A greater share of organizations that use process improvement methodologies than those who do not say they have seen major improvement in HCAHPS scores or other patient experience performance measurements.

One of the key tenets of process improvement is the need to track and measure performance, bringing to mind the adage that if you can’t measure it, you can’t manage it.

However, the challenge for providers is not necessarily measuring patient experience performance, it is gaining access to timely data.

In spite of that goal, respondents in the 2017 HealthLeaders Media Patient Experience Survey say that HCAHPS or other CMS survey (78%) is the top tracking method for patient experience activity, followed by postdischarge phone calls (61%) and third-party survey service (non-CMS) (50%).

Certainly, the need for acquiring timely patient experience data is behind respondents’ growing use of social media monitoring (45%)—note that this year’s response is up six percentage points over last year’s survey.

It is perhaps not surprising that a greater share of organizations that use process improvement methodologies (87%) than those who do not (58%) mention HCAHPS or other CMS survey as the method they use to track and measure the success or failure of their organization’s patient experience activity.

In fact, nearly all responses for tracking methods are higher for respondent organizations that use process improvement methodologies compared with those who do not—the one exception is in-house survey activity (non-CMS)—an indication of the level of emphasis that process improvement places on metrics and performance measurement.

The good news for providers and patients alike is that nearly all respondents (87%) in the survey report that their organization has seen improvement in HCAHPS scores or other patient experience performance measurements, indicating that progress is being made in response to their efforts.

The survey results are: 13% say they have seen major improvement, 44% moderate improvement, and 30% minor improvement. Only 5% say they have seen no improvement.

Note that the results reveal that there is a correlation between the use of process improvement methodologies and patient experience performance improvement.

For example, a greater share of organizations that use process improvement methodologies (16%) than those who do not (6%) say they have seen major improvement in HCAHPS scores or other patient experience performance measurements, and a greater share of organizations that use process improvement methodologies (47%) than those who do not (36%) say they have seen moderate improvement.

Conversely, a greater share of organizations that do not use process improvement methodologies (10%) than those who do (3%) say they have seen no improvement.

Healthcare analytics is evolving to a greater focus on analyzing data using prescriptive analytics and providing proactive solutions.

This article first appeared in the September 2017 issue of HealthLeaders magazine.

Healthcare analytics is evolving from analyzing what has happened (descriptive) to anticipating what will happen given past data (predictive) and, in its most powerful iteration to date, expecting what will happen plus providing proactive solutions based on those predictions (prescriptive). So what comes next?

The next step in this evolutionary process is the application of artificial intelligence to healthcare data to help providers make the most effective decisions possible, both financially and clinically.

While AI is still in its early stages and has yet to be fully embraced by healthcare leaders, many believe that it offers tremendous potential for analyzing the vast amount of data generated by
the industry. 

At this point in time, the application of AI in healthcare is fairly minimal. According to respondents in the 2017 HealthLeaders Media Analytics in Healthcare Survey, for example, only 14% of respondents say that their organizations use a software platform that provides an artificial intelligence capability.

However, 35% of respondents say they don't currently have this capability but plan to within the next three years, indicating that there is potential for growth.

That said, AI is not for everyone, and 35% of respondents say that their organization does not plan to have this capability. A fairly large share—17%—don't yet know how their organization will proceed.

Steve Hess, the lead advisor for this Intelligence Report, is chief information officer at UCHealth, an integrated health system serving the Colorado area.

"At this point in time, the application of AI in healthcare is fairly minimal."

The system includes seven hospitals, 1,620 hospital beds, and more than 17,000 employees. He points out that the difficulty today is not access to data or having enough tools to analyze it—far from it; the real challenge is not having the time to extract analytical value from the data.

"We don't have a shortage of data. We don't have a shortage of dashboards. We have plenty of tools. What we don't have is plenty of time to analyze all of that data. Prescriptive analytics are what the healthcare industry needs to move the needle."

Clearly, the solution is not more tools, but more intelligent ones.

Financial and clinical analytics now

There are currently a wide variety of uses for healthcare analytics, an indication of its effectiveness and flexibility.

For example, respondents in our survey say that cost containment efforts (78%) and maximizing reimbursements (64%) are the leading uses for financial analytics now, with the next four responses falling in a tight cluster between 57% and 59%.

Note that compared with last year's survey, responses have increased for cost containment efforts (up 12 percentage points) and population risk assessment (up 9 percentage points), evidence of provider interest in continuing to bend the cost curve and applying analytics tools to manage the increased risk associated with value-based care.

The top responses for finance-related data drawn on now are both forms of claims data—Medicare/Medicaid patient claims data (75%) and commercial payer patient claims data (69%)—the same responses as in last year's survey.

This is a reflection of provider interest in analyzing the relationship between patient care and revenue. It is also worth mentioning that care partners' cost data (26%) and care partners' provider productivity data (23%) receive low responses, likely because of the
difficulty involved in gaining access to this type of data.

These data types will be critical as providers seek to understand costs and improve care across the continuum in the future.

The leading response by a large margin for clinical analytics use now is improving clinical quality (79%). Identifying gaps in care (65%) and lowering cost of care (60%) are second-tier uses. The top two data types for patient-related data drawn on now for analytics activity are clinical data from EHR (80%) and patient demographics (71%), part of an increasing focus by providers on analyzing patient care more deeply.

Two relatively new sources of patient-related data—social determinants of health (26%) and patient genetic data (9%)—are also expected to see growing analytics use in the coming years, in both population health and personalized medicine applications.

"The real holy grail is being able to look at all that data along with genetic data and really tailor treatment plans to the individual, not to the disease."

 

"I would call that precision or personalized analytics," says Hess. "Population health can mean so many different things. It could mean that you're just looking at utilization data, you're looking at claims data, you're looking at social determinants data, you're looking at remote monitoring data, and you're trying to intervene with a patient prior to them having to get treated in a more expensive care setting.

"But the real holy grail is being able to look at all that data along with genetic data and really tailor treatment plans to the individual, not to the disease. And I think the larger organizations, including us, are starting to invest in biobanks, DNA sequencing, and the pharmacogenomics data, and really trying to bring that data back into the EHR to impact the therapies and the treatments that an individual gets by virtue of them as an individual, not as a disease. So I think we're at the very early stages of that right now in the industry."

Hess says that UCHealth has been collecting DNA data through a partnership with the University of Colorado. The university has a biobank and is sequencing data for UCHealth patients through a special consent process. He estimates that there are approximately 23,000 DNA samples collected at this point, and pharmacogenomic work has started to match it up to the drugs. 

"We haven't quite yet closed the loop between the DNA data that's being sequenced and collected back to the EHR, but we're close to that. Over the next 12–24 months we fully expect to close the loop between the DNA sequencing and the EHR."

Data-related challenges

Respondents say that their organizations expect to face a number of data-related challenges in performing analytics over the next three years. The top three challenges are integrating internal clinical and financial data (47%), establishing/improving EHR interoperability (43%), and integrating external clinical and financial data (43%). In each case, the data comes from multiple sources and is not easily collated, which is likely why it is a challenge for providers.

Although the response for ethical concerns regarding the use of patient genetic data (8%) receives a low response, it is also true that the provider usage rate of patient genetic data for analytics is small.

For example, only 9% of respondents say that they draw on patient genetic data when conducting patient-related data analytics. As such use becomes more widespread, concern about ethical issues may also grow. 

Hess says that the use of patient genetic data has many ethical implications for patient care, and that it is an issue currently being studied at UCHealth.

"Using patient genetic data adds a bunch of ethical implications. As an example, what if we sequence your DNA data and you are a patient of ours but we haven't seen you in two months, and we notice that based upon your DNA sequencing, the medication that we prescribed for you two months ago probably could have been a better choice? Or there's another nonpharmaceutical therapy that might be better for you? What are our obligations for reaching back out to you? 

"It might be that we find something based upon DNA sequencing that wasn't available to us a year ago when we treated you, which is now available to us. And what if we find something in your DNA that is game-changing—what do we do about that? And do people really want to know some of those things? Do they really want to know what their DNA is showing in terms of being predisposed to cancer, diabetes, or some other disease?"

Tactical challenges

According to the survey, the top three tactical challenges respondent organizations expect to face in performing analytics are the need to deliver timely analysis (46%), overcoming insufficient skills in analytics (42%), and insufficient funding in light of other priorities (37%).

Note that two of the top three tactical challenges are either indirectly or directly related to financial resources—the solution to overcoming insufficient skills in analytics is investment in training or adding new analytics staff, and insufficient funding in light of other priorities is
clear-cut.

Delivering timely analysis is perhaps a universal problem—life as we know it requires a real-time response to information needs, and healthcare is no different.

It is worth mentioning that the response for insufficient staff (35%) is fourth on the list of analytics challenges, which is also an indicator of insufficient financial resources.

Lacking financial resources is something that plagues most healthcare IT departments when it comes to analytics, particularly the advanced forms of prescriptive analytics—the needs almost always exceed the budget—because there is simply too much data and the complexity of analyzing it effectively can be overwhelming.

According to Hess, outsourcing the more advanced parts of the analytics workload while retaining core EHR data responsibilities and mainstream analytics functions can be an effective strategy.

"About 18 months ago I made a decision that we can never find nor retain the data science experts that we're going to need in the future. So even though we're partners with the University of Colorado and we have really intelligent individuals in the Denver area, it is extremely difficult to attract and retain that level of expertise. That's why our partnerships with companies that are in Silicon Valley and competing with Google and Microsoft and all these different global organizations, that's a better approach for us. 

"We have a talented, talented team that knows how to deconstruct the Epic data model really well, but we could never get to that next level that we're going to need to go to. I think you can count on one or two hands the number of healthcare organizations in this country that can actually do what we're talking about in terms of advanced analytics."

As an example, Hess mentions two outsourced initiatives that involve scheduling efficiency, one for the University of Colorado Cancer Center's chemotherapy infusion centers (starting May 2015) and the other for UCHealth's operating rooms (starting May 2016).

"We don't have a shortage of data. We don't have a shortage of dashboards. We have plenty of tools. What we don't have is plenty of time to analyze all of that data."

The initiatives were outsourced to California-based LeanTaaS, which uses advanced predictive analytics and machine learning algorithms to provide efficient scheduling and usage of the resources.

The results for the infusion centers were positive. According to Hess, once the initiative was formally launched, patient wait times were reduced by 60% during peak periods and averaged 33% lower throughout the day. There was also a 28% reduction in infusion center staff overtime.

Hess describes the process this way: "[We] feed our data to LeanTaaS in the cloud, deidentified. Then they would come back with solutions on how to change our scheduling templates [in Epic] to get more patients through. So existing scheduling data is sent to the cloud, run through machine-learning algorithms, and then it comes back out with, hey, change these four-hour infusions to six-hour infusions, these eight-hour infusions to four-hour infusions, and so on, like a big game of Tetris to get more patients through.

"And we're now on iteration four of their algorithms, and it gets better every time. It's not a one time in, change it, and then set it and forget it. It's constantly learning and changing." 

According to Hess, the operating room scheduling initiative, which is still being rolled out across UCHealth System's ORs, has also been successful.

"And we're now on iteration four of their algorithms, and it gets better every time. It's not a one time in, change it, and then set it and forget it. It's constantly learning and changing."

So far in 2017, the program has been implemented at 86 ORs across the organization. At the time the program was launched in May 2016, UCHealth's OR block utilization—the share of the allocated OR time that is actually utilized—was about 65% on any given day.

As an example of the progress that has been made, current block utilization within the 25 ORs at University of Colorado Hospital's Anschutz Inpatient Pavilion (AIP) is at 76.5%, up 4.7 percentage points over the most recent six-month period. The current 2017 utilization target is 80%.

Note that Hess says that each percentage point of increased utilization at an OR adds approximately $100,000 to the unit's bottom line.

Analytics development

Survey respondents say that the three most promising areas for analytics development are clinical best practices (56%), real-time delivery of actionable information (54%), and population health data (47%).

It is worth mentioning that the need to deliver timely analysis (46%) is the top tactical challenge that respondents say they expect to face in performing analytics over the next three years. The good news for providers is respondents expect progress in an area that is important to them.

Achieving real-time delivery of actionable information, given the quantity and complexity of healthcare data, is likely only going to be accomplished through the use of prescriptive analytics. Hess describes the state of the industry this way:

"At some point, the IT departments and COOs and CEOs across the country, they're going to realize that they're spending hundreds and thousands or even millions of dollars on getting data out. And it's not helping them figure out what levers to pull any better. They have to go after prescriptive analytics capabilities that actually come back with, ‘Based upon what we're seeing, here are the three things that you need to be doing to be more effective.' " 

Achieving a patient experience culture of excellence at healthcare organizations means having a dedicated chief experience officer to manage patient experience, and using process improvement methodologies such as Lean or Six Sigma.

This article first appeared in the July/August 2017 issue of HealthLeaders magazine.

Building a culture of patient experience excellence within a healthcare organization should be a relatively straightforward undertaking.

A strategy must be developed, resources and manpower allocated, and leadership responsibility assigned. Execution of the strategy should be a simple matter of following the strategic road map. 

However, perfecting organizational culture in healthcare can be especially challenging. According to respondents in the 2017 HealthLeaders Media Patient Experience Survey, for example, difficulty changing organizational culture (31%) is the biggest stumbling block to creating an effective patient experience program at their organizations.

Part of the reason that transforming organizational culture within healthcare organizations is so difficult is their size and complexity: They are typically large institutions with a diverse range of professional and nonprofessional staff, representing a long list of departments and functions.

Further, patient care is increasingly taking place outside the four walls of hospitals and includes the full range of the continuum—primary care offices, ambulatory and outpatient locations, convenient care clinics, skilled nursing facilities, and home health providers—often placing it outside the reach of direct management control.

In response to the complexity of this undertaking, many providers have added a dedicated chief experience officer to their leadership team to help manage the organizational culture process.

According to the survey, 45% of respondents say that their organization has a chief experience officer or an individual with similar responsibilities. But while hiring such an executive is an important step in fostering a culture that embraces patient experience excellence, more is needed given the many challenges.

Sven Gierlinger is vice president and chief experience officer at Northwell Health, an integrated health system serving the greater New York area that includes 22 hospitals, 6,675 hospital and long-term care beds, and more than 550 outpatient facilities.

Gierlinger is also the lead advisor for this Intelligence Report. He points out that difficulty changing organizational culture also relates to the evolution of the healthcare industry to a more consumer-oriented model.

"I think that the healthcare industry hasn't looked at [the] patient as a customer like they have in other industries because payment is insurance-based. The patient is now becoming more of an educated consumer. For that type of culture, especially for an employee that has worked in healthcare for decades, it may be difficult shifting that perspective. Leaders of today must learn from and respect the past in order to move forward and adapt to an uncertain future."

Importance of Process Improvement Methodologies 

Along with establishing leadership accountability through the appointment of a chief experience officer, the use of process improvement methodologies to enhance patient experience performance has also proven to be an effective strategy.

For example, 64% of respondents say that their organizations use process improvement methodologies such as Lean or Six Sigma to improve patient experience, indicating that a greater share of respondents are using process improvement than using a chief experience officer. 

Perhaps not surprisingly, the use of process improvement methodologies is correlated with organizational size, which makes sense given the difficulty of managing patient experience across a large enterprise and the corresponding need for a more disciplined approach.

Note that a greater share of respondents from health systems (77%) and hospitals (74%) than physician organizations (26%) say that they use process improvement methodologies to improve patient experience. And based on net patient revenue, a greater share of large organizations (82%) than medium (76%) and small organizations (50%) say that they use this.

Patient Experience Improvement Areas

The survey divides patient experience improvement areas into a number of different categories—patient-focused, organization-focused, staff-related—to better examine the areas in which respondents are seeking improvement in an effort to meet their organization's patient experience program goals. 

It is encouraging that the leading staff-related patient experience improvement areas over the next three years are identifying concerns while patients are still on-site (53%), increased rounding (52%), and real-time patient feedback (41%) and staff-patient communications training (41%) in a tie. 

Rounding provides the most immediate feedback. Note that rounding and the presence of a chief experience officer on staff or the use of process improvement methodologies are correlated.

For example, among organizations with a chief experience officer, 62% mention increased rounding, compared to 45% without such a position.

Further, among organizations that use process improvement methodologies, 64% mention increased rounding, compared to 29% among those who do not use this approach.

Positive Patient Experience 

Respondents in our survey say that the top three areas in which a positive patient experience is most important for their organizations are discharge and follow-up (51%), the emergency department (50%), and outpatient/ambulatory visits (45%).

A positive patient experience at discharge and follow-up is beneficial, because it can help reduce hospital readmissions.

Likewise, a positive first impression in the ED may encourage patients to use other hospital services in the future, and a positive experience in an outpatient/ambulatory visit also helps promote the potential use of a provider's inpatient capabilities.

"If you don't create a great first impression, it's much harder to achieve a positive lasting experience," Gierlinger says. "If you have a bad experience, it can play out in a variety of ways. I think that, visually, what you see when you first walk in a space is extremely important. And when that first human contact or interaction is warm and inviting, with a smile—it makes you feel comforted and safe, and that's ultimately what we all want from any healthcare experience." 

Gierlinger also notes that when going over survey ratings and doing patient interviews, he's not necessarily interested in only reviewing the low scores.

He says it can be illuminating to look beyond the scores to understand the patient's perception of his or her care, and cites an emergency department example, an area where Northwell Health has applied process improvement methods extensively.

"I want to figure out what's the difference between good and great, what's the difference between 'probably recommend' and 'likely to recommend,' because our leaders who are rounding mostly find satisfied patients with no issues, but you don't really know if they gave you a 'probably' or 'definitely recommend.'

"A good example of this is when we identified that how we insert the IV in the emergency department is actually painful, which posed an issue. Many patients actually told us that this intervention was extremely stressful and painful, and our clinicians were not as compassionate as they would have hoped. When looking at our inpatient survey, I believe this had a significant impact on our pain management scores. Asking our patients about pain actually triggered a response to the pain they received from the IV in the emergency department. To really move the dial on performance improvement, we must be mindful of the whole experience through the lens of our patients." 

Ninety-one percent of surveyed healthcare leaders expect to average a positive margin over the next three years.

Nearly half (49%) of survey respondents indicate that cost reduction efforts yielded year-over-year savings of 5% or more for their most recent fiscal year—this result is identical to last year’s survey (49%), according to the June 2017 HealthLeaders Media Cost and Revenue Strategies: The Need for Transparency and Understanding True Costs survey. At the upper end of the scale, 12% of respondents had cost reductions of 11% or more. Both results indicate that there is room for further savings from cost reduction programs.

Looking to the future, 57% of respondents expect average annual cost reductions of 5% or more over the next three years, up eight percentage points over last year’s survey. At the upper end of the range, 13% of respondents are expecting average annual cost reductions of 11% or more. Respondents remain optimistic about their ability to bend the cost curve on a healthcare system long cited for its inefficiency.

The survey also explored provider operating margins. Twenty-one percent of respondents estimate a negative operating margin for the most recent fiscal year, and 78% estimate a positive margin. These results are comparable to last year’s survey in which 17% estimated a negative operating margin and 78% estimated a positive margin. Only one percent of respondents report flat results for this year's survey.

The outlook for the next three years shows some improvement, with only 7% of respondents saying that they expect to average an annual negative operating margin over the next three years, and 91% expect to average a positive margin during that same time period. These results are comparable to last year’s survey in which 7% expected to average a negative operating margin and 87% projected positive annual margins over the next three years.