Removing Barriers to Clinician Engagement: Partnerships in Improvement Work

Removing Barriers to Clinician Engagement:
Partnerships in Improvement Work
HEALTH CATALYST EDITORS

© 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
This report is based on a 2019 Healthcare Analytics Summit (HAS 19) presentation
given Jack Beal, JD, Vice President, Performance Improvement and Deputy
General Counsel, The University of Kansas Health System, and David Wild, MD,
MBA, Vice President, Performance Improvement, Assistant Professor, Department
of Anesthesiology, The University of Kansas Hospital, titled, “The Doctor’s Orders
for Engaging Clinicians to Drive Improvement.”
Removing Barriers to Clinician Engagement
David Wild, MD, MBA
VP, Performance Improvement
Assistant Professor, Anesthesiology
University of Kansas Hospital
Jack Beal, JD
VP, Performance Improvement
Deputy General Counsel
University of Kansas Health System

Clinicians play a significant role in all decisions
affecting health system quality and cost, making
them critical players in improvement work.
However, reimbursement pressures, competing
time pressures, misaligned incentives, and a
lack of credible data often make engaging
clinicians in improvement work one of the
biggest challenges in healthcare.

This report describes effective strategies for overcoming barriers when engaging
clinicians in improvement work and shares how to achieve the following goals:
Partner with clinicians in
improving quality and
reducing cost.
Align improvement work
with all aspects of the
organization.
Identify problems and
improvement ideas at all
organizational levels.

Understanding Barriers to Clinician Engagement
Clinicians face mounting challenges in addition to
delivering care, including climbing student debt,
administrative requirements (e.g., regulatory
measures), and the undelivered improvement
promise of the EMR.

While clinicians are accustomed to a
professional culture in which they’re the
primary decision makers at the point of
care, data-driven decision making and
improvement work are altering that
paradigm.
Health systems must strategically engage
with clinicians regarding improvement
work by inviting clinicians to become
partners in these efforts rather than
adding to the burden.

Clinician engagement is not a technical
problem; it’s an adaptive problem. As such,
simply throwing more technology at the
issue won’t solve it.
Instead working to deeply understanding
clinician challenges will drive solutions
that account for clinician needs, provide
clinician-centered data around
improvement initiatives, and create
partnerships with engaged clinicians.

An ideal setting for improvement work
aligns and engages clinicians through
ownership and shared accountability
throughout the organization.
Improvement leaders build this partnership
with trust and transparency.

Three-Part Data-Driven Improvement Framework
To support data- and analytics-driven improvement, organizations need a
workforce dedicated to collecting, sharing, and using data efficiently.
Three levels of improvement teams make this possible:
A team to share
information
throughout the
organization
An advanced
analytics team
responsible for
predictive and
prescriptive
modeling
A team to
develop,
support, and
deploy
improvement
across the
organization

Three-Part Data-Driven Improvement Framework
These performance improvement teams have responsibilities across the
system and the entire continuum of the organization, across clinical and
business opportunities.

Three Levels of Clinician Engagement
Health systems can apply clinician engagement strategies at three strategic
levels: local departmental or divisional (value-based performance), and
leadership (department finance and planning sessions).
Local-Level:
Clinician-Led
Improvements
Departmental or
Divisional-Level:
Value-Based
Performance
Leadership-Level:
Department
Planning and
Finance Sessions

Local-Level: Clinician-Led Improvements
A program that engages clinicians in point
improvements at the local level (e.g., the
University of Kansas Health System Care
Connections Program) establishes clinician
partnerships in improvement work.
Through Care Connections, the University of
Kansas Health System provides foundational
support for each improvement project with
data, measurement, and analytics resources.

The program has four main features that engage
clinicians from the ground up:
Moves from paying for clinician time to paying
for project completion.
Encourages practicing clinicians and their
teams to generate improvement ideas.
Ensures organizational alignment by providing
executive oversight and coaching for project,
measure, and outcome selection.
For academic medical centers, improves
academic productivity by requiring clinicians
to present and publish their work.

Two arms make up the Care Connections Program:
Care advancement
Care transformation
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Under care advancement, the health
system suggests improvements with a
request for proposal (RFP)
announcement. Interested clinicians
submit a proposal with a hypothesis,
proposed project, and proposed
measures. An executive steering
committee then reviews all submissions
and approves funding.
Care transformation aims to support
great ideas from clinicians and their
teams, even for projects leadership
hasn’t identified. Clinicians submit
projects to the executive steering
committee for approval and funding.

Departmental or Divisional-Level:
Value-Based Performance
Value-based performance (Figure 1) engages
clinicians at the divisional or departmental
level (e.g., all pulmonologists or orthopedists)
in line improvement.
This level engages a group of clinicians to
provide data to problem solve, present solutions,
and measure and share financial gains with
department on a quarterly basis in four steps:
1. Find improvements.
2. Support the department of division.
3. Remove barriers to support.
4. Generate and share value.

Departmental or Divisional-Level:
Value-Based Performance
Figure 1: The value-base performance clinician engagement level.

Leadership-Level:
Department Planning and Finance Sessions
The department planning and finance sessions
engage senior clinician leaders in conversations
about what to improve, why, and how.
This level engages with multiple departments and
specialties to discover how the health system
delivers care as well as the quality of that care.
At this engagement level, improvement teams
produce information for clinicians on improvement
work, hold office hours with analytics leadership
and a planning meeting with senior leadership,
and develop an annual improvement plan.

Clinician Engagement at Work
By engaging clinicians at all three levels, local, departmental,
and leadership, the University of Kansas Health System
has made critical steps towards more meaningful
systemwide improvement, as of September 2019:
Approved 37 projects, representing the majority
of clinical departments (17 of 21).
Achieved measurable improvement and savings in
80 percent of projects within the first month.
Put annual growth and improvement plans in
place in all 21 clinical departments.

Clinician Engagement at Work
Specific examples (shared at HAS 19) of the
impact of the University of Kansas Health System
clinician-driven improvement program include:
Reduction in COPD readmission from 28 to 4
percent in half a year.
Adopting a less expensive, but equally effective,
form of acetaminophen in the perioperative
space (increasing use of the less costly oral
form from only 2 percent to 20 percent).
A departmental cost savings in antibiotics
from an average of about $175 average per
patient per admission to an average of $100.
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Clinician Improvement Partnerships Drive
Meaningful Change
With clinicians making the vast majority of
decisions that affect quality and cost,
improvement efforts can’t succeed without
their engagement.
Health systems that create alignment with
clinicians around improvement projects,
rather than dictating to them, will build
lasting partnerships to delivery high quality
of care at lower costs.

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

More about this topic
Link to original article for a more in-depth discussion.
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Bryan Oshiro, MD
The Best Way Hospitals Can Engage Physicians, Nurses, and Staff
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EHR Integration: Achieving this Digital Health Imperative
Daniel Orenstein, JD, Senior VP, General Counsel, and Secretary

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Dr. David Wild serves as the Vice President of Performance Improvement at the University of
Kansas Health System, based in Kansas City, Kansas. In this role he has responsibility for process,
performance, and quality improvement work, the development and deployment of the System’s
improvement and management systems, applied analytics, clinical variation reduction programs,
and clinical and operational redesign across the inpatient and ambulatory enterprises. Dr. Wild is
also a practicing anesthesiologist and Faculty in the Department of Anesthesiology at the University
of Kansas Medical Center.
Dr. Wild completed his undergraduate and M.D. degrees at the University of Missouri-Kansas City
and his residency training in Anesthesiology at Saint Louis University where he served in multiple
operational and leadership roles prior to joining the University of Kansas Health System. He recently
completed his MBA at Rockhurst University with an emphasis on business intelligence and
analytics. He has served as the President of the Kansas Society of Anesthesiologists and is active
at the national level in development of new delivery and alternative payment models for
perioperative care.
David Wild, MD, MBA

Jack Beal serves as the Vice President of Performance Improvement at the University of Kansas
Health System, based in Kansas City, Kansas. In this role he has responsibility for process,
performance, and quality improvement work, the development and deployment of the System’s
improvement and management systems, business intelligence including applied analytics, clinical
variation reduction programs, and clinical and operational redesign across the inpatient and
ambulatory enterprises. In his role as Vice President of Performance Improvement, Jack partners
with David Wild, M.D. Jack is also Deputy General Counsel for the health system, providing
leadership with respect to all legal and regulatory matters and key financial and strategic
transactions.
Jack received a B.S. in Finance from William Jewell College and his law degree from The University
of Tulsa, graduating with highest honors. Previously, Jack was a Shareholder at Polsinelli PC,
where he practiced in the areas of health care and corporate law. While in private practice, Jack
developed significant experience with health care merger and acquisition transactions, with a focus
on the structure, development and negotiation of innovative arrangements to align and improve the
quality and cost effectiveness of care in numerous settings.
Jack Beal, JD

Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

Removing Barriers to Clinician Engagement: Partnerships in Improvement Work

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