Working with Clinicians to Target Performance Improvement 

Frustrated because you can't seem to engage clinicians in performance improvement that leads to sustainable cost reductions? That's most likely because you're not focusing on what matters most to clinicians-the patient experience and how safety, quality, resource use, labor, supplies, and services contribute to it.  

A new approach to performance improvement can help guide clinicians to make changes in clinical processes that eliminate unjustifiable variation and waste, increase efficiency, and reduce costs across the healthcare continuum. Created by Deloitte Consulting, the clinical effectiveness and efficiency approach (CE2) targets the patient experience and the quality and safety measures that enhance it.

HFMA recently asked Denise Hartung, a consultant and researcher who helped create CE2 to explain how it works. 

HFMA: What are the components of CE2? 

Hartung: CE2 uses benchmarking to identify clinical value bundles or DRGs that have high cost variances and to set performance targets for cost, quality, and safety. It establishes teams of clinicians and gives them the tools to analyze the care processes in each high-variance clinical area to identify areas of waste and opportunities to redesign clinical processes with the patient as the focus.

HFMA: How does the CE2 framework differ from traditional performance improvement?

Hartung: It is oriented around process, rather than function. It focuses on aspects of care that have clinical relevance to a particular DRG, such as drugs, supplies, excessive length of stay, adverse events, and quality indicators, rather than productivity and departmental costs. Also, it's evidence-based.  It provides evidence from the literature or best practice examples to clinicians who are trying to figure out the right level of utilization, the right drugs to use, or what is working and what isn't working in patient care. It also uses clinical information systems to make it easier for clinicians to do business in a cost-effective way.

HFMA: Can you give an example?

Hartung: A group working on heart failure had variation in utilization around a particular imaging test because many physicians didn't know the evidenced-based criteria for the frequency of the test or whether a patient had the test in the past six months or had it in some other setting. The physicians agreed to adopt the evidenced-based guideline. The clinical information system built the guideline into the order set and created a link- so a physician could easily find out the last time a patient had the test as well as the results of the previous test before he ordered a new one.  The clinical information system made it easy for physician not to over utilize and duplicate the test-not a cookie-cutter approach to medicine, but a collaborative, team-established clinical process  based on evidence of what is best for the patient.

HFMA: Why is it so important to lead with quality when looking to eliminate waste and drive efficiency? 

Hartung: If you tell clinicians sitting around a table, 'Let's devise the best quality, the safest experience for patients,' they will do what they have been trained to do-fix the things that aren't working and redesign care so everything is firing on all cylinders. That means patients get the right amount of care in the right setting and for the right length of time.  Right now, many hospitals are absorbing the cost of poor quality that just doesn't show up as a cost center. 

HFMA: What can CFOs and other senior finance executives do to support clinical effectiveness efforts in their organizations? 

Hartung: CFOs can help legitimize the business case for improved clinical processes and quality improvement, both on the cost side as well as the reimbursement side. They also can make a good business case that safety and quality performance can be a strategic advantage in the marketplace.  

CFOs can be sure performance improvements are reflected in the bottom line. If the hospital is doing fewer imaging tests or if the length of stay is down, then resources have to be adjusted accordingly. Financial leaders can give the clinical improvement teams credibility by emphasizing to top executives and the board that improving quality is not only the right thing, it's good for bottom-line cost reductions.