind it is this: if the dashboard is not used, no one will even see the quality measures. People: In addition to the skill sets previously mentioned, you also want team members to work well together. A clear project priority can help. For example, if your priority is to update a large set of basic clinical content (such as medications, procedure orders, documentation templates), you may want to have a team of heads down people work on the project; that is, people who are good at putting their heads down in front of a computer and working diligently and efficiently on updating records. Build good communication processes into this team by having everyone update a central status report at agreed-upon times. On the other hand, if your priority is to simplify a difficult clinical workflow, then you want to have heads up people who are keen observers of clinicians and clinical workflows. Good communication would consist of using observations and input from clinicians to generate a design specification document that can be validated by the appropriate stakeholders. Once you know who will be on your project team, you can start documenting your project plan by listing your project resources down a single column of a spreadsheet. These resources could be the actual names or placeholders for the necessary skillsets (such as Network Analyst, Physician Contact, or Clinical Team Leader ); to be named later. Process: Now that you have your resources, you need to document what they are going to do. Make a Tasks column to the right of the Resource column. Divide the tasks into three broad areas: 1) governance (including communication), 2) technical work, and 3) operational activities (including end user training). For each of your resources, go through each work area and list the appropriate task along with the task duration dates. Resource Tasks Build (Week 1-2) Alice Testing (Weeks 2-4) Bob Build (Week 1-2) Clara Testing (Weeks 2-4) David Testing (Weeks 2-4) Training (Weeks 5-6) Next, plot out each task along the resource s row, with each column corresponding to a week of the project: Page 4
Resource Tasks Week 1 Week2 Week3 Week4 Alice Build (Week 1-2) Testing (Weeks 2-4) Build Build Testing Testing Testing Bob Build (Week 1-2) Build Build Clara Testing (Weeks 2-4) Testing Testing Testing David Testing (Weeks 2-4) Training (Weeks 5-6) Testing Testing Testing Now you have a (very) simple Gantt chart of your project. It still needs some work, of course. For instance, in the example above, Alice may be overbooked in Week 2, in which case you would either shorten her build or testing time or add additional resources for that week. You will also probably want to consolidate the duplicate tasks, and color code the different types of activities so that it is clear who is doing what in any given week. Communicate your successes: Optimization results are exciting because they are measurable and they make staff members work easier. Communicate the results of the work you have done so far in your organization s newsletter, emails, etc. and get everyone excited. This will also improve the EMR adoption rate! Recording your successes can also be a morale-booster for your optimization team. When I worked as a director of clinical optimization, I used to keep a list of all my team s optimization results. One year, the team had more than 300 successes, ranging from the small and simple (create referral reports for the physical rehabilitation department) to the large and complex (reduce admission documentation time by 50%). You should have heard the cheering when I unscrolled that list during our team s year-end celebration. A Worthwhile Challenge Creating a clinical optimization program is a challenging task, but if done right, has significant quantitative and qualitative rewards. It can set your organization ahead of its competitors, make patients smile, and improve staff and physician satisfaction. It is important to have senior level involvement, a solid governance structure and a communications strategy that includes the entire organization. An effective clinical optimization program will transform your organization, leading to streamlined access to data, increased clinician collaboration, better processes, and improved outcomes. About Hayes Hayes works with healthcare organizations to increase net revenue and improve patient experience. Hayes was ranked Top Professional Services Firm by KLAS* for four consecutive years (2007 2010), and has received multiple Best in KLAS awards since 2005. Hayes is also ranked in Healthcare Informatics Top 100 and Inc. 5000. Hayes consultants are subject-matter experts in IT strategic planning, clinical and revenue cycle optimization, system implementation and overall operational efficiency. Hayes also offers software solutions to improve efficiency and productivity. To learn more about Hayes services, visit www.hayesmanagement.com or call us at 617-559-0404. *Best in KLAS Awards: Software & Services Page 5