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How to Make a Complex Quality Challenge Simple

How to Make a Complex Quality Challenge Simple

Hospital CEO incentives are often driven by how well the system meets financial, and increasingly, clinical goals. At Mercy Health, the occupants of the C-suite are not the only ones who benefit when the Ohio-based system meets or exceeds expectations.

The system’s 33,000 employees working within the 23 hospitals in southern Ohio and Kentucky also stand to gain. Once the hospitals’ operations meet a simple set of financial and clinical goals, everyone who works at Mercy gets an incentive payment.

Like other systems, Mercy is coping with long list of quality measures required by or requested by government agencies, insurers, and rating sites such as U.S. News & World Report.

The key is to keep things as simple as possible, offer clear, easy-to-digest feedback and “get everyone rowing in the same direction” said Anton Decker, MBBCh, who serves as chief clinical officer of Mercy Health and president of Mercy Health Select.

“It is very hard to keep it all straight, in terms of what is important, what truly changes patient outcomes and, frankly, what has the largest return on investment,” Decker said.

He has a three-pronged approach to quality and financial measures linked to staff incentives.

Keep it Simple
The first step is to limit the number of measure that will drive the bonuses. This year, the hospital launched a program that identified six key measures (the work to identify them began last year). It set goals and incentivized the entire staff to meet them. If the six goals are met, the hospital board reviews and approves bonuses. Each region gets a percentage and the board uses a formula that allows the incentive money to “trickle down” to all employees, Decker said.

The measures, many serving double duty for other quality monitoring programs, are:

  1. Net revenue growth
  2. Skilled nursing facility utilization for joint replacement patients in bundled payment programs
  3. Readmission rates
  4. Access to primary care
  5. Implementation of programs to address the opioid epidemic
  6. A package of primary care benchmarks such as blood pressure and colon cancer screenings.

On the 15th of each month, the hospital publishes what it calls the “clinical operation performance report” on the six measures. It first goes out first to 2,500 managers and then to the rest of the staff, both electronically and in booklet format.

In the quest for simplicity, information is provided in data visualizations, rather than numbers-heavy Excel spreadsheets. The visualizations are not fancy; often they are simple line charts. The goal was to create “crystal clear” messages, something Decker and his team worked hard at. They want to ensure that staff could understand at a glance what the graphs are telling them.

“The culture started changing when people started almost looking forward to it—’I wonder how we’re doing this month?'” he said. “Previously, this was the purview of select leaders…. Suddenly, 33,000 people had something to rally about.”

He called it “the joy of exploration,” not a term generally associated with quality measures.

The monthly report features data, plus an executive summary and stories from a clinician and a patient. In addition to the measures in the incentive program, the document and website also include charts on performance in other areas, such as length of stay and patient experience.

The online version is interactive. Clicking on part of a graph opens an in-house intranet page with a monitored discussion group, he said.

The dynamic Decker wants to get away from is “us-versus-them.” Staff are incentivized for both clinical and financial performance, and so is the CEO.

Greater Physician Awareness
The system is also using data and staff engagement to drive individual projects, such as trying to break even on Medicare.

Some of the doctors didn’t even know the health system lost money on Medicare, Decker said. But, they got on it and reduced Medicare losses on vascular and general surgery.

“We are never going to be successful financially if our clinicians are not a part of operations and finance,” he said. “The notion that physicians can just mind their own business and see patients and, miraculously, we’ll take care of finances… we just don’t think that works. ”

Decker said he gets the impression that a lot of hospitals could do more to address their concerns about how to deal with the abundance of quality measures.

“Most health systems just throw their hands up,” he said. “They basically do the victim thing––it is being done to them––instead of driving the message and being in control of it.

Not that it’s easy.

There are challenges, Decker acknowledges, and the wins are coming slowly. Some problems are stubborn, such as the high use of the emergency department by the hospitals’ own employees.

‘Good Leaders Simplify’
Health systems that want to try the Mercy Health approach should start by identifying ten items that are important to the organization, and which can be measured. It won’t be easy, Decker warned, and it won’t be fast.

The alternative? “If everything is important, nothing is important,”

The next step is to hire a data visualization expert to come up with simple, easy-to-understand graphics that will best communicate performance measure to staff.

Finally, keep simplicity in sight. Always.

“Healthcare is complicated everywhere,” Decker said. “Good leaders simplify.”