10 keys to reducing wasteful care variations

10 keys to reducing wasteful care variations

Healthcare organizations are looking to reduce care variations to reduce unnecessary expenses and improve care delivery for patients. Leading organizations are employing a variety of strategies to trim variations, with support from information technology systems—they’re prioritizing care standardization efforts across multiple service lines and various care processes.

A report from the Advisory Board looks at key strategies that top healthcare organizations are using to better standardize care across their systems. It’s one of the reports out of the consultancy’s Health System Performance Initiative.

Make investments in reducing care variation

Efforts to extract cost savings from traditional sources—labor and supplies—are yielding diminishing returns. The largest untapped savings opportunity for health systems involves the restructuring of fixed costs, such as rationalizing redundant services across facilities and reducing inpatient capacity. Leading organizations are accelerating these efforts, because they can pay off by reducing overhead costs associated with multiple approaches to care. IT systems can provide needed information for analysis and to help organize efforts.

Add process design and finance experts to the clinical leadership team

Leading organizations say it’s no longer difficult to achieve consensus on clinical specifications. Now, it’s hard to embed standards into daily workflows and documenting measureable impact. Teams looking at care variation should not only have physicians on it—nurses, informatics experts, finance and supply chain representatives increasingly are being included. IT is important here to both incorporate changes in workflow systems, and to measure and analyze results.

Don’t offer delays to change-resistant physicians

Leading organizations know that certain physician specialties historically have resisted efforts to limit care variations, but these providers have decided against “backloading” highly specialized areas—they’re not giving them additional time to participate in these initiatives, or giving them generous exemptions for compliance. Such tactics delay savings and institutionalize care variations. Advisory Board research finds that effective organizations have “stopped exempting even the highest volume physicians from adhering to consensus-based standards. This approach is made more palatable to physicians by these systems not mandating 100 percent compliance, but rather allowing for 20 percent to 30 percent running room for principled exceptions.”

Minimize physician involvement in designing standards for routine care

Trying to gain wide physician participation in efforts to reduce care variation can backfire. They’re already busy. Instead, leading systems allow physicians different ways to get involved, particularly based on the complexity of the care variation being addressed. Using IT to enable this can help give physicians this capability to participate as needed. For example, at Banner Health, clinical consensus groups, which focus on condition-specific care, are staffed with professionally trained program managers to allow physicians, as well as other clinicians, to work at the top of their license, Advisory Board notes.

Rule out misleading documentation

Poor documentation can undermine efforts to reduce care variation—it often results from logical tradeoffs. Leading organizations say they are trying to align care variation reduction with ongoing clinical documentation improvement initiatives, with an eye to finding waste-reduction opportunities.

Account for realities facing front-line staff in the design process

Providers must rethink when and how to incorporate workflow considerations into the creation of new care standards. Complications usually only are discovered after the design of a new order set is largely complete, and clinicians struggle to implement it in daily practice. Leading organizations are studying workflow mapping and assessment when they design new standards, and that can involve analytic applications or simulations of prospective changes that study the impact of proposed changes.

Consider the capacity for incorporating change in planning

Leading organizations say it’s possible that clinical consensus groups may be able to devise more new clinical specifications and order sets than can be logically implemented—too many changes can cause havoc with the staff who have to put them into practice. Advisory Board notes that Intermountain Healthcare has sought to lessen the blow by ensuring that guidance councils first work on order sets already in its EHR system; Texas Health Resources uses a computerized “heat map” that displays the aggregate impact of all ongoing change initiatives, identifying areas where staff are being asked to absorb too many changes.

Develop ways to revisit standards that don’t produce desired results

New care standards may not work as intended, or they may cause resistance from frontline staff who may be forced to use workarounds to adapt standards that don’t really fit their environment. Design processes should include feedback loops and review mechanisms that enable opportunities to revisit standards that don’t achieve desired results. Banner Health, for example, has formalized a process for addressing adoption challenges for new standards.

Don’t aim to monitor all care standards in real time for deviations

Information technology may be able to enable organizations to monitor adherence to new standards—but don’t do it. In some cases, real-time monitoring won’t improve care or generate cost savings. Having such mechanisms could complicate care or overwhelm practitioners. Leading organizations suggest using IT systems to monitor compliance at different tracking frequencies, measuring compliance to frequencies that are based on feasibility as well as need.

Ask uninvolved physicians to lead care variation reduction efforts

The number of initiatives needing physician leaders often outstrips the supply at most institutions. Care variation efforts might appeal to some doctors who may have shunned other types of initiatives. Health systems shouldn’t just go back to the same well of physician volunteer already involved in other initiatives—looking beyond the usual suspects may likely speed identification of interested physicians, thus growing the health system’s overall physician leadership bench.

For more information

The full Advisory Board report on reducing care variations, based on insights from pioneer health systems, can be found here.