At Stanford Health Care we have implemented the high performance model for improvement of Clinical Effectiveness. It was our desire to move from a volume-rewarded system to a value-rewarded system that created a platform for changing culture, improving outcomes and ensuring safer and more effective care.
We found that linking quality outcomes and appropriate resource utilization is an effective mechanism for bringing clinical and operational areas together with finance to drive the change needed to meet the upcoming challenges in demonstrating value. Clinical Effectiveness fits hand-in-glove with a value-based approach to clinical quality and moves an approach from process measures, such as core measures, to outcomes, patient satisfaction, prevention of harm, survival rates and profitability.
The Clinical Effectiveness Model:
The design of the model will bring key stakeholders together under one roof with four guiding principles – quality, safety, service, and value. Use of the model has yielded amazing results using our lean PDCA improvement framework. We achieved significant cost savings ($100M) and reduction in events with harm (50%) and improvement in our clinical outcomes (top quartile).
And as healthcare continues to evolve so has our model. We knew that changing clinical practices and sustaining those changes was a challenge and so we developed a unique process using human centered design and decision science to not only make our efforts stick but to foster front line innovation.
The Clinical Effectiveness Process:
We use a mindset and a methodology which puts real users at the forefront to solve important systemic challenges. It is a deeply empathetic, qualitative, action-oriented, and innovative process.
Discovering Hidden Needs and Stakeholders
We start by looking at the needs, aspirations, and behaviors of people first, before we focus on how the solutions that are technically feasible and financially viable can be implemented. The realities of execution in the health care industry require a systemic, human-centered approach. The tools and services we create must support and serve the people, who are the heart of these complex systems. We ask how might we redesign our health care processes and practices to improve clinical outcomes as measured by quality, safety, service, and value.
As we bring innovation to the forefront we must realize that innovation=process X culture. The culture necessary for this process to thrive is one of openness, equality, and encouragement. Our process embraces the belief that we are all innovators as long as we take on the designers’ mindset. To think like designers we must:
- Connect bright sparks
- Build empathy
- Encourage wild curiosity
- Explore systems
- Prototype and iterate
We use many tools to gain inspiration. Our goal is to really get to know the users and to uncover nuance of their perspectives and values. We learn through data, literature reviews, and secondary research. We look or observe through being a fly on the wall, photo journaling, and shadowing. We listen through conversations with users, expert panels, and extreme users. We try through analogous experiences, and in-situ (in-context) experiences.
Framing Challenges and Generating Ideas
Synthesis is a powerful tool that allows us to find meaning, direction, and uncover the opportunities for innovation. Through the process of storytelling, themes will emerge. Those themes will identify design challenges. In order to properly address these challenges, it is important to frame the challenge in the form of a “how might we”. Simple brainstorming techniques are insufficient without this important consideration being applied.
Bringing Ideas to life
Rapid prototyping is an essential tool for innovation. Taking action begins with bringing ideas to life in a way that others can experience. Through our prototyping we share, communicate, and get buy-in from team members. We learn and gather input early, while it’s cheap and easy to change course. We then build enthusiasm and generate pull from real users in the system.
Kim Pardini-Kiely currently serves as Vice President for Safety & Risk Strategic Ventures for The Risk Authority Stanford, Stanford Health Care and Stanford Children’s Health. She is a healthcare executive experienced in leading hospital operations and in driving clinical improvements in outcomes. Kim has presented nationally and internationally on a wide variety of healthcare topics and her passion for excellent and down to earth style has earned her high marks. She is a nationally recognized expert in improving clinical outcomes, implementing clinical analytic departments, transforming hospital culture and creating models that focus on value.