It is estimated that up to 30 percent or $510 billion of the $1.7 trillion U.S. healthcare industry is wasted effort and cost. The single best way to reduce this waste is to make sure the right activities are performed by the right people, at the right times and for the right reasons. The largest impediment to doing it right is missing information between the various players in caring for a patient. In other words, the waste and cost is in the handoffs among providers.
The key to a coordinated, efficient and effective care team is a hub of information that is complete, clear, accurate and up-to-date. Every healthcare organization has an encounter-management system that serves this purpose. But this is only half the story. In addition to a common set of information provided for the team to function, is a repository of information provided about the team so they and their management can evaluate and improve the team’s performance. This is where business intelligence capabilities come in.
This article details the specific types of information being used by care teams for greater clinical effectiveness, efficiency, safety and cost-effectiveness, and then describes how this same information can be used to continuously improve the team’s performance through business intelligence processes.
Examples of Teams in Various Industries, Including Healthcare
Teams are a proven means of improving performance in many industries. Here are a few examples:
•Retail Performance Triangles. I worked for several years providing analytical information to performance triangles made up of a buyer, a replenisher and a financial analyst. The unique talents of each point of the triangle meant that the right merchandise was available in the right place, priced correctly to move well and make money for the company. These people operated from a common set of information about their merchandise, including measures of sales, margins, purchases, inventory, advertising and distribution costs, etc.
•Manufacturing Excellence Teams. Also known as jidoka in quality circles, these teams are made up of operational members (plant managers, team leaders, line people) and analytical members (industrial and manufacturing engineers, production analysts, financial analysts). Their purpose is to improve on the run through constantly changing processes, in response to observations and measures of those processes.
•Insurance Claim Service Teams. When I hit a bear with my truck last year, I was contacted by Nicole from “Claim Service Team 3.” Her team’s mission was to make the claims process as smooth and cost-effective for the insurance company, and as painless and fair to the customer as possible. Members of her team shared a base of information about me, about my situation and about claims of the type I was making. These members were both internal (claims specialists, actuaries, etc.) and external (state troopers, repair garages, etc.) to her organization.
•Clinical HealthCare Teams. We are learning firsthand the real value of care teams as a member of our extended family is living with terminal cancer. The care team includes physician specialists, primary care physicians, nurses, chaplains, social workers and a host of others both inside and outside the clinical realm. What makes this team work so well is that they share information on a near real-time basis regarding our family member’s history and condition status. When Becky, the hospice RN shows up each morning, she is aware of any information received by her teammates at any time the previous night. Less duplication, less waste and less frustration for all concerned.
Two key characteristics make these teams effective. The first is that each of the players performs a specific function within the goals of the particular team. The second is that the entire team has a common set of information which eliminates waste and delay caused by handoffs of missing or bad information. For the clinical healthcare organization, supporting teams is crucial to success for the good of the patient, the good of the providers and the good of the payers for those services.
But there is a third characteristic of successful teams that really increases the value of care teams for all of the parties. This is the accumulated business intelligence of the care team.
Teams that Save Money vs. Teams that Don’t
By way of analogy, picture a class in school where the students are given ample amounts of information about the subject, but no grades. They might learn a lot, but not really know how they were doing. And curiously, most students tend to underestimate their performance, which leads to not really using all they learned.
Conversely, picture another class where the students are given no information about the subject, but ample information about their performance. In this case no learning would take place, except what the students carried with them or went out and found for themselves. This would be a haphazard learning environment.
What is needed is both types of information—information for the students (subject material) and information about the students (grades). Care teams, and all teams for that matter, need both of these types of information.
What differentiates clinical care teams that save money for their organizations from those that do not is the extent to which they use both of these types of information. And the beauty of using business intelligence capabilities is that by rolling up much of the information made available for the team, you turn it into information about the team.
Providing Information for Care Teams
A small sample of the information that care teams use includes:
•Who the patient is as well as their health history.
•What healthcare conditions or changes to those conditions caused the various encounters.
•Where the patient encounters took place.
•When the encounters took place. This includes when during the day and more importantly when during the patient’s health history.
•Why the patient had the encounters (emergency, routine visit, hospital admission, etc.)
•How the encounters took place. Increasingly, remote care mechanisms such as phone, monitors or e-mail are used.
•Who provided the care.
•What the results of the care were, including lab values, functionality measures, etc.
•For certain roles on the team, financial information such as how much revenue the encounter produced, who paid for it, what it cost, etc.
In our classroom analogy above, this constitutes the subject matter for the care team. Coordinating this information is usually the scope of operational systems such as patient encounter systems, lab systems, accounting systems, etc.
Turning Information for Care Teams into Information about Care Teams
If this information, and especially measures of activities and outcomes, is rolled up and analyzed over time for patterns, trends and anomalies, then the same data used for the team becomes valuable information about the team. This information can be used by the team itself, by other teams of the same type, and by management in the clinical organization for a variety of purposes.
In our classroom analogy above, this constitutes the grades of the care team. Organizing, cleansing, summarizing, storing this information in a repository and making it available for retrieval is usually the scope of analytical systems (i.e. business intelligence applications).
Operational and Strategic Decision Support
When rolled up, this analytical information can be used for a number of operational decisions such as:
•Care team performance vs. other care teams and the organization as a whole, so you can learn from the best teams and spread the knowledge, and quickly identify and correct problems being experienced by the worst teams.
•More intelligent staffing and scheduling.
•Equipment and supplies in the right quantities, available at the right time and in the right place.
•Information about patients, groups of patients, etc. ready for the care team’s use.
•Training and development for the right providers, in the right place, at the right time.
Efficiency, effectiveness, cost-effectiveness and overall readiness are increased, and wasteful handoffs are reduced.
But the value is increased further by the strategic decisions that this analytical data supports:
•Quality Program Support. Providing visibility to the actions and outcomes being performed in order to qualify for quality programs, which demonstrates your abilities to payers, public health authorities, patients, prospective clients, prospective employees, etc.
•Recognition and Pay-for-Performance Support. Providing similar information to payers and groups offering recognition in order to demonstrate the value of the care you provide.
•Increased Profitability. Increase revenues from new employer groups, new payer groups, new patient markets, as well as cut costs for activities that your people and their patients find frustrating such as paperwork, rework, duplicated work, etc.
•Investment Decision Support. Providing evidence on which to base decisions such as type and location of facilities, type and amount of equipment, so they will do the most good to your patients.
•Knowledge and Skills Management. Understanding the characteristics of your patient-centered activities and the people providing care supports recruiting decisions, staff development decisions, training program content, etc.
Driving performance throughout the organization in a consistent manner requires a common base of evidence regarding where your organization is headed. Rolling up this evidence from the actions and outcomes of your care team processes helps you align this information from top to bottom.
Care teams promise a great deal of value to clinical healthcare organizations and their constituents. But the determining factor in whether or not the care teams can deliver on this promise is the degree to which the members share a common set of information for both operational and analytical purposes. The next step in pursing this common base of information and receiving the operational benefits of greater coordination and efficiency, as well as the analytical benefits of greater development of the knowledge and wisdom of your teams, is to begin to organize the data you already own using business intelligence methods, practices and technologies.
Thanks for reading. I look forward to your comments.