In addition to daily rounding, top hospital and health system leaders use a variety of statistics to paint a picture of their organizations' financial and clinical health. Here are five tactics to avoid drowning in a sea of unstructured information.
An effective CEO has to strike a balance between overreliance on data and informal surveillance. Here are five tactics to avoid drowning in a sea of unstructured information.
1. Use What Works for You
For Nancy Howell Agee, more information is better in helping her synthesize a daily snapshot of the health of Carilion Clinic, the seven hospital, Roanoke, Virginia–based nonprofit where she is president and CEO.
For her daily use, she’s built a custom dashboard that shows med-surg scheduling statistics, census information in the ICU, pediatrics, and whether there are any "holes" in the OR schedule.
Admissions, obstetrics volume, volume at the cancer center, high-level imaging stats, and both inpatient and outpatient ED and OR volumes round out the picture. Although dozens of other related metrics are available, these give her a good sense of challenges that may need closer attention.
"I look at that twice a day, and most of our senior management team routinely looks at that," she says.
Marc Harrison, MD, president and CEO of 22-hospital nonprofit integrated delivery system Intermountain Healthcare based in Salt Lake City, says he pays more attention to certain metrics that are closely associated with customer service than clinical outcomes, at least on a daily basis.
"I’m more interested in access than just about anything, because we can’t make people better if they can’t get in to see us," he says.
He looks at waiting lists for outpatient clinics, outpatient wait times, call abandonment rates at the health system’s call centers, and the time taken and ease of getting a hospital transfer into the system’s tertiary and quaternary facilities.
2. Drill Down Occasionally
Agee can look more closely into all these metrics. One way to do that is to pay close attention to staffing and measuring daily visits to the health system’s 240 practice locations.
She pays special attention to a workforce report that measures whether the health system is staffing appropriately based on volume.
Harrison finds himself drawn to paying special attention to conversations happening among clinicians about best practices.
While that type of monitoring isn’t a metric exactly, he sees such diligence as essential to the health system’s attempt to drive value.
For example, the orthopedic program runs a weekly meeting in which surgeons from around the system make presentations to each other on best practices—based on their recent experience with patient cases.
"It’s kind of a group consult, but as a system leader, I’m less interested in the outcome of those conversations than whether the conversations are actually occurring," he says.
Harrison sees these meetings as a way both he and clinicians can learn about physician preference items, for example, or adequate volumes to justify offering sophisticated procedures in certain facilities, he says.
"This is a surrogate for population health and value," he says.
3. Don’t Overdo the Financials
Agee views financial metrics less frequently—monthly and quarterly—with her leadership team. They discuss whether the system is meeting its budget, how the payer mix is changing, or how clinician RVUs are trending.
They also spend time reviewing home health visits, urgent care health visits, and what kinds of cases are trending higher or lower in the OR. Other metrics, such as analyzing whether the health system is meeting, ahead of, or behind plan, by entity, also take place less frequently.
"That’s about a half-day meeting with senior execs," she says.
Harrison likes to pay close daily attention to hospital transfers because he says they speak to accessibility on the inpatient side, but he wants to understand the ROI behind the things the health system does. Somewhat surprisingly, that’s not always reflected in financial statistics.
For example, one area of innovation at Intermountain is its work on integration of behavioral health and clinical programs, which embeds mental health services in some of the system’s primary care clinics.
"We’re able to do that as a payer and provider," he says. "We spend $22 per patient per year and return $120 per patient per year in the form of better overall health and less ER visits."
Those kinds of metrics, in which it takes time and trial-and-error to make the connections to come up with an ROI, are important in a world where there is a race on to make use of predictive analytics, he says.
4. Share the Data
Sharing metrics among the leadership team can help make sure the organization’s bases are covered.
"We also have a close to real-time view of everything happening in all seven of our EDs, and we look at volume, work hours, holds, wait times, and left-without-being-seen,” says Agee.
Harrison is incorporating predictive analytics into his regular dashboard.
"Predictive analytics is trying to understand which patient needs an intensive approach and who needs a less intensive one to maintain their good health," he says. "That suite of metrics will be important in providing ultra-segmentation of a market."
Initially, that work will be algorithm-driven, but in the near future, Harrison says with machine learning and automation, healthcare can take advantage of what he calls a fourth industrial revolution.
"Each of us represents a couple thousand data points, and a supercomputer can compile our risks compared to a large population based on our characteristics," he says. "Then we can actually provide precision medicine—not for cancer or heart disease—but to keep people well."
5. Avoid Surprises
"Everything boils down to metrics, but I’m always cautious that they tell you a story but not the whole story," Agee says. "You also have to tune into what’s really happening to your patients and staff."
In other words, metrics are important but not sufficient.
"Taking the information and pressing back is important," she says. "Data is not the intelligence. What else do you need to know?"
For example, she says, recently, observation days jumped 20% across the organization. She followed up and asked why. The explanation was that it affected by a holiday and the two-midnight rule for inpatient status.
"Why would that suddenly change? We’d planned on that," she says. "I went with it, but as I was thinking more about it, they reran the statistics, found a mathematical error, and observation days weren’t up at all. That’s important because our work days and PTO are affected by this statistic."
Harrison believes surprises can be minimized by more closely linking clinical performance with financial performance by taking more risk in reimbursement. It’s a good way to force reliance on data and metrics, says Harrison, who estimates between 35% and 40% of the system’s reimbursement is currently at risk.
"Because we have a health plan [Select Health], we’re ahead of some other organizations. We’re learning, but eventually all healthcare systems have to get in the water and swim," he says.
Philip Betbeze is the senior leadership editor at HealthLeaders.