Collaboration-enabled healthcare enterprises – Part 3

How Advocate Health democratized innovation

In Part 1, I made the point that two disruptive shifts are threatening to disrupt the HIT industry because, together, they’re changing the focal purpose of technology from delivering information to empowering teams to empowering mobile, interdisciplinary teams, centered around the patient, to work together both virtually and physically as one team at scale.

The first is a disruptive shift in the product of the practice of medicine. The second is a disruptive shift in the value currency of health and care.

What’s becoming clearer to every health system that’s transforming itself to operate in the outcome economy is that the current bumper crop of technology solutions we have today–HIS, LIS, RIS, EHRs and HIEs–were never originally designed to meet the needs of the outcome economy.  In this consumer-centric, outcome economy, technology has to take on a much bigger and challenging role than its past role of organizing and presenting information to decision makers. Now it must help us bend the cost curve. And to do that, technology has to empower the people best positioned to bend the cost curve: health professionals and consumers.

There’s the infamous macroeconomic cost curve, the inflationary curve of rising national health expenditures that’s threatening our nation’s solvency–which continues to rise at least 2% faster than our GDP growth year-over-year. And then there’s the cost curve that’s threatening the solvency of health care delivery organizations where price cuts, slowdowns in volume, and growing operational costs are shrinking margins at a pace never before experienced by the industry. In the past health systems were able to raise prices and increase their volumes to stay ahead of their operational cost growth.

But to empower health professionals to bend their own cost curve, technology has to do more than connect them to just information.  Connecting people to information is, of course still a necessary requirement for technology, but it’s no longer sufficient.  It now must also intelligently connect people to the people, teams, insights, guidance, and complex processes both within and beyond their four walls–and intelligently reinvent and automate as many portions of those processes as possible by working on their behalf and help coordinate those processes in a way that improves the quality, outcomes and experience of care at a lower cost.

This time health systems have no choice but to innovate their way out of their collapsing margins because the quick fixes of the past are no longer enough. Raising prices and increasing volumes no longer works in the outcome economy where prices increases are no longer an option and outcomes are becoming incomes. Booz & Co has forecasted a 15-25% decline in prices through the remainder of the decade. So health systems can’t cut operational or labor costs fast enough to reverse their collapsing margins. So the C-suite has no choice but to find new innovative ways to improve the quality, outcomes, and experience of care and remove waste and inefficiencies.

This unprecedented margin squeeze has elevated innovation to an urgent and mission critical priority in the board room of every health system. But there’s a twisted irony in how most health systems are approaching innovation. Most are actually approaching innovation in the most un-innovative way possible–by creating an “Innovation Center”. Don’t misunderstand me.  Innovation centers play an important role in creating safe and risk-tolerant spaces away from the pressured protocol-driven care settings for creative design and conserving limited resources by prioritizing demands for support and development.

But, at the same time, the Innovation Center approach constrains the organization to handle only a few carefully chosen, usually high profile projects at a time, forcing the organization into making a few big bets rather than a large number of small bets that could add up to make a much bigger impact. The Innovation Center approach also shifts the responsibility for innovation to a small elite group of “innovation experts”, leaving 99% of associates disengaged in the innovation process. Of course everyone is invited to “submit their ideas” to the innovation center, but this creates a lottery-like experience for employees because winning tickets are rare and the cost and emotional disappointment of submitting ideas that don’t make the cut quickly extinguishes the initial excitement of each idea submitter. At the end of the day, it’s no different from the tired suggestion box model.

The Innovation Center, of course, is expected to stand up a world-class innovation ecosystem within the enterprise because some of the greatest ideas for innovations come from associates on the frontline, especially those who interact daily with patients and suppliers. But the challenge comes in finding a cost-effective and scalable way to empower the masses to engage in the innovation process without pulling them completely away from their day jobs. Is there a cost-effective way to drive organic innovation across the enterprise by empowering frontline associates and teams to easily pilot and prove their ideas for improving the quality, outcomes, and experience of care and removing waste and inefficiencies. And, of course do this without needing to engage the innovation center or incurring additional costs?

In my travels and meetings with customers across the US, I’ve stumbled upon several market leaders that have found a cost-effective way to drive organic innovation across the enterprise–in a surprising way and getting surprising results. And they all seem to have one thing in common. They’re all leveraging the content, communication and collaboration platforms of Office 365 across the enterprise to empower their frontline teams to reinvent both clinical and non-clinical processes. And what they’re finding, as a result, is that these frontline teams are not just coming up with new and even surprising ways to improve the quality and experience of care and remove waste and inefficiencies but also proving them out by testing the uptake and impact of them within their live work environments. 

Advocate Health Care is one of those organizations that’s found a way to democratize innovation across the enterprise. While many healthcare organizations limit their processes to workflows within the confines of their EHR, Advocate Health Care has rolled out Office 365 to every clinical and non-clinical worker and challenged them to find innovative ways to improve communications and processes with the adaptive tools in Office 365, like OneDrive, PowerBI, Skype for Business, OneNote, SharePoint, and Outlook. They’re using Office 365 alongside and in conjunction with their EHR to reinvent clinical and non-clinical processes in ways that their EHR can’t or was never designed to do as well. EHRs are great at connecting people to information, but not nearly as good at connecting people to people, teams, insights, guidance, and complex processes both within and beyond their four walls. That’s where Office 365 shines.

I recently had a chance to talk with Rance Clouser, Vice President, Field Services at Advocate Health Care to find out how they were leveraging Office 365 to drive organic innovation across the enterprise. I wanted to learn about innovations that they were seeing from their frontline associates and teams, and which ones came as a total surprise.  Below is a transcript of my conversation.

Schmuland: Could you briefly describe Advocate Health Care as an organization, your footprint and your journeys to the cloud and becoming a collaboration-enabled healthcare enterprise?

Clouser: Advocate Health Care is the largest health care organization in Illinois, with over 37,000 associates, 12 hospitals, over 1200 employed physicians practicing at 250 sites of care. We cover a large geographic area which has challenged us to find new and innovative ways to communicate and collaborate.

As you mentioned Dennis, we have rolled out Office 365 to the organization in order to address a clear need for communication and collaboration tools that would allow our associates to connect in order to share experience, ideas, and best practices.  Aside from email and calendar, we have enabled our associates to connect with Skype for Business and SharePoint.  Prior to implementing Office 365 we had stand-alone implementations of SharePoint for collaboration at each hospital and support center.  But with our implementation of Office 365 we migrated all of our stand-alone collaboration sites into SharePoint Online and built a governance structure and a self-service portal to allow associates to set up and manage their own collaboration sites to address project and team needs.  To date we have over 5000 sites created with over 15,000 associates participating.  Recently we have begun a project to move our intranet to Office 365 SharePoint Online.  A lot of consideration was taken in making this decision and at the end of the day we went with SharePoint Online because of the cost savings to the organization (startup cost for an on premises solution estimated to be $400,000), the built in responsive design, and the advantage of search across not only our intranet content but also the collaboration and team sites.  We are beginning our migration this month and will be complete by the end of January.  With all of this activity we have also recently began working with L3 and Microsoft on moving our Office 365 traffic from the Internet to a dedicated circuit through ExpressRoute.  Moving this traffic away from the internet will make for a safer, more reliable experience and the ability to continue the expansion of the Office 365 tool set.  I would also like to mention that in the process of moving the intranet content to our new SharePoint Online home we have enabled our content owners to collaborate and learn together via Yammer.  Imagine trying to coordinate the learning and questions with over 100 site content owners across the system through a small central project team.  With Yammer we can leverage the entire team of site content owner, folks with questions can post and anyone from the group can answer.  We do monitor the responses but it has taken off organically and definitely unleashed collaboration and speed of adoption of the new intranet platform.

How to improve care quality, reliability, outcomes and experience

Schmuland:  It’s been nearly 15 years since the Institute of Medicine’s report To Err Is Human: Building a Safer Health System shocked the healthcare industry out of its state of denial.  Yet, 15 years after patient safety became a top priority goal for every health system, all we have to show for our noble efforts are pockets of limited success.  Hospitals find continuous process improvement difficult to sustain and most suffer “project fatigue” because so many problems need attention.

On any given day, about 5 percent of inpatients are still affected by a healthcare-associated infection; among chronically ill adults, 22 percent still report a “serious error” in their care; and nearly 30 percent of Medicare inpatients are harmed in the course of their care. How is Office 365 helping you innovate in the areas of quality, safety, or high reliability care and what surprising innovations have come from the frontline?

Clouser: As you know, high reliability care in our industry remains elusive except for small silos of success within a few organizations.  The pace of improvement is just too slow–in both breadth and depth. Even the leading high reliability care organizations have difficulty scaling success in one department or hospital into another. In its work with thousands of hospitals on quality improvement, The Joint Commission has concluded that there are two key barriers standing in the way of safer care: culture change and one-size-fits-all solutions that fit few because each unit and facility can have unique root causes and contributing factors to safety issues.  And so we’re teaming closely with the DNV-GL to transform every affiliate of Advocate Health Care into a high reliability organization by removing those two barriers.  Office 365 is helping us remove those barriers in several ways.  First, we’ve built High Reliability Leader (HRL) rounding dashboards with SharePoint and embedded PowerBI reports on process and safety baselines and improvements in those dashboards.  Our HRLs capture safety and variability issues across departments and sites in Excel by issue, unit, director, date, and time.  Feeds from each unit roll up into PowerBI PowerPivot reports in the HRL rounding dashboard so that both leaders and teams can see their performance relative to other units and their progress over time against themselves as well as others.  Beyond just the value of insights on high reliability-related events alone, these dashboards have helped us establish a top to bottom organizational culture of relentless process improvement, agility, and laser focus on reducing variability.  The second way that Office 365 is helping us is in overcoming the one-size-few barrier because it’s easy to adapt PowerBI, SharePoint, Excel, and Skype for Business to meet the unique process improvement needs down to the unit and even team level.

Hand hygiene compliance is one of those absolute requirements for us in our journey toward high reliability.  According to the CDC, one in every 25 patients still contracts a hospital acquired infections during a hospital stay and yet so many of these could be prevented with simple hand washing, which still only happens about 50% of the time at the national level.  Driving hand hygiene compliance across an organization like Advocate Health Care, with more than 250 sites of care and acute-care hospitals, requires a hand hygiene enforcement and tracking solution that can not only scale across every facility but also adapt to the unique needs and contributing factors for hand hygiene non-compliance of each unit and facility.  To do this, we’ve used PowerBI and PowerPivot to track and enforce hygiene compliance across the enterprise with our Speedy Audit application.  Observers at the various sites enter their compliance observations, how many times the clinician washed or sanitized their hands per patient interactions, for example, into the Speedy Audit app.  All of that data is rolled up into PowerPivot to enable us to track compliance by clinician, by unit, by month, and see up or downward trends. Feedback to the units and clinicians is immediate — which creates just in time education opportunities and broad awareness that this is a non-negotiable clinician performance requirement.  Plus, since we’ve recorded our in-person training courses with Skype for Business our education and ongoing training is available on-demand to anyone at their convenience.

Our residency programs are using SharePoint to proactively manage the handoff process between shift teams.  Each resident ends their shift by signing off on a checklist for each patient that includes status of each patient, test results pending, what needs to be done, signs to watch for, quality checklist items, specialists involved, and anything the incoming team should be aware of.  This reduces the risk of errors and delays related to things like missed warning signs that incoming residents weren’t alerted to, action items agreed to verbally but never completed, important data points scribbled down but never communicated, and overlooked messages buried the forest of others in the EHR.  This SharePoint handoff checklist is reducing length of stays and keeping patients from falling through the cracks during the single most critical times of the day during their in-patient stay.

How to remove waste and inefficiencies

Schmuland: With downward pressures on pricing and volumes colliding with rising operating costs every health system executive I talk to is looking for new and innovative ways to remove waste and inefficiencies. Most have squeezed out as much as they can from their supply chains and are now looking for new ways to improve clinician productivity, team communication, collaboration and performance, and take out costs and waste. Is Office 365 helping you innovative in any of these areas? Any surprising innovations from the frontline?

Clouser: PowerBI has produced a few of those surprising inefficiency-removing innovations for us.  Insights and reports that used to take days to weeks can now be delivered and put to use in minutes to hours. But even more important, we’re able to use that data to optimize the use of the limited resources we have. Take, for example a simple case like knowing where and how our interpretive services are actually needed versus actual utilization across the enterprise. There are never enough interpreters so we have to make sure that they are being optimally used 100% of the time. With PowerBI we know precisely what interpreter interactions are occurring by languages, by patient, age, gender, ethnicity, by location, by time, and by unit. For example, behavioral health is currently our top unit utilizer and signing is our top language. The need is high for sign language and having the data and information to support this helps us match the resource to the need.

Another surprising innovation that’s enabled us to optimize the use of the limited resources we have is using Skype for Business video conferencing between the staff intensivists at our eICU central facility and the ICUs of some of the smaller hospitals. By equipping our eICUs with one-click videoconferencing, our intensivists can hold inter-disciplinary rounds on the ICU patients at any hospital without needing to get in a car and drive there. This innovative practice allows for us to hold these rounds regularly which are necessary in order to ensure quality, coordinated, and safe care is maintained with our ICU patients. These rounds also ensure that the patient care plans are up to date and the patient is on the quickest and safest path to discharge from the unit.

And within our own IT department, we’ve leveraged SharePoint to drive out waste and inefficiencies in how we manage our IT contracts. We’ve configured auto-notifications, workflows and the content management features in SharePoint to eliminate the need to manually track renewals and, as a result of that, are able to be proactive in reviewing and renegotiating contracts well in advance of their expiration dates. Having this visibility in a centralized tool also allows everyone interacting with each vendor to contribute their feedback and asks well in advance of the re-negotiation process. This alone has improved our negotiating positions and also enabled us to get more out of our contractors with each renewal.

How to integrate

Schmuland: What has your experience been like with integrating Office 365 with other applications and with outside entities that you partner with or share risk with? Has Office 365 made it easier for you to communicate and collaborate with outside organizations? Any surprise innovations here?

Clouser: Skype for Business has been a driver for collaboration and communication both within and outside the organization and we continue to see our clinical and support staff users find innovative ways to use the tool. As a starter we have federated our Skype for Business solution with our EMR vendor, Cerner Corporation, as well as Microsoft, which really extends the team and support for the products. Our Cerner technology is remote hosted with the vendor and having access to the Cerner support and implementation teams enables us to move at a faster pace. In addition to the vendor community we have federated with other health systems who are utilizing our eICU program. In this scenario the federation of Skype for Business allows our clinicians to communicate asynchronously for non-urgent updates. This communication allows care givers at both sites to minimize interruptions which is a known contributing factor to safety issues.  In the future we are looking to integrate our Skype for Business solution to our Cisco Telepresence rooms extending the reach of video conferencing to the desktop. Overall, we feel like we’re at the very beginning of this journey to collaboration-enable our enterprise and continue to be very excited about the next wave of innovations that our associates will dream up with Skype for Business.

What are your thoughts? Let us know via email, Facebook, or Twitter.

Dr. Dennis Schmuland

Chief Health Strategy Officer | US Health & Life Sciences

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