Over the last seven months, St. Joseph Health System (SJHS), a large Catholic healthcare organization located across California and western Texas, has been using a multi-disciplinary approach to engage its physicians and clinicians in understanding the impact of clinical practice patterns and resource variability.
During a presentation at the Healthcare Financial Management Association's National Institute conference in Las Vegas in late June, Tammy Alvarez, director of evidence-based care and clinical effectiveness at SJHS, and Denise Hartung, director of Deloitte Consulting, discussed the ways in which Deloitte's Clinical Effectiveness/Efficiency Framework (CE2), has helped SJHS provide the right care to the right patient at the right time and made patients and their experiences the health system's number one priority, among other benefits.
"The key principles of CE2 are engaging clinical and administrative leadership, reducing variability and improving reliability, and hardwiring evidence-based practices and continuous improvement," said Hartung. "The healthcare system in the country has gotten to a different place than it once was so we need to make a change in how we think about delivering care."
Hartung said using the CE2, a healthcare system develops a DRG or clinical bundling approach that engages physicians in the cost reduction process through system leadership. Alvarez utilized the CE2 in her health system's sepsis and stroke programs.
"We frequently go into organizations looking for cost reduction opportunities. We look at clinical bundles with potentially the biggest impact to work on reducing readmissions, physician financial alignment, reducing complications, decreasing mortality, cost variability, and strategic focus," said Hartung.
Alvarez said SJHS has a vision to create a sustainable infrastructure for the spread of evidence-based clinical practice using four major functions that include convening clinical and operational experts to develop evidence-based toolkits that incorporate all the clinical and operational best practices. The toolkits are then presented to the health system's various locations, which Alvarez calls "ministries," along with clearly-defined clinical and timeline expectations. After the adoption of the toolkits, the local ministry has the opportunity to adapt the toolkit to their local environment. Lastly, operational support will be facilitated by the health system.
"This is about sharing across the system. Ministries are sharing best practices and what's working and what's not working," said Alvarez. "It's important to not only be transparent but have honest conversations. This initiative brought our CFOs and CEOs together. It's about all the systems working together and how their work can overlap. At the end of the day sometimes you're so busy, you don't realize the importance of thinking of your systems working all together."
Alvarez said from using CE2 so far, she can share a number of important lessons including getting the entire executive team on board, engaging the CFO early on, understanding and listening to the physicians and realizing the limits of evidence-based practices.
"I think what's really changed is the type of conversations our teams are having. I think there was a lot of skepticism at first but now doctors are sitting down and having these conversations and want to be a part of these teams," said Hartung. "There's an excitement about fixing something that's been broken. It's a real positive energy."