There are many ways to approach outcomes improvement in healthcare. Health Catalyst advocates the three-systems methodology whose individual components remain firm: best practices, adoption, and analytics. There are also various ways to interpret the three systems and this article uncovers nuances in how they are defined. With this unique perspective, organizations may be better able to understand how to develop outcomes improvement projects that not only launch with enthusiasm, but sustain energy over the long-term. Furthermore, outcomes improvement done right is scalable so that small firms, those with fewer resources, can adapt the methodology to improve their performance.

1. Moving Healthcare
Outcomes Improvement
Projects to the Finish Line
̶ Dr. Bill Knowles

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A Simple Example of Best Practices
In the late eighties I was involved with
the Grant Fitness Center firefighter
program in Columbus, Ohio, overseen
by Grant Medical Center.
We discovered long-term health risks
for firefighters and the potential
benefits of a multidisciplinary, team-
based fitness program.
Over a decade later a 2001 article in
Occupational Medicine, cited
“increasing attention over the last
several years” to occupational health
programs for firefighters.

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A Simple Example of Best Practices
A primary challenge of implementing
the firefighter program was the
accumulation of sufficient data that
would appropriately address the
healthcare risks.
I developed software that could store
and report on dozens of parameters in
different areas ̶ clinical and lab values,
and physical data, such as body fat
measurements.
The initial results generated much
optimism among clinical staff and
firefighters alike.

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A Simple Example of Best Practices
This experience provides a simple
example of how to improve outcomes
in patient care.
The medical center identified a cohort
(firefighters) with potential health risks
and involved a small team of health-
care professionals with subject matter
expertise in different areas.
The data system I developed could
then be used for analysis by the team
for advising them on improvements
needed at both the individual patient
and program levels.

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Methodology for Improving Patient Outcomes
While the firefighter program is an
over-simplification of the process, we
can see three basic systems that can
provide a systematic approach to
improving patient outcomes:
• Best practices
• Adoption
• Analytics
This same pattern can be followed in any
sized healthcare organization, simply
adjusting to the needs and resources of
the organization and its patients.

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Methodology for Improving Patient Outcomes
Best practices is represented by the
various professionals who leveraged
their experience and knowledge, and
standardize processes in the program.
The adoption system is represented
by the multidisciplinary team’s carrying
out the program.
The analytics system is represented
by the software system that was
developed to store, analyze, and
report on the firefighters’ related
healthcare data.

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Outcomes Improvement in Action at TCH
Our Health Catalyst team partnered
with Texas Children’s Hospital (TCH)
in outcomes improvement endeavors
using the methodology found in Part 2
of Dr. John Haughom’s book,
Healthcare: A Better Way.
TCH uses a series of care process
teams (for different specialty areas)
consisting of healthcare professionals
who take ownership of quality, cost,
and patient satisfaction measures
associated with healthcare delivery.

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Outcomes Improvement in Action at TCH
These care process teams design their
own solutions to targeted improvement
objectives, also called aim statements.
These are permanent teams with
integrated clinical and technical
members, who also have the support
of their respective leadership team and
the executive team.
An underlying principle for the teams is
that of continuous improvement that
ultimately benefits the patients and
their families.

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Outcomes Improvement in Action at TCH
As one aim is completed, they move
on to the next targeted objective for
outcomes improvement.
This effort is guided by evidence-
based medicine principles, leveraging
both best practices and data analytics
to determine and move forward on
opportunities meeting the Triple Aim.
Teams are guided by best practices
and analytics (data dashboards) in the
adoption of these projects/programs.

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Outcomes Improvement in Action at TCH
This methodology has improved the
lives of patients at TCH as the
organization focused its improvement
initiatives on care processes with
high costs and variability.
One of these target areas was the
management of patients with diabetic
ketoacidosis (DKA), which was
noticed to have a measurable degree
of variation, and thus some gaps in
quality of care.

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Outcomes Improvement in Action at TCH
With a care improvement team and
measurable goals in place, supported
by an enterprise data warehouse (EDW)
and a pediatrics diabetes analytics
application, TCH made significant
strides in improving diabetes care,
especially for DKA patients.
RESULTS
81% of DKA patients assigned to a diabetic care unit and Core Diabetic Nurse
17% relative increase in DKA patients receiving evidence-based evaluation and order sets
19% relative increase in DKA patients receiving IV insulin within one hour of order
33% relative decrease in length-of-stay for DKA patients
ROI approximately 33%

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Relentlessly Focus on Outcomes Improvement
It has been rewarding for our Health Catalyst teams to partner with
such exemplary healthcare organizations as Texas Children’s, and to
do the work that we do. To see our efforts in outcomes improvement
filter down to the patient level is especially gratifying.
DAN LOWDER
Health Catalyst
Technical Director
At Health Catalyst, I’m given a situation related to patient care or
patient costs and asked to build a solution to measure outcomes.
By a relentless focus on outcomes in everything we do, we are
ensuring that the end result is ultimately saving the patient either
time or money, or improving his/her health. In most cases, this
focus results in improvements in all three of these areas.”

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Outcomes Improvement Is Scalable
The key to continuous quality
improvement is to follow a
systematic approach.
While it is easy to see how an
organization the size of TCH could
harness the resources and staff to
do so, you may not easily see how a
small organization could implement
such a system.
As the firefighter example proved, it
is possible to adapt this method-
ology to any size organization.

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Outcomes Improvement Is Scalable
Today there are numerous sources
to inform an organization on best
practices and standardization
guidelines, including a discretionary
search of the Internet.
Numerous data software systems
are available with their respective
tools for analysis and reporting.

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Outcomes Improvement Is Scalable
Then one or more permanent
clinical teams can be formed with
the existing staff to carry out the
outcomes improvement program.
Time constraints sometimes are
given as a challenge to forming
these permanent teams, however,
experience shows that the time
savings from reducing redundancies
and eliminating other types of
waste, more than compensates for
the time invested.

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An Effort that Reaps Exponential Rewards
It is very rewarding to be involved
with people and organizations that
know how to do the right thing for
the patient the first time, and every
time, using best practices to inform
patient care.
As one progresses with these
outcomes improvement efforts, the
rewards become more and more
obvious.

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An Effort that Reaps Exponential Rewards
A primary motivator for me to become
a physician was to positively impact
the lives of patients and their families.
I originally had thought that my
contributions could help improve
the lives of thousands of people
over my lifetime.
Now I wake up each day excited
about the prospect that what I am
doing along with others potentially
will benefit not thousands, but
millions of people!

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Moving Healthcare Outcomes Improvement Projects to the Finish Line
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet, VP of Client Operations
Successfully Rolling Out Healthcare Improvement Initiatives with Key Influencers
Tom Burton, Co-founder and Executive VP
The 4 Clinical Teams Needed to Drive Sustainable Improvement
Susan Easton, Engagement Executive, VP; Kathleen Merkley, Clinical Improvement – VP
Tracy Vayo, VP of Knowledge Services; Kirstin Scott, Senior Medical Writer
Keys to a Successful Health Catalyst Data Warehouse Platform and Analytics Implementation
Jared Crapo, Sales, VP; Eric Just Eric Just, Technology, VP; Dan Lidgard
6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare
Bobbi Brown, VP of Financial Engagement; Leslie Hough Falk, Customer Engagement, VP

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Dr. Bill Knowles has a unique background to support the vision to transform healthcare through the
application of relevant experience, processes, and technology. His certifications as a physician,
certified Oracle developer, and project management professional (PMP), combined with the years of
experience he has working in these areas, have formed a strong foundation for achieving success in
Life Science programs and projects. Bill has established and been the director of several project
management offices, in addition to being a project management team lead and senior technical
consultant. He has travelled to domestic and international client sites to lead software implementations, and has
years of experience providing program and project management, as well as technical and clinical registry
guidance, mentoring, and training to healthcare professionals and support staff. Bill has been a senior director
of client engagement at Health Catalyst since 2014, and he is fully bilingual in English and Spanish. He also is a
graduate of the accredited Health Catalyst University Accelerated Practices Program, which trains professionals
in the acceleration of outcomes improvement.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com