Fu­el­ing pro­duc­tiv­ity

Sort­ing out the met­rics and ef­fi­cien­cies of a com­plex health­care sys­tem Editor’s note: The fol­low­ing is an edited excerpt of the tran­script of a May 25 editorial we­b­cast, “Stay­ing Pro­duc­tive” con­ducted by Modern Health­care. The pan­elists were Peter Knox,

Modern Healthcare - - OPINIONS WEBCASTS -

Joe Carl­son: Peter, how does staff re­spond when you in­tro­duce con­cepts like try­ing to mea­sure cost-to-pro­duce and units-of-pa­tient-careper-day? Are folks re­cep­tive to that?

Peter Knox: They are, and I think that this is bal­anced with a strat­egy around de­vel­op­ing a pas­sion­ate team. We’ve found that peo­ple are—many times in health­care to­day—frus­trated with their work and with their work environment, the in­ef­fi­ciency of their work, with be­ing able to re­ally fo­cus on what’s im­por­tant in the work, the pa­tients or some­one who is serv­ing the pa­tients. So when we en­gage, we’re en­gag­ing in a di­a­logue around, again, the qual­ity of work. We’re en­gag­ing in a con­ver­sa­tion that’s much broader in try­ing to in­volve peo­ple in try­ing to un­der­stand work and cre­ate bet­ter so­lu­tions to the work. So we found that peo­ple are very re­cep­tive to cre­at­ing a bet­ter work environment for them­selves.

Carl­son: Dave, do you have spe­cific met­rics that are used to mea­sure nurse pro­duc­tiv­ity and other mea­sures re­lated to that?

Dave Re­gan: There’s all kinds of met­rics that are used, and one of the things that Kaiser is ex­plicit about and we agree with, is a part of the cul­ture of most af­ford­able and best ser­vice, is a cul­ture of con­tin­u­ous im­prove­ment and data on every­thing. Whether it’s the house­keep­ing depart­ment and how much of an area has to be cleaned in a given day to how long it takes for nurses or other care­givers to re­spond to cer­tain types of sit­u­a­tions. There re­ally is an amaz­ing amount of data, and it’s en­hanced be­cause of the na­ture of Kaiser’s model that be­cause it’s a unique model with a closed sys­tem you get a set of lon­gi­tu­di­nal data that might not be avail­able in other set­tings. … There is al­ways a de­sire to know what the facts are, what’s the data we have, how do we as­sem­ble it and how to we think about it.

Carl­son: Bill, a sim­i­lar ques­tion for you: Is there a stan­dard in­dus­try­wide mea­sure of hos­pi­tal pro­duc­tiv­ity or are there new mea­sures that are be­ing con­sid­ered or that Iowa Health is look­ing at?

Wil­liam Leaver: I think we try to look at how many hours are re­quired to pro­duce what­ever unit of ser­vice we’re mea­sur­ing, and those are pretty stan­dard. You’re look­ing at that across—whether it’s a nurs­ing unit, your phar­macy or your ra­di­ol­ogy—but I think our fo­cus, much to Dave’s point about his ex­pe­ri­ence at Kaiser, is re­ally now about shift­ing to­ward look­ing at … the care of the pa­tient over a long pe­riod of time … But even­tu­ally we’re go­ing to mi­grate to look­ing at how well did we take care of our di­a­bet­ics over the year and did we keep them out of ex­pen­sive set­tings like hos­pi­tals and so forth? So I think our mea­sure of pro­duc­tiv­ity is go­ing to shift pretty dra­mat­i­cally over time and what we fo­cus on will shift as well.

Knox: One of the things that I’m in­volved with at IHI, I’m lead fac­ulty for a pro­gram called Im­pact in Cost and Qual­ity, and we have 42 or­ga­ni­za­tions right now that are en­gaged with us in a year­long ini­tia­tive to re­ally re­duce costs— im­prove qual­ity and re­duce costs. And when you asked the ques­tion: Is there a stan­dard in­di­ca­tor, mea­sure across health­care to­day on pro­duc­tiv­ity, I think the an­swer would be no. Even, I think, health sys­tems and hos­pi­tals are in dif­fer­ent places in terms of their ca­pa­bil­ity to mea­sure things and when we try to come up with a sin­gle in­di­ca­tor in this ini­tia­tive, it was very dif­fi­cult. In fact, we couldn’t do it. That would be the goal, much like we have con­sis­tent, stan­dard­ized qual­ity mea­sures that are well-rec­og­nized. But we’re not there yet.

Carl­son: What tech­nolo­gies have had the big­gest im­pacts, do you think, on pro­duc­tiv­ity?

Knox: I think we have some se­ri­ous con­cerns about in­for­ma­tion tech­nol­ogy and how peo­ple are ap­proach­ing it. I sin­cerely be­lieve that it needs to start with re­design. Work and care re­design. And then we looked at how IT is sup­port­ing that and can sup­port it.

Carl­son: If cost was not a fac­tor, do you think it’s pos­si­ble for health­care providers to have a per­fect record on qual­ity?

Re­gan: I think the an­swer is no just be­cause you’re just deal­ing with a huge uni­verse of peo­ple, and I think the op­ti­mum thing is how do you re­duce bad out­comes in ev­ery area to a very low rate? And I guess if that’s per­fect, then I would sug­gest that you can do it.

Leaver: I would echo that and add that I re­ally think we need to fo­cus more on pop­u­la­tion health and think about our pa­tients over a long pe­riod of time, be­come much more pa­tient-cen­tered. <<





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