1. The Healthcare Outcomes Improvement Engine:
The Best Way to Ensure Sustainable, Scalable Change
Neil Andersen

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The Healthcare Outcomes Improvement Engine
Successful and sustainable healthcare
transformation relies on an organizational
culture with a systemic focus on healthcare
outcomes improvement.
Effective engagement from multiple
disciplines coupled with standardized
improvement processes will create a
scalable and sustainable outcomes
improvement environment.
I call this the outcomes improvement
engine—a system primed to generate
improved outcomes at a consistent and
scalable pace.

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The Healthcare Outcomes Improvement Engine
Four Key Components
An effective healthcare outcomes improvement
engine requires four components:
1. Engaging executives
2. Prioritizing opportunities
3. Adequately staffing initiatives
4. Communicating success early and often

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The Healthcare Outcomes Improvement Engine
Engaging executives
The outcomes improvement engine
begins with effective engagement—
around which several stakeholders
and teams work together.
The executive leadership team
launches the improvement work by
developing a strategic vision.
A clear strategic vision enables people
to prioritize work and to allocate
scarce resources appropriately.

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The Healthcare Outcomes Improvement Engine
Engaging executives
This team governs the prioritization of
outcome goals and the work required
to operationalize the strategic vision.
Domain specific teams that report up
through the executive leadership team
are then responsible for executing to
the strategic vision.
The executive leadership team should
include board members, C-suite, and
others with influence in improvement
work and clinical operations.

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The Healthcare Outcomes Improvement Engine
Engaging executives
While titles may vary across healthcare
systems, this team must have good
representation from system-level leaders
who can foster a culture of data-driven
quality improvement initiatives.
They usually have decision rights for the
entire organization, help to define the
priorities, and ultimately own the
enterprise-wide strategic vision.

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The Healthcare Outcomes Improvement Engine
Engaging executives
The members of the executive leadership
team can align incentives with outcomes
improvement initiatives.
This sends a powerful message to the
organization: real and sustainable
outcomes improvement is important and
something everyone should focus on.
Effective engagement in outcomes
improvement requires buy-in and support
at the board and executive levels, and all
clinical and operational levels as well.

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The Healthcare Outcomes Improvement Engine
Engaging executives
Close collaboration and consistent
communication between key stake-
holders ensures a process that
prioritizes outcomes improvement and
safeguards resources for high-priority
improvement work.
These key stakeholders typically
represent data and analytics
infrastructure, quality improvement,
domain specific governing bodies and
executive leadership.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
An outcomes improvement engine runs
best when it targets opportunities prioritized
through a standardized objective process.
It must be driven by healthcare analytics
and clearly understood throughout the
organization.
Developing a prioritization rubric
acknowledges that resources are a
scarce commodity and that leadership
has selected only those initiatives that
demonstrate ROI of scarce resources.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
Prioritizing one opportunity likely means
turning down another; individuals involved
with the denied opportunity will want to
know why they were rejected.
Leaders need to be objective when
prioritizing the work—otherwise they risk
losing organization-wide support, buy-in
from key stakeholders, and, ultimately, the
momentum to realize the strategic vision.
The lesson here is to be objective in
identifying the rubric for prioritization.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
The leadership team can use objective
tools like the Key Process Analysis
(KPA)to select the best prospects for
improvement and cost reduction.
The KPA tool combines clinical and
financial data to highlight the best
quality improvement and cost reduction
opportunities by utilizing the 80/20 rule
to identify cost-driving areas where
large variation exists among processes.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
While objective healthcare data is
good for consistency, subjective
criteria are also useful—specifically,
a balance of objective data with
subjective criteria will account for
cultural or domain-specific
circumstances that may cause
workflow bottlenecks.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
A three-part example explains how objective data and subjective
criteria work together:
1 The objective data shows a high-level of opportunity in reducing
readmission rates among hypertensive newborns.
2
The subjective criteria, however, indicates that the health system is
not sufficiently organized with the right team members (the women
and children’s team) to focus on this work.
3
With this paucity of team members qualified to work on reducing
readmission rates among hypertensive newborn, this is not a
promising opportunity for immediate improvement.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
The leadership team can learn two things from
the three-part example:
1. They will need to select another area
for improvement.
2. They need to look at strategy to build
up the women and children’s team
with innovative leaders who can head
improvement opportunities.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
As the executive leadership team establishes a standardized rubric,
within organizational priorities, to assess improvement opportunities,
they should consider the following six questions:
1 Does this work align with other board and executive level strategic priorities?
2 Are there regulatory pressures/penalties that need to be addressed?
3
Will the organizational/departmental readiness and culture of improvement
ownership support your prioritized initiatives?
4 Do you have leaders/innovators ready to own the work?
5
Is there data available to provide the analytical infrastructure necessary to
measure improvement?
6
Are there other improvement initiative requests from domain specific teams
that align to higher level opportunities?

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
The EDW Is a Scarce Resource for the
Outcomes Improvement Engine.
The rubric will help the various teams driving
the improvement initiatives stay focused on the
strategic priorities and avoid unnecessarily
allocating resources to other initiatives that
come in from across the organization.
A robust and effective enterprise data
warehouse (EDW) operating system is critical
to creating and scaling the outcomes
improvement engine.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
The ability to bring disparate sources of data
into one location gives the improvement teams
a powerful platform to create and measure
best practices to quickly improve outcomes.
The EDW’s ability to create a breadth of
reports, however, makes it an attractive tool
throughout the organization.
If not managed appropriately, a high volume
of unfiltered requests for data will drive the
EDW focus away from the prioritized
strategic initiatives of improvement.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
Too many EDWs evolve into an operational
reporting shop which takes away resources
and focus from facilitating real improvement.
This shift to basic reporting usually creates
an environment where scarce data
architecture and BI resources feel under-
utilized and overworked.
They are spending much of their time and
effort managing basic reports and
processes—tasks with little meaningful
impact on improving quality or lowering cost.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
Effective Prioritization Comes from the
Executive Level.
The same can be said for other departments
that are involved in facilitating improvement
initiatives across the organization.
If prioritization doesn’t happen at the
executive level, any scarce resource will
run into demand issues.
These resources are essential assets in
outcomes improvement work, and leader-
ship needs to protect them as such.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
The leadership team should restrict focus to
projects that meet the following requirements:
Have a clearly defined value proposition.
Help the organization build standardized
processes to focus on improvement.
Deliver opportunities tied to strategic objectives.
Have organizational buy-in.
Produce meaningful and measurable outcomes.
Can be spread across the system.
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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
Domain-specific improvement teams at every
level need to develop standardized processes
to articulate the ROI for projects that drive the
goals set by the executive team.
Improvement methodologies provide tools to
facilitate this process (e.g., A3, outcomes
improvement worksheet, etc.).
Standardizing on an approach that moves
teams through the outcomes improvement
journey relieves pressure on resources.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
A system-wide cultural shift toward thinking
of the EDW and scarce resources primarily
as assets for outcomes improvement takes
time and hard work.
This starts with a clear strategic vision from
the executive level that’s evangelized to
each improvement team.
Specific improvement opportunities that fit
within the strategic vision can be communi-
cated from the domain level improvement
teams up to the executive teams.

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The Healthcare Outcomes Improvement Engine
Prioritizing opportunities
Importantly, the work is prioritized and
sanctioned by the executive team.
This effective engagement communicates to
the rest of the organization that outcomes
improvement is a priority and that the teams
doing the work will have the resources
required to reach their goals.
When multiple domains improve processes,
and establish best practices, they will have
a big impact on the areas prioritized as
opportunities for improvement.

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The Healthcare Outcomes Improvement Engine
Adequately staffing initiatives
Components one and two—engaging
executives and prioritizing opportunities—
organizations need the appropriate staff.
This ensures that they not only have the
workforce, but that that have the right
people (those who are properly trained
around the standard improvement
methodology).
This allows for a clear and efficient path to
standardizing outcomes improvement and
earning organization-wide adoption.

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The Healthcare Outcomes Improvement Engine
Adequately staffing initiatives
The leadership team oversees the creation
of domain-specific permanent improvement
teams with dedicated resources.
They are organized for long-term
improvement and consist of innovators and
early adopters.
Team members include: data architects,
process improvement specialists, clinical
leadership, and ad hoc members. These
teams focus on improving outcomes.

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The Healthcare Outcomes Improvement Engine
Adequately staffing initiatives
As standard knowledge assets are created
and assimilated into the workflow, the
domain team ensures that the organization
adopts the process and scales it throughout
the system to become best practice.
Once initial improvements are made, the
same team continues to monitor and
maintain the gains while beginning work on
additional processes that drive improvement
on the measured outcomes.

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The Healthcare Outcomes Improvement Engine
Communicating success early and often
Success, large and small, excites the masses
around improvement and turns skeptics into
believers by showing value in focusing on
outcomes improvement early on.
Leaders who share early wins
across the organization acknow-
ledge teams for their hard work
as they make progress—rather
than waiting for the finish line.

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The Healthcare Outcomes Improvement Engine
Communicating success early and often
It can take several years to achieve bigger
goals, so recognizing the smaller achievements
along the way sustains morale and empowers
the team to continue their improvement journey.
Frequent and consistent communication also
changes organizational culture to scale
outcomes improvement efforts.
By acknowledging successes throughout the
outcomes improvement process and sharing
them across the organization, improvement
teams create value in their process.

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The Healthcare Outcomes Improvement Engine
Communicating success early and often
As others see their success, they’re
encouraged to buy into the initiative.
For best results, standardize communi-
cation around successes using a repeatable
process and format.
Messaging should come from operational
and strategic leadership levels to keep the
focus on clinical and quality improvement.

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Engagement Keeps the Healthcare Outcomes
Improvement Engine on Track
Changing a health system’s culture to
focus on analytically driven outcomes
improvement is challenging because
culture isn’t measured.
Improvement gains are often subtle
and part of a larger process.

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Engagement Keeps the Healthcare Outcomes
Improvement Engine on Track
Communicating wins—even small ones—often
drives engagement, as improvement teams are
proud to see how their work continuously
impacts patient lives, and the organization
clearly sees and understands the value of
outcomes improvement work.
In addition, a dedicated executive leadership
team that prioritizes improvement and protects
the resources needed to realize key initiatives—
particularly the EDW operating system—will
keep the healthcare outcomes improvement
engine running consistently and efficiently

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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.
The Healthcare Outcomes Improvement Engine: The Best Way to Ensure Sustainable,
Scalable Change
The Top Five Essentials for Outcomes Improvement
Ann Tinker, Engagement Executive, VP; Leslie Hough Falk, Customer Engagement, VP
Improving Healthcare Outcomes: Keep the Triple Aim in Mind
Kathleen Merkley, DNP, APRN, SVP-Clinical Improvement Line
Michael Barton, Engagement Executive, VP; Tracy Vayo, VP of Knowledge Services
Five Deming Principles That Help Healthcare Process Improvement
Dr. John Haughom, Senior Advisor
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet, VP of Client Operations
Governance in Healthcare: Leadership for Successful Improvement
Dan LeSueur, Technical Operations, VP

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Neil Andersen joined Health Catalyst as a data architect in October 2011. Prior to joining the
Health Catalyst team, he was a partner at Practice Advisory Group. While there, he improved
financial outcomes and the overall efficiency and productivity for many medical practices
throughout Arizona. He also built and used analytical tools to monitor and direct management
decisions. Prior to working at Practice Advisory Group, he worked at Grant Thornton as an IT
and securities auditor. Neil graduated from Brigham Young University with a Bachelor of
Science degree in business information systems.
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