In this business profile, Larry Volkmar, a managing director in the performance improvement practice at The Claro Group, discusses key strategies for improving clinical and financial performance.

Larry VolkmarWhat are some of the biggest challenges you see affecting healthcare organizations from a performance improvement standpoint?

There are three evolving dynamics increasing organizations’ focus on performance improvement. First, as government and commercial payers begin to tie clinical outcomes and patient satisfaction scores to payment, hospitals and health systems are taking a hard look at their current performance and determining where and how they need to improve. In addition, Medicare is tasking organizations to reduce readmissions, hospital-acquired infections, and other avoidable issues that can negatively affect care quality and escalate costs. To avoid the associated penalties, hospitals and health systems have to take aim at these areas as well.  

The second issue is that although the industry is moving toward quality-based reimbursement, it hasn’t completely made the switch. Figuring out how to be successful in a value-based world, while continuing to operate in a volume-based one, is challenging. Plus, the future is still a bit unclear, and organizations don’t know exactly when or how the industry will fully transition, so there is a lot up in the air.

Finally, as a result of the emphasis on value and the emergence of several risk-sharing programs, hospitals are having to partner with physician practices to raise quality and reduce costs for various procedures. To that end, a number of hospitals are acquiring physician groups, even if they don’t align strategically with the hospital’s goals. This lack of alignment can make system-wide improvement difficult.

How does the service that The Claro Group provides address these challenges?

The Claro Group is a seasoned consulting firm with broad healthcare knowledge. One way we help organizations improve their performance is by reducing variation across the enterprise. We partner with organizations to assess how well they perform as compared to peers, looking at system-, hospital- and practitioner-level data. We then determine which hospitals and providers are top performers and what they are doing differently that yields good results. We then help the organizations spread best practice throughout the entire entity.

For example, if an organization wants to enhance clinical documentation, we would first examine overall hospital performance and then drill down into the work of various providers, benchmarking them against their peers. This highlights those performing at both ends of the spectrum, so we can apply best practices and limit variation across the board.

We also work with organizations to improve clinical processes as well. For instance, we might partner with a health system to improve outcomes for gastrointestinal (GI) surgery (large and small bowel procedures). We would work with a group of physicians, bringing them together and sharing performance data. Depending on the organization’s culture, this data may be blind or not, as some organizations are more transparent than others. Either way, we would show the physicians how much variation there is in surgical outcomes and ask them to describe the evidence that influences how they practice. We would also review which practitioners achieved the best outcomes, both clinically and from a financial standpoint. Along with the project’s executive sponsor, we would then encourage the physicians—and this is the hard part—to agree on what interventions, processes, and procedures truly make a difference in the care of a surgical patient. The goal here is to identify best practices and begin to spread them across the organization.

In the case of gastrointestinal surgery, we’ve worked with several organizations to identify four key interventions that have a measurable effect: The first is getting patients up and ambulating early after surgery. The second is giving them small amounts of fluids fairly soon after surgery to keep their digestive system moving. The third is to switch from IV antibiotics to those taken by mouth as soon as the patient can manage it. The last is actually one of the most important: calling a second time-out in the operating room to check for bowel leaks—because this can lead to peritonitis, which is the number one complication following GI surgery. If everyone on the surgical team stops and makes sure there are no leaks, then there is usually a better outcome for the patient, and he or she is more likely to progress quickly to discharge.

Most of these interventions are not hard to implement, especially if you involve the clinicians actually doing the work in determining what the correct interventions are. Although this example relates to GI procedures, we apply this same strategy to any clinical problem. In the end, we want clinicians to be stakeholders in improvement, so they have greater buy-in for the work. Clinicians are the experts, and they don’t want a hospital executive or consultant telling them how to practice medicine. So, we let them, as a group of peers, decide what’s the best way to deliver care.

What are some key considerations for healthcare leaders when choosing a consultant?

When making a decision about a consultant, organizations should first assess how well the company fits with the organization’s culture. If there isn’t alignment, then the relationship is more likely to run into trouble. A good consulting partner will aim to gain an appreciation of your culture before they start working with you and before they make any recommendations for change. To do this, they may spend considerable time with executive sponsors and organization leaders, as well as the staff involved in the areas targeted for change.

You should also make sure that the consultant has subject-matter experts that are well-versed in the types of changes you’re trying to implement. Has the consultant done this type of work before? Do they have the necessary expertise on their team? For instance, if your organization is considering changes in the pharmacy, does the consultant have a pharmacist as part of the team?

As healthcare organizations implement use of your service into day-to-day operations, what advice would you offer so they can best set themselves up for success?

One of the first things to do is lay the groundwork for change. It’s always good to have a strong and engaged executive sponsor from the organization. This person should serve as the champion, and thus will be the first to communicate the need for change and what that might look like. The last thing you want is to have the consultant—who has never worked with these particular clinicians before—be the first one to bring up the idea of doing things differently.

Once the project gets underway, it’s important to have regular check-ins and follow-up meetings with stakeholders in which progress toward goals is clearly articulated. Everyone should be clear right from the beginning about what the organization wants to accomplish, and these goals should be consistently communicated throughout the enterprise.

One of the reasons an organization hires a consultant is that most healthcare executives already have one full-time job, and sometimes that job can be consuming, making it difficult to carve out time to meet with the consultant. However, the most successful engagements are those where the executive sponsor has actually made time for the consultants, and the organization has freed up staff time to focus on what needs to be done to realize change.

For those health systems that have acquired provider practices, make sure you move your physicians and other providers to the point where they are practicing at the tops of their licenses. Actually, this is good advice for all of your practitioners. You want your medical assistants to practice at the tops of their scopes of practice just as you want your registered nurses to perform at the tops of their individual states’ scopes of practice. 

With the implementation of a new electronic medical record (EMR) or even an updated release of an existing EMR (specifically in the physician practice world), many of our clients are experiencing a drop in revenue as the learning curve is sometimes steep. Our team at The Claro Group has worked with physicians and providers to mitigate drops in revenue associated with new roll outs of EMRs or upgrades to existing systems.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

To learn more about how The Claro Group can help your organization implement a successful performance improvement project, go to our website at

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The Claro GroupContent for this Business Profile is supplied by The Claro Group. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Monday, November 28, 2016