Nancy Lakier, R.N. is the founder, CEO and managing principal of Novia Strategies, a San Diego-based healthcare consulting firm that advises hospitals and health systems on improving their operations, quality and financial strength. Lakier sat down recently with Healthcare Informatics Editor-in-Chief Mark Hagland to share her perspectives on the important topic of clinical transformation, and its implications for patient care leaders in this current moment of unprecedented change, in the U.S. healthcare system’s shift from volume to value. Below are excerpts from that interview.
Let’s talk about the processes that enable clinical transformation. And, where are we on that journey of 1,000 miles as a healthcare system, around learning to do clinical transformation?
I believe that healthcare systems [patient care organizations] are still in the process of determining how to provide care that ensures quality at the lowest cost; yet their operational systems are not fully aligned with those outcomes. And while many of them are doing amazing things, there is some pretty substantive infrastructure rebuild that’s needed in order to rebuild that. For instance, at that high, 40,000-foot level, many organizations have recently merged, or acquired, or been acquired by someone else, so they’re sorting out what services they need to provide, where they should provide them, who should provide them, and how they should provide them, and it’s highly likely that their current infrastructure is not highly aligned with their strategic plan for the future. Coupled with that, there’s the care continuum problem. We have historically been an acute-care-focused health system, with rehab providers, home health, community providers, etc., [constellated around an acute-care core]; so now, the other substantive transition we’re going through is, what care is going to be provided, by whom, and where, and then integrating patients and families into the process.
And finally, related to this, we have very little data that’s actually usable at the point of decision. So the third transformation that has to occur is in the information that people have, and to ensure that it’s not too little and not too much, and that it informs the decision-maker, so that they can make solid decisions based on the information they have at hand.
Nancy Lakier, R.N.
I often reference the fact that the healthcare industry is undergoing its Industrial Age Revolution and its Information Age Revolution at the same time, whereas all the other major industries in the U.S. went through their Industrial Age Revolutions a long time ago. What are your thoughts on that?
I agree, but I would divide the Industrial Age Revolution into two parts. One is, we have robotics and all kinds of new implants, and surgical procedures that make our ability to provide much more comprehensive care than in the past. For instance, we can place someone with spinal cord injury in apparatii in mechanisms that allow them to move. So there’s the technological revolution going on in the care delivery arena. But the second element there is the provision of data to patients and providers. For instance, there are monitoring devices tied to an iPhone that can automatically send the blood sugar of the patient. There’s a hospital in the Southeast that’s providing apps to integrate patients into the care delivery process and get more insight into patient medical compliance. So there’s that, around high-tech engagement in care processes.
But there’s the third element of who is the staff, where do you need them, and what is the work of that staff? So we see substantive changes in the roles and functions of staff. For instance, case management used to be an inpatient function; now it’s a continuum function. Mid-level providers are another example—they need far more expertise and skills to keep up with the technological component; there’s a lot more quaternary care taking place across the country.
Where does the mapping and analysis of care delivery processes fit into all of this, in your view?
That actually goes back to the data, and having the right information in the right place. We have a lot of data, but we don’t have a lot of good information that compares and contrasts what processes are critical. And let me go back up and answer that question—one of the key pieces is, do organizations know how to actually deliver and drive quality and process improvement work, which you’re referencing in terms of the outcome? I believe that clinical redesign is the approach, the methodology of looking at how care is delivered, looking at how and when it’s delivered, and in what settings, and also that care is being delivered by the right staff person. And the key is to know how to take that data and turn it into real information that gets results.
So how do I mine the data? How do I pull it out, so that a physician, nurse, pharmacist, will have quick and easy access to the data? How do I pull it out to make it easy to use? And how do I get results? You have to embed the data into processes to get action. For instance, around lengths of stay. Where were the gaps in order data, where patients sat in a bed for two or three days without anything happening? So a physician can look at the gaps—but you need to embed processes—who’s going to do the work to change processes? And what do we expect? And are we getting what we should be seeing?
For instance, a lot of time, we get the data, someone needs to make a decision, and then we need to follow that up with hundreds if not thousands of steps to make the changes—those are some critical steps that have to be taken.