Enhancing Operational Efficiency with Southern Ohio Medical Center

Thanks for having us today again. My name is David Richard, I'm the director of performance improvement and clinical information systems at somc. And with me today I've got Tiffany Lacosti, she's the manager of performance improvement. And SOMC lives in Portsmouth, Ohio. It's about two hours south, directly south on 23 from Columbus on the river, about two hours east of Cincinnati. So if you can get an idea there. And it's a 211 bed non for profit hospital. We have a wide range of services for acute and ambulatory, including open heart and cath lab and lots of different specialties. 40 clinics in the ambulatory space, plus now. So rural community setting, but we offer a lot to our community and so we have a wear a number of hats and performance improvement. But my role includes quality improvement, quality reporting, accreditation, research and other things and also our informatics with our EHR vendor. So lots of different responsibilities that we can get into.

Okay, excellent. So when you say for people that are not in healthcare or as familiar with performance improvement, is it the same thing as strategy and how does it work at somc?

That's a tough question. So I see strategy is a little.

Different than performance improvement.

So when I think of strategy, I think mainly of business strategy. And what are the levers that an organization can pull to create a competitive advantage in a market based on their strengths and opportunities? Right. And compared to that, performance improvement is solving problems. It's looking at, you know, what's an informed way to evaluate a problem at hand or an opportunity at hand and to get to those core insights about how you can produce a better process, eliminate waste, increase efficiency and you know, really hardwire with some process, control things moving forward so that your quality improves. So those things are very related but slightly different. And at SOMC we are really integrally involved with quality improvement throughout the organization. It's a regulatory requirement that we have a plan in place for what are the metrics that we're going to monitor for the organization that are key clinically and operationally? And what are the bumpers that are going to trigger a formal process improvement project using our methodology and how are we going to evaluate the effectiveness of that? So that's a tall order and probably a good segue for some of your other questions.

Yeah, sure. So, so when you think about it, how many, how many scorecards do you have or how many departments are you managing? Like does performance improvement go across the organization? And you know, for a 200 bed hospital, like how big does performance improvement look? Kind of in an organization like that.

It'S definitely a team approach. So we don't do it in a vacuum, but the scope is pretty large. So we have over 400 individual scorecards that we're managing with hundreds and hundreds of metrics. And those are for departments, they're for task forces, therefore clinical registries. If you think about a registry for our open heart program or our cath program, Radiation oncology program, different things. There's metrics associated with our regulatory agencies, the higher Department of Health, cms, you know, we're involved in quality improvement registries. So for nursing, that looks like nursing quality, Indian QI is what the acronym, but it's nursing sensitive indicators and so on and so forth. So we also have dashboards for every single provider in the organization. So we have over 200 employed providers around that number. And so each one of them has a dashboard with physician or provider specific metrics based on their performance that are used for credentialing and privileging and incentives. So it's pretty massive. And we don't monitor every single metric.

And the performance of those metrics.

We rely on all our leaders and teams throughout the organization, but we are involved in data population for all those and making sure that for metrics that have an opportunity that there's an action plan in place to address that.

Wow. And so how are you, how are you managing 400 dashboards prior to Clearpoint?

Poorly. We had over 400 scorecards still, but they were just in an Excel format. And so data management was a real chore. We had dedicated people just doing population and Excel cells based on data collection efforts across the organization. And they spent an inordinate amount of time populating those spreadsheets, regurgitating that information across all the duplicate of places that it needs to live to surface that.

Information for various teams.

And we had a really poor control on the decentralized effort of process improvement, of quality improvement. So much so that, you know, really pockets of greatness existed throughout the organization. But if our regulator came in, say Joint Commission or cms and they said.

Show me evidence of, you know, your.

Performance improvement plan and the execution of that, we struggled to demonstrate it. So really having that in a centralized location that it could be evaluated and displayed was super challenging for us. We passed inspections, but it had room for improvement.

You just hand them a zip file with 400 spreadsheets and say, good luck, figure it out.

They want you to walk you through those spreadsheets? Unfortunately, yeah, something to that effect.

So where do you get all of the data from. Because it sounds like that's, it sounds like there's overlapping data in the dashboards, but also sounds like there are a lot of different places where the data comes from as well.

It streams in from everywhere. So some of the data comes from our leaders as they're evaluating their operational processes and they may submit data, some of the data may come from our claims. So whenever we send bills out the door, those bills have codes associated with diagnoses and procedures and things. And that information can come back to us through different agencies like our payers. The data may be abstracted or collected in house for our registries by professionals that are trained to collect that data for those registries. Or a good example of that is our infection prevention department. They submit infection data on hospital acquired infections, surgical associated infections, device associated infections, and submit that to the government. But then we look at that data all throughout the organization. So maybe it lives at a global level. But we also want to know what's the department specific rate for that type of infection so we can see trends.

On, oh well, this department is having.

A higher rate of infections than another department. And why is that? So it comes from everywhere and it's a real job to try to organize that and get it where it needs to go so that teams can have insights and make decisions on, on improvements.

That's what I was going to say. From a, from a quality improvement perspective, this is a little bit off of clearpoint, but just, I know you're, you're leveraging clearpoint to get all that information together, but, but what have you seen for the benefits of just being able to display this disparate data to the various audiences where you're providing dashboards for them?

It's far superior at a glance with.

The visualizations that we're capable of in clearpoint to demonstrate trends.

So in our Excel dashboards, a lot.

Of times we did not have visualizations for those. It was too time consuming to build all those out for hundreds of scorecards and metrics. Clearpoint streamlines that you have standardized templates, you can duplicate those. And so really that work is not, is not difficult. And so now we're able to show metrics in a much more streamlined fashion and surface insights about those metrics in.

A really much more efficient way.

So lots, lots of efficiencies there. Where there's duplications or wherever we want to share information amongst multiple teams, those metrics can be linked and there's one.

Source of truth and we're only populating.

One Location and it goes multiple places where it needs to be seen. So before that was all manual. Take that one piece of data and put it 20 different places and however long that took, that's great.

Can you show us some of clearpoint and let us see how you leverage the tool?

Absolutely. Tiffany's going to help us with that.

So she does a lot of work.

In the system and she's a pro.

All right, so as David mentioned, my name is Tiffany, I'm a manager of performance improvement and I'm going to show you guys a little bit how we have streamlined clearpoint and share our data with our staff. So one of the things that we struggled with before was really sharing our data as well as sharing our improvement strategies that we had in our projects that we have going on. So we utilize the HTML link from clearpoint and we have this linked straight to our SMC intranet. So this is, you can see up here I have the Internet. It's literally just a button that I have here that everybody within the organization can click on from our CEO all the way down to frontline nursing staff, housekeepers, anybody can access this. So when I come here, I have all these links. And at smc we have our overall summary dashboard, which kind of gives a really high profile view of how we're performing. We have our big five strategic values is what we call them in clearpoint, we change that from objectives. So that's what that looks like within clearpoint to us. And then every single department within SMC has a dashboard. And underneath our big strategic value dashboards, we have these grouped by area or director. And so, you know, here, looking at inpatient nursing, you're going to find all of our inpatient unit dashboards. Underneath pharmacy, you're going to find all of our pharmacies. Surgery, of course, would be surgery. So looking at this, I'm just going to show you quality because that's what David and I typically focus on here at smc. And when I click on it, it's going to open up the dashboard and so you can see our measures right at a glance. As David mentioned, it has the graphs for us so we can quickly see how are we trending and tracking with our data. Is there something that we need to do about it? Do we need to start an improvement project? And some of these we've even been able to add trend lines on. So it's nice and easy to see how we're trending and tracking. And so we have, you know, these solid lines here that can quickly see, okay, we're moving down, so maybe we need to make some changes, or maybe we're going up and we're doing really well and we need to highlight that to our staff and talk about it. And so that's how we can easily see our metrics now. One thing that we struggled with in the past was our performance improvement initiatives. Those were always tucked away somewhere. It wasn't anything. We didn't have a great way of sharing those projects and the great results that we get with them. So with clearpoint, we were able to take their initiatives. Our verbiage for that is ABW or ABW a Better way. And now we can quickly navigate to those. So I can click on ABW here. And if I want to look at improving the organizational E prescribing rate, which is something that is regulated for us to do by the government, we can quickly come here from anybody, frontline staff, all the way up to our C suite to see what are we doing about our E prescribing rates. As I scroll down through here, clearpoint gives a lot of customization ways for us to be able to basically include everything that we have as part of our ABW projects and our initiatives to put right here in clearpoint. So we've got process maps, anything that you might use for brainstorming, so fishbone diagrams, or maybe you use the five whys. We have all that right here at their fingertips, as well as the data that is associated with these improvement projects. So you can see our E prescribing rate. And if you guys are familiar anything with leading and lagging indicators, we use this with our improvement initiatives and we have both of those here. So you can see if we are working towards both of them and how they are turning and tracking. We also have evaluation and sustainment plans available here. This is a great tool for people, frontline staff, to really get involved in those initiatives that we've discussed. You know, frontline staff is really who we rely on to get us to where we need to be. So as leaders here in pr, we do a lot of data, we're looking at that trending and tracking it. But to get us to where we need to be, that frontline staff is going to be who's going to get us there. They're going to have the ideas, they're going to have solutions for us. And this gives them the ability to see, oh, we're not doing that great. Are we doing something about it? If we're not, let's start an improvement project to get there. And if they are looking at this and they say, oh, this would be a great idea to improve our E prescribing rate. I don't see it on here. Also back here at the top they have our leaders that are associated with this project and leading it. So I could easily say I need to reach out to Tiffany and David. They're part of this project and they're going to be able the ones to be the ones to help me get involved in this project. So this is what we use for departmental dashboards. Now as David mentioned, all of our providers, so providers are physicians, nurse practs, physician assistants. At that level, they all have their own dashboard as well. Those we keep strictly in the clearpoint Live system here. We don't use the HTML link for that typically because those are more protected. They do have more specific information. So Dr. Adams is one of our obgyns and this all is just for him and his specific data so we can see how well he's performing and he has access to this as well. So historically the physicians where we do have them more locked down per to say they did not have access to their dashboards and this is tied to their incentive. So at this with clearpoint, we were able to give them access at a level where they could get in here and they can learn more about their measures as well. So I don't think David hit on that too much. But also a problem that we ran into is because we have so many dashboards and so many measures, it's hard to keep up on that. Right. Where does all that data come from? What does it even mean? And on the Excel spreadsheets you really don't have a way to explain that. You're trying to keep it in one view so you can quickly look at everything that you need to see. And clearpoint really gives us the ability to break it down a little bit farther. So this is something that we do report to the government. And I'm easily able to put this here for Dr. Adams to understand more about what this measure is and what do we do with it. Also there's links right here for them. So straight to Joint Commission. What are these ICD10 codes that David had mentioned earlier with our coding, what is included in this and what is some more information about it? So this really gave us the ability to become more transparent, a quick view of how we're trending and tracking and then even learn more and understand what we're doing with that data as well.

That's really cool. I was going to say how did you get people interested in this? But then I just heard their compensations tied to it, so I imagine that's one way you can do it. Tell me a little bit about how it's still pretty hard to transition from spreadsheets to, to, to any system. So tell me a little bit about, you know, the, the choice for clearpoint, getting people involved, what the transition was like. Like, you know, don't, don't sell it, like too easy, but maybe just like some of the highlights.

So as David mentioned, we had so many scorecards, so it was a pain, not just for us, but for leaders as well. It was something that they didn't love. And as we all know, if you don't love it, then you kind of put that to the backside. But it's something that we have to do. And so with clearpoint, we did an onboarding process. So once my team had it built out the way that we wanted it, based off our organizational structure, what we did was we slowly pulled in leaders into the environment. So we had them review their dashboards, look at their measures. We want to make sure that these are their scorecards. So what are measures that are meaningful to you? And as we got those settled with them, then we introduced them to clearpoint, we reviewed it, and one of the big selling points was that because there is a learning curve with clearpoint and there is some work built into it, my team is going to centralize all that work within us. So it was a great selling point for them to be like, oh, I have this great visualization of my scorecard. My measures look great. I have all this information at my fingertips and I don't really have to do anything with it. I just send it over to the performance improvement team and they take care of all that. So as we onboarded, we got some really great feedback. We also let people know, you know, this is your scorecard, make it how you want it to see. So if you want to see a different graph, then let us know. If you want to see as much customization as we possibly can with the system, we're more than happy to do that. And so people are really happy, especially with the linking with one source of truth. What David mentioned, you know, we might have one piece of data from infection prevention that goes on 20 different scorecards. Well, they don't have to report that to me. I just get that straight from infection prevention. And we linked it all together and now they just automatically go.

That'S, that's.

Another key thing that really helped us was automation. So Wherever we could, we tried to use the data loader and format our data in a way that could be absorbed by the system and just populate all the different places that it needs to go. That was a huge time saver for us. A good example of that is our organizational patient experience or service data that we get from Press Ganey. So those are surveys about the patient's experience, whether it be an acute or ambulatory encounter. And they're asked a series of questions about their encounter and they rate it on a scale poor to great, zero to 10. And we get those results every month. And it's how many reports, Tiffany, do we get? It's a dozen reports that include all of our departments in which they have frontline staff and patient interaction. And so we were manually populating that and it took one person 40 hours once a month to populate all that data in all the places that it needed to go. And we've cut that down to 15 to 20 minutes simply by using that data loader in internal application to convert it into the right format and then hit that and upload it. And it's just made huge efficiencies for our team. So where that was done by a dedicated person before, we've cross trained our team to share the load of the support that Tiffany was talking about. Like, just give us your stuff or we'll take care of it for you. And so we've been able to do so much more than we were previously with less FTEs.

Yeah, I can imagine. Yeah, I can imagine someone really enjoying having 40 hours back in their month to go to performance improvement projects rather than just do data entry. That's great. When you, when you all were talking about like the, the practitioners or the department owners kind of owning their dashboards and customizing things, I would imagine there is still some structure like, like you must be, be linking them to, linking some measures to a strategy, some measures to regulations, some that they recommend. How do you, how do you kind of balance that, that process?

There are some non negotiable measures.

Right.

So our five strategic values, we've mentioned those Safety, quality, service, team or finance. So for each of those there are prescribed measures that we want each department to monitor if it applies to them. And then on top of that, if you're a service that provides, you know, care that is measured in some way that is involved in public reporting or comparative data in the healthcare industry, we're going to put that on your dashboard. It's going to be there and you're going to Monitor it as we should. Right. Beyond that, that's where our teams have the ability to customize and include the KPIs and operational metrics that are important to their teams. And it could be something as simple as volumes that they want to track, or it could be a process driven thing like an audit that they're looking at to see, you know, how are we doing on our periprocedural consents. This was an issue in the last survey. We want to make sure we get this process hardwired. And so we're going to be auditing that on a regular basis. And so they'll throw that on their dashboard. It could be a temporary basis, but we promote that as a way for leaders to have one place that they can look at all of their data that's important to them and share that with staff. And so we've really tried to encourage that as much as possible. Say, hey, I know in the past we've limited what will go on your dashboard because it's so time consuming to, to manage it and populate all that data.

Let's go the other direction.

Let's make this meaningful for you.

That's great because I know there's also this other challenge in healthcare reporting is you have data sets that are either required for regulation or required for reimbursements like Hedis. Or you might be looking at a proprietary 25 to 50 measures for revenue cycle management or something like that. But then for each department or each practice or each, you know, professional that has their dashboard, you can choose of those data elements, you can choose the ones that are appropriate for them. So you're still using these common or even regulated data sets, but you're all, you're not making them go through pages of information, you're letting them see just the ones that are important for their department. Where in all of Clearpoint you might have most of that or all of that information, but you're not overwhelming people with data as well.

Yeah, that's pretty important. We're working on a measures catalog as like a repository of all the measures that are involved in our industry that are important for comparative purposes. But if you notice on our quality dashboard or even our department dashboards, we're streamline that based on our priorities. You can't improve everything all at once based on your resources. So you have to kind of prioritize and strategize to what's important that we can take action on right now.

Excellent. And for someone who would just be getting started in Clearpoint, so think Back, I don't know, a year, year and a half. What advice would you give? What advice would you give them?

We would tell them to have a clear vision and make sure that you communicate that very clearly. And so with us it was a lot. I mean, we've had four or 500 scorecards in Clearpoint, so that's a big undertaking. You know, how are you going to manage that and how are you going to organize that and how are you going to do it in a way that it's simple for you to follow and be organized and be able to take your data and your initiatives to the next level. So make sure that you have that long term vision. Sometimes it seems very overwhelming when you're first getting started with Clearpoint and you're like, I have 500 scorecards that I have to get in here. How am I going to organize it? Just have that vision, communicate it. Fairpoint was great in working with us and training us and making sure that we got to where we wanted to be. I know it's a lot as a healthcare organization, we don't speak the same language, but clearpoint did a great job in learning how we are organized here at SMC and what's important to us and how we do strategize with our initiatives and our measures and everything. So just make sure that you have that vision and you communicate it. And then also it was a lot of work. So we do have four to 500 scorecards in there. It didn't happen overnight. It took us close to 18 months to get to where we are today. Just by slowly building that out, making sure that we took our time and we communicated and got to where we wanted to be. That onboarding timeline, taking everybody's input with our leadership and getting their feedback was a great way to do it as well. Instead of just doing all 400 scorecards at one time, we took the time to make sure that they were meaningful and we got to where we wanted. So just make sure that you have that vision, you communicate it and you take your time to get there.

There's a ton of options in the system. I mean, it's really limitless on what and the ways that you can build it out. And so having a path in your mind of what you want to achieve, like Tiffany said, in communicating that with your onboarding representatives and implementation team, investing in implementation resources at clearpoint to help get you started, I think that is pretty important because even though you have that vision, how you execute it, surfacing that information so that you can make decisions about access or display options or aggregation or calculations. Those things really need to be worked out to realize your vision. Relying on your implementation team, investing in the implementation team and sharing within your vision is important.

Yeah. And something I heard in there, one, thanks for complimenting our team. I think they're, they're, they're awesome as well. But one of the things I heard in there outside of that was you didn't really do a one for one translation of spreadsheet to clearpoint. You kind of met back with leaders and gave them the opportunity to shape it. So they were seeing, instead of just oh, here's your click on the spreadsheet, now click on this Internet site. It was more like we're going to improve this. So they saw like a clear jump in improvement because it was a natural time. It sounded like to, to, to relook at the measures and relook at how you display data and how you talk about it. So we, we talked about this a little bit before, but it's also a great way to get buy in is to say, you know, we're upgrading you not just to take the workload off of us of managing 400 spreadsheets, but to give you something better for, to, to look at, to interact with, to, to visualize how the, the initiatives or the better ways impact that all at once. So, so it wasn't just a one for one. It was actually a true step up in the way that you work.

Yeah, we knew it was broken.

So it was a great opportunity to like you said, get the buy in from leaders and make it something meaningful for them and then level up. Because now we're adding descriptions and qualitative information to enhance what was there previously for the metrics that are, that are surface. So how are they calculated? What's the measure description? I mean, Tiffany showed one with links to specifications for a measure that are online. Super helpful for those that are trying to interpret it. What does this measure mean? So definitely Great.

David and Tiffany, we're out of time. I, I learned a lot today. I greatly appreciate you taking the time to spend with us and, and share more about your experience.

Thanks for having us.

Appreciate it.

All right, thank you all.

Thanks.

Thanks, bye.