Standardization, structure counter healthcare chaos

ATLANTA—Healthcare systems struggle under what one strategist sees as a chaotic period of “uber-change.” One way to make progress within this mayhem is to apply standardization and structure.

“The heat is on,” said Orlando L. Alvarez, Jr., senior vice president of strategy and planning at the Sisters of Charity Health System in Cleveland on June 12 at the Cardiovascular Service Line Symposium in Atlanta. “What is driving the change is cutting cost. There is a frenziness around what the government is doing but that doesn’t lay the groundwork for organized change.”

Cardiology is wrestling with volume shortfalls, healthcare reform, readmissions penalties, challenging margins and scrutiny with appropriate use. “You have all these pressures coming at you at once,” he said.

Alvarez shared his four-year experience of steering Sisters of Charity from a decentralized system into an efficient enterprise. He faced what he described as a disjointed system of five hospitals and two long-term care facilities that now shares goals and direction. The system was losing money, in part because of outsourcing.

“It wasn’t about adding FTEs,” he said, but rather evaluating existing resources.

Key to that turnaround was a focus on standardizing, creating structure and developing monitoring processes. That approach applied to staff, processes and capacity. “Is this what we need to be doing?” he recommended systems ask. Decision makers should look at timing and return on investment, recognizing that some initiatives may require longer investment.

He emphasized the importance of metrics and accountability. Metrics are critical to success, Alvarez said, and can be used to assess progress in real time to proactively flag problems. He recommended implementing a performance measurement system that includes a dashboard with goals and objectives and the team involved, tracking from the individual to health system level.

Use a scorecard to monitor metrics such as patient satisfaction and length of stay. Scorecards also can be developed to highlight human resource patterns such as staff turnaround. Quality scorecards can be designed to assist in tracking value-based purchasing or clinical quality initiatives. Sisters of Charity uses color coding–green, yellow and red—to provide an easy visual message of the status on any metric.

Business plan lookback tools offer a way to assess return on investment and ensure that projections made during the proposal stage are met. “Did they hit their metrics? Was it a wise investment of our capital?” he said.

He recommended scorecards for all initiatives with monthly meetings to review data, evaluate status and hold employees accountable for variances.

“All this data help you make smart decisions,” Alvarez said. “We are not at the end of the road but we are getting our arms around it.”