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,
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. <<