When Premier healthcare alliance officials announced this week that their data-sharing collaborative saved 92,000 lives and $9.1 billion since 2008, the emphasis was on the data, but in a briefing Wednesday about the private sector’s role in Medicare Susan DeVore, Premier president and CEO, explained that one of major drivers behind the collaborative's success was the culture change that took place among the healthcare providers.
The organizational change was the type of shift that any business must achieve to be high performing, she said.
“It was very much about culture,” DeVore said, detailing a number of questions that the high-performers had acted upon.
“Are boards of directors engaged in all of this, do they have quality agendas and mortality reporting committees? Do the providers have C-suite executives, who actively walk the talk and engage in and require transparency to the point where the nurse who never had the power to can challenge something now? Do you have data, and are you transparently putting the goals and data up on the walls of the nursing units?” she asked.
In addition to cultural change, to be high performers providers need to have a performance improvement method. “It didn’t matter which one it was,” she said. “But if the provider didn’t have a systematic method across a complicated hospital or health system, it couldn’t sustain or drive the improvement. It had to have data- and best-practice sharing,” she said.
After the first three years of QUEST, Dartmouth conducted an evaluation for Premier to figure out why some providers were high performers and others lagged in achieving the objectives.
Dartmouth researchers found that rapid and continuous improvement in quality, mortality and cost were powered by executive and clinical leadership, alignment of initiatives with the organization’s strategic goals, staff engagement and empowerment, use of an improvement framework, timely and reliable data, use of a deployment framework and active participation in a learning community.
QUEST participants shared their data and best practices with each other across six measures. In addition to cost, mortality and use of evidence-based care, providers also quantified reduced readmissions and preventable harm events and improved patient experience.
Because there are not enough evidence-based processes figured out yet, said DeVore, both outcome and process measures are needed in quality improvement. “If you measure outcome in those six dimensions, and you have data that allows you to drill into the outcomes to find out what was going wrong and take the thing that’s going wrong and build evidence around the process, that would drive the outcome,” she said.
The same holds true for cost, for which the participants have identified “what we think are the 15 usual suspects for waste in hospitals,” such as overuse of imaging and step-down units, DeVore said.
One of the unexpected takeaways she learned was that financial incentives did not have as much to do with performance improvement as she would have thought. The financial incentives were not enough to matter in the overall scheme.
“It was the competitive, transparently reporting of who was the high quality hospital, or who has the highest compliance with the scientific evidence,” she said. It was more about the desire to be a high quality health system and "the potential loss of current funding as a result of being called a lesser-quality performer," DeVore said.