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Clinical and Operational Accountability in a Large IDN
Session 188, March 7, 2018
Matt Eversole, System VP, IT COO
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Conflict of Interest
Matt Eversole
Has no real or apparent conflicts of interest to report
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Agenda
• Clinical Operations Performance Report (COPR)
• COPR Roles & Process
• KPI Accountability & Collaboration
• BI Standardization & KPI Drilldowns
• Challenges / Success Factors / Recommendations
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Learning Objectives
• Appraise best practices of creating, producing, and distributing an enterprise performance scorecard that spans clinical, operational, and strategic domains in a Value-Based Care environment
• Evaluate data visualization techniques that enable self-service analysis of key performance indicators, permitting accountable leaders to focus constructive attention on lower performing facilities / practices / providers / support services
• Create a culture of "performance transparency" which is a prerequisite to enterprise deployment of self-service analysis of key performance indicators
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Learning Objectives
• Apply knowledge management theory and collaboration technology to enable efficient Q&A and sharing of best (and worst) practices related to key performance indicators
• Evaluate data warehousing and business intelligence strategies that best enable a flexible and reliable enterprise scorecard infrastructure
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• 22 hospitals
• 450 points of care
• 34K employees
• 2,400 provider CIN
• 7 markets
• “One ministry. One calling.”
• Zero AMCs
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Development
• Leadership heavily involved in developing
and setting performance targets for KPIs
• Many KPIs also have self-service drilldowns
provided
• Each KPI is assigned a clinical and
operational owner in each market, as well as
a system leader and data analyst
• Reported at the system and (7) market levels
• Distributed to 700 Directors (and above) and
2,400 CIN providers on a monthly basis
• Each KPI has a dedicated SharePoint intranet
site to encourage sharing of best practices
and other collaboration
Deployment
COPR Overview
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Strategic Initiative KPIs COPR KPIs
2018 COPR KPIs
Inpatient & ED Patient Experience
7 Day Follow Up (High Readmission Risk ACO)
Medical Practice Patient Experience
Profit/Loss per MCARE Patient by Condition
Hospital Salaries & Supplies/WEIPA
Domestic Admissions to Improve Quality
CIN PCPs as a % of all PCPs in the Market
Ambulatory Care Sensitive Condition Admissions
RN Voluntary Turnover
Reduce Epic Documentation Time
Net Revenue Growth
Reducing Avoidable Readmissions
Patient Safety
Primary Care Access
Disease Prevention (Primary Care 6)
Reducing Opioid Dependency
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COPR Roles (Per KPI)
• System Leader
– Overall lead for the KPI, convenes regional Dyad Owners to share best practices
• System Data Analyst
– Responsible for data quality, answering data questions
• 14 (7 x 2) regional “Dyad Owners” held accountable for KPI performance
– Clinical
– Business
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Actionability & Accountability
• “Dyad Owners” (and ultimately Regional CEO) held accountable for KPI performance
• Expectations set related to collaboration with other markets’ Dyad Owners
• KPI drilldowns provided where most beneficial
• Culture of performance transparency
– E.g. provider level performance is not blinded
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KPI: MyChart Response Timeliness
Links to KPI-dedicated
site on intranet which
includes:
-Drilldown Analytics
-Discussion Forum
-KPI Profile Document
-Dyad Owner Roster
-Collaboration Documents
Email links to Dyad
Owners for this Market
COPR KPI Intranet Site
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3 “Key Takeaways” from COO/CCO Each Month
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More Than Charts
• Market Execs contribute text for Executive Summary which includes:
– Clinical KPI progress
– Operational KPI progress
– Strategic KPI progress
– Patient Story
– Clinician Story
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Flip Builder for Online Presentation
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COPR Miners• A lot of data shoveling is involved in producing the
COPR
– Not realistic that all the data for all the KPIs is sitting in a data warehouse
– Tough choices on what to fully automate vs. monthly flat file transfer
• Centralized EDW (COPR Mine) and BI team (COPR Miners) for COPR production and some of the KPI drilldowns
• De-centralized analyst teams for drilldowns where more appropriate
• Cognos for COPR, Tableau (mostly) for KPI drilldowns
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Finding a Balance with Standardization
Important measures,
but juice-not-worth-
the-squeeze for
standardization
Standardized look,
production, process.
Putting the “K” in KPI
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Practice Operations Performance Report (POPR)
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Drilldown Example: Cost Per Case
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Drilldown Example: Opioid Metrics
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A Few Thoughts on Predictive Models & “Advanced” Analytics
• Review of abstract for this session: “Discussions have moved on to data analytics and AI/predictive analytics on these KPIs, rather than building scorecards and dashboards themselves”
Predictive analytics,
e.g. patients at high risk
for readmission, belong
here on the Key Driver
Diagram
Not here on your
Enterprise Scorecard.
Your board is not interested
in a predicted readmission
rate, they are interested in the
outcome of a lower readmission ratehttps://tdwi.org/articles/2017/12/05/BI-ALL-Understanding-Differences-Data-Science-and-BI.aspx
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Challenges
• Opportunity cost of all the development effort
• KPI du jour sometimes means the hot new KPI this year drops off COPR next year
– E.g. MyChart message responsiveness
• Finding the balance between the “perfect” KPI and data oblivion
• Frustration with lack of progress on the most-difficult-to-improve KPIs, e.g.:
– E.g. Acute care utilization rates
– E.g. Patient satisfaction
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KPI: Inpatient & ED Patient Experience
Response: Added a new
KPI for 2018 focused on
reducing documentation
time in Epic
Top Quartile
targets, but not top
quartile
performance
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COPR Key Success Factors
• Teaming of Execs, BI, and marketing results in a report that is actually fun to read
• BI team bandwidth dedicated to COPR production each month
• Collaboration sites + responsible parties being told to use them
• Exec bonuses tied to common Strategic Initiative KPIs
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Recommendations
• Are your Execs onboard with driving the strategy, and willing to assign accountability for KPI outcomes?
– If not, stop, do not pass GO
• Formalize roles-per-KPI and assign the right people to them
• Figure out the communications / collaboration strategy that works for your organization
• Figure out the right balance of Business Intelligence standardization that works for your organization
• Right size total enterprise scorecard level of effort for your organization
