We are living in a data-rich, information-poor era of healthcare, with what feels like a chasm between where we are and where we aim to be with patients’ outcomes, quality improvement and practice growth. The gulf is overflowing with data that are both the key to our success and the hurdle holding us back.
The downside of data diving
Managing a cardiovascular service line (CVSL) today requires both clinicians and administrators to process large amounts of internal and external data. Depending on your role, you may find yourself wading through the same or updated reports daily, weekly or a couple of times each month. If you are a clinician, you may doubt that reading reports is the best use of your time. You wouldn’t be alone in such frustration. A 2016 survey found that physicians spend 21 percent of their time, or 168,000 full-time-equivalent hours, on nonclinical paperwork and 49 percent of physician respondents always or often feel burned out (The Physicians Foundation; see bar graph). The same year, another group of researchers found that physicians and their staff spend 15.1 hours per physician per week processing external quality data, contributing to an inefficient system that yields “negative physician attitudes toward quality measures” (Health Affairs 2016;35[3]:401-406).
Even I, a healthcare administrator who enjoys a data-dive, must admit that the volume of data can be overwhelming and that the complexity of many reports could divert me from my institution’s goals of enhancing patient care, improving quality and growing the service line. So, yes, there’s a downside to working in the current era of data-collection-on-steroids but, fortunately, there also are strategies for crossing the data chasm to arrive at a place where we are achieving goals and have data to prove it. In this series, we’ll explore strategies for efficiently getting to the meaning in so-called meaningful reporting and share ideas for optimal practice management.
Storytelling as a bridge
“Numbers have an important story to tell. They rely on you to give them a clear and convincing voice,” wrote Stephen Few, author of Show Me the Numbers (2004). He was discussing business practices in general but could have been speaking specifically to CVSL administrators.
U.S. physicians say they are dissatisfied with their financial reporting experiences, and their behavior demonstrates both that dissatisfaction and their consequent lack of engagement (Association of American Medical Colleges [AAMC] 2016 Faculty Forward Engagement Survey). Our experience at Wake Forest Baptist’s Heart and Vascular Center was in line with the trend. One of our departments scored 83 percent for overall satisfaction but only 40 percent for “explanation of finances to faculty.” In talking with the department’s clinicians, we learned that the problem wasn’t a lack of data sharing but rather the amount of data we were providing (too much) and how we were presenting it (too complex). Our intent was to be transparent, but the result was dissatisfied, overwhelmed physicians. In short, we were missing the mark with storytelling.
This week alone I have received data or reports on patient satisfaction, denials, admission orders, cath lab and electrophysiology lab daily volumes, new faculty research expenses, new location revenue projections, unsigned documentation, outreach contract support, our quarterly CORE measure scores, DRG profiles and profitability, month-end financials, potential bundle models and procedure benchmarks. Simply passing these and other data on to the clinicians is not effective. My task is to decipher the information from many sources and then share the right data points with the right clinicians in ways that will be meaningful for each recipient.
The medium makes the message
Our organization created “Pulse,” a portal that allows clinicians to see their own current statistics in real time across a variety of carefully selected areas of clinical productivity and quality outcomes, including how they are stacking up against current goals. All of the clinicians in our network can log on to Pulse at any time from any computer at the medical center. Pulse makes it easy for them to ask questions about coding, budgets and targets. As shown in the line graph above, Wake Forest physicians consistently log onto Pulse and to review their RVUs. Their engagement, as measured by Pulse website use, spiked in the last month of every quarter, suggesting they are now monitoring their individual performance against budgeted targets—a task not all physicians had adopted. Since building Pulse, we are meeting our work RVU targets across the institution, which is, of course, due to many variables, physician engagment among them.
Pulse has become the tool we reference in conversations with clinicians, which have become more frequent and productive. Providers now come to me with deeper, more relevant questions than in the past. I see them engaging with the data in more meaningful ways and applying it to their practice. That is our goal—to help end-users change behaviors and enable us to meet our health system’s goals.
As we transition into new healthcare models and the demand for higher quality outcomes at lower costs increases, there will be even more data. Successful healthcare leaders will translate the data into meaning and help our partners apply it toward positive outcomes. The extent to which we convince clinicians to dive into the data chasm with us and swim to the other side may depend on our ability to tell an engaging story.
Megan S. Berlinger, MHA, is the business administrator for the Heart and Vascular Center at Wake Forest Baptist Medical Center in Winston-Salem, N.C. She joined the Wake Forest team in 2006 after completing an administrative fellowship at The Johns Hopkins Medical Center in Baltimore.