May 3, 2024
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Steering innovation with a vision for enhancing both quality and patient safety continues to be of paramount importance even as the healthcare industry increasingly faces a myriad of challenges. In a recent study about the Top 10 Safety Concerns, staffing shortages and other obstacles reflected some of the care delivery challenges that have emerged in these two aspects of healthcare during the pandemic.
Organizations across the continuum of care, therefore, continue to work towards tackling these and becoming high-reliability care systems to better serve their patient population. That means identifying gaps and issues, and solving them, proactively and in novel ways as needed.
In a recent conversation, Dr. Peter Pronovost, a world-renowned patient safety champion, critical care physician, and a prolific researcher with over a thousand peer-reviewed publications, outlined his journey into patient safety. He dived into his shift in approach towards problem-solving, designing systems to eliminate value defects, focusing on patient experience and outcomes, enabling transdisciplinary research to synthesize diverse knowledge to reduce risks, developing strategies to address the current labor constraints, and more.
Dr. Pronovost’s transformative work leveraging checklists to reduce central line-associated bloodstream infections has saved thousands of lives and earned him national acclaim, including being named one of Time Magazine's 100 Most Influential People and a recipient of the prestigious MacArthur Foundation Genius Grant, and he continues to lead groundbreaking initiatives.
Today, he serves as the Chief Quality and Clinical Transformation Officer and the Veale Distinguished Chair in Leadership and Clinical Transformation at University Hospitals (UH). He also serves on the President's Council for Science and Technology Patient Safety Working Group, advises the World Health Organization's World Alliance for Patient Safety, and regularly addresses Congress on patient safety issues. He's a strategic advisor for several healthcare technology and venture capital companies, has founded several technology companies including VisICU and Doctella, and is known as one of the top 25 innovators and most influential executives and physician leaders in healthcare.
Here are 7 key strategies and lessons from Dr. Pronovost for building efficient health systems that empower care teams and patients alike.
Dr. Pronovost shares that considering a lot of healthcare is still primarily fee-for-service, and clinicians are often more focused on their patients only, the fusion of evangelism and science is vital. It creates a culture that gets care teams to think about the quality of care at a system level and implement successful large-scale changes.
When he first joined UH, there was a lot of focus on meeting the budget. Dr. Pronovost’s goal was to create a model of value in healthcare, and doing that by “leading with love … That is accelerant. Get that culture right for innovation, because innovation occurs when diverse ideas meet and connect with each other.”
In fact, Dr. Pronovost’s podcast, titled Micro Moments with Peter also focuses on "micro moments" of collaboration and resonance that have a profound impact on clinical transformation and quality improvement. This includes empathetic patient interactions, supportive conversations with colleagues, and collaborative problem-solving sessions.
In concrete terms, that meant identifying known defects in value in care delivery - be it in preventative care or chronic disease management - and eliminating them. And then transforming care at a system level by leveraging technology.
For UH, one of the biggest focuses remains to keep people healthy at home. Considering the budget and health system margin restraints, Dr. Pronovost implemented a “Believe, Belong, Build” model that was used to transform UH - its success measured by improved outcomes, financial stability, and enhanced access to care.
The focus is on cultivating a “self-enforced” culture that empowers the team and the system to be efficient, autonomous, and able to autocorrect when it comes to improving quality and safety. The success of a system lies in its ability to run itself without micro-management, according to Dr. Pronovost.
This model is what led UH to win the American Hospital Association Quest for Quality Award and “It's the only model that we've seen that now allows us to have a strategy that wins in fee for service, which we're still mostly paid, wins in value, and improves access in our community, our population's health needs,” shares Dr. Pronovost.
Also, the model has enabled UH to keep people healthy at home, rigorously reducing length of stay for surgical patients by giving them different access points for better care in the community, be it providing access to same-day specialists from primary care, doing hospital at home, setting up a virtual clinic from the ED, etc.
Reducing the labor costs and being able to free up units in the health system to create more surgical units, while empowering patient care outside of a hospital setting, helped UH “win in our ECO contracts and our fee-for-service and free up capacity to meet the unmet demand for things that need care in the hospital. It's this virtuous cycle - we turned our finances around from losing a whole lot last year to now being ahead of budget through this integrated approach.”
In a recent publication with Dr. Brian D'Anza at UH, Dr. Pronovost outlined a digital health framework to help system leaders better connect digital health to value transformation.
It names 3 categories of digital health: telehealth or direct care delivery, digital access tools, and digital monitoring. For Dr. Pronovost, adopting a problem-focused framework for connecting digital health to value in healthcare helps prioritize solving problems rather than getting distracted by trendy technologies.
He also emphasizes that health systems need to start thinking of innovation in terms of problems that need to be solved. For instance, Dr. Pronovost outlines a four-part strategy being implemented at UH to address the challenges of current labor constraints, the resulting costs, and the potential increase in safety risks. It includes identifying work that can be stopped, automated, outsourced, or kept sacred at the bedside.
Dr. Pronovost shares that “there's a lot of beliefs around the digital piece that we have to rethink” and challenge. This includes the overemphasis on technology rather than focusing on the problem, the notion that technology alone can succeed without rigorous usability testing, and the idea that pilots are enough without a clear plan of scaling.
He challenges the academic mindset that is often focused on grants and publications. The focus, he emphasizes, should be instead on the ultimate goal of bringing the benefits of learning to patients, which requires scalability.
“Health systems are riddled with pilots that work that never go anywhere and that’s because it's too often owned by the ventures or the innovators rather than operators,” he states. Instead, UH has a model that combines the two - innovators have a role in problem definition, diligence, and running the pilot, but operators have to commit to solving these big problems. Post pilot, there’s an ROI analysis, and operators are then entrusted to scale it.
He reiterates how “Every pilot that I do, every project, I think scale from the very beginning and why that's so helpful, it forces me to simplify. So many of these complex projects that you do in a pilot, they're either way too expensive to scale or they're not practical enough given the complexities. Then why do it? If it's not going to be a model you can scale, you're wasting your time. Let's focus on something that is scalable.”
It is aligned with the concept of having a problem-solving framework - whether that is understanding how it fits into the frontline care team’s workflow, whether it will drive revenue, does it solve a problem - all components that have to be solved for at scale, from the very beginning.
With a vision to shorten length of stay and thereby increase surgical throughput, Dr. Pronovost and his team at UH did a system-wide roll-out of Enhanced Recovery After Surgery (ERAS) programs. Even as COVID-19 hit during the planning stage, turning a crisis into an opportunity, Dr. Pronovost worked with the team to roll out ERAS across 15 service lines.
Utilizing a fractal structure for coordination across levels - where each service line had its own team and a lead, and each hospital had its own lead as well - the implementation was done in cohorts of 5 service lines. This fractal system allowed for rapid scaling.
Since implementation, the system has achieved impressive adherence rates, increasing adoption from ~25% to ~80%; reduced surgical length of stay from 6.2 days to 1.8 days; and significantly lowered complications, costs, and mortality across various service lines.
Dr. Pronovost emphasizes that even though setting a target of 15 service lines, vs starting with just one as health systems usually do, is a big ask, what enabled the success is the “shared accountability because it's not like I walk away and wash my hands. I say, ‘okay, here's how we're going to make this feasible’. Start with one to get the prototype and then get leaders for these other ones and they could use that [prototype] to go create it [service line plans].”
It enables sharing of best practices around protocols to implement, how to best engage people, etc. - and creates an iterative process where learnings, and consequent improvements, can be applied from one cohort to the next. It helps foster a “culture of learning and improving” that reduces the cycle times and builds a “management system that is then self-sustaining.”
As big tech companies such as Amazon and CVS enter the healthcare landscape, Dr. Pronovost outlines four key priorities to strategically navigate this competitive environment.
As more physicians are increasingly taking the leap to get into launching health tech startups, Dr. Pronovost advises the key to producing technology that adds value and stands out are:
With a mission to develop a patient-centered, high-value integrated program, Dr. Pronovost created the Centres of Excellence (CoE) at UH. Taking ERAS a step further, these CoEs look to optimize protocols, promote best practice guidelines, and eliminate unnecessary treatments and procedures.
At CoEs, comprehensive navigation, appropriateness criteria, and transparency in outcomes sharing result in enhanced value, appealing to both employers and payers. For instance, “within 48 hours of you getting scheduled, a nurse is on a call or on a digital call with you answering your questions, making sure you have your papers. They stay with you every step of the way of having appropriateness criteria because we know 30% of every procedure is not needed, but nobody does appropriateness where we say, no, that's a defect in value if you have an operation that you don't need.”
The overwhelmingly positive outcomes have since resulted in selling to commercial payers, private employers, and direct-to-employer contracting, which enables fulfilling cost margins from commercial payers.
For more insights from Dr. Pronovost, listen to the full interview here.
And if you’d like to learn more about the ERAS program at University Hospitals, watch our Best Practices for Deploying an ERAS Program webinar with Dr. Heather McFarland, Vice Chairman, Operations at UH, and Dr. Kevin Elias, President, ERAS USA and Gynecology ERAS Leader at Brigham & Women’s Hospital.
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Steering innovation with a vision for enhancing both quality and patient safety continues to be of paramount importance even as the healthcare industry increasingly faces a myriad of challenges. In a recent study about the Top 10 Safety Concerns, staffing shortages and other obstacles reflected some of the care delivery challenges that have emerged in these two aspects of healthcare during the pandemic.
Organizations across the continuum of care, therefore, continue to work towards tackling these and becoming high-reliability care systems to better serve their patient population. That means identifying gaps and issues, and solving them, proactively and in novel ways as needed.
In a recent conversation, Dr. Peter Pronovost, a world-renowned patient safety champion, critical care physician, and a prolific researcher with over a thousand peer-reviewed publications, outlined his journey into patient safety. He dived into his shift in approach towards problem-solving, designing systems to eliminate value defects, focusing on patient experience and outcomes, enabling transdisciplinary research to synthesize diverse knowledge to reduce risks, developing strategies to address the current labor constraints, and more.
Dr. Pronovost’s transformative work leveraging checklists to reduce central line-associated bloodstream infections has saved thousands of lives and earned him national acclaim, including being named one of Time Magazine's 100 Most Influential People and a recipient of the prestigious MacArthur Foundation Genius Grant, and he continues to lead groundbreaking initiatives.
Today, he serves as the Chief Quality and Clinical Transformation Officer and the Veale Distinguished Chair in Leadership and Clinical Transformation at University Hospitals (UH). He also serves on the President's Council for Science and Technology Patient Safety Working Group, advises the World Health Organization's World Alliance for Patient Safety, and regularly addresses Congress on patient safety issues. He's a strategic advisor for several healthcare technology and venture capital companies, has founded several technology companies including VisICU and Doctella, and is known as one of the top 25 innovators and most influential executives and physician leaders in healthcare.
Here are 7 key strategies and lessons from Dr. Pronovost for building efficient health systems that empower care teams and patients alike.
Dr. Pronovost shares that considering a lot of healthcare is still primarily fee-for-service, and clinicians are often more focused on their patients only, the fusion of evangelism and science is vital. It creates a culture that gets care teams to think about the quality of care at a system level and implement successful large-scale changes.
When he first joined UH, there was a lot of focus on meeting the budget. Dr. Pronovost’s goal was to create a model of value in healthcare, and doing that by “leading with love … That is accelerant. Get that culture right for innovation, because innovation occurs when diverse ideas meet and connect with each other.”
In fact, Dr. Pronovost’s podcast, titled Micro Moments with Peter also focuses on "micro moments" of collaboration and resonance that have a profound impact on clinical transformation and quality improvement. This includes empathetic patient interactions, supportive conversations with colleagues, and collaborative problem-solving sessions.
In concrete terms, that meant identifying known defects in value in care delivery - be it in preventative care or chronic disease management - and eliminating them. And then transforming care at a system level by leveraging technology.
For UH, one of the biggest focuses remains to keep people healthy at home. Considering the budget and health system margin restraints, Dr. Pronovost implemented a “Believe, Belong, Build” model that was used to transform UH - its success measured by improved outcomes, financial stability, and enhanced access to care.
The focus is on cultivating a “self-enforced” culture that empowers the team and the system to be efficient, autonomous, and able to autocorrect when it comes to improving quality and safety. The success of a system lies in its ability to run itself without micro-management, according to Dr. Pronovost.
This model is what led UH to win the American Hospital Association Quest for Quality Award and “It's the only model that we've seen that now allows us to have a strategy that wins in fee for service, which we're still mostly paid, wins in value, and improves access in our community, our population's health needs,” shares Dr. Pronovost.
Also, the model has enabled UH to keep people healthy at home, rigorously reducing length of stay for surgical patients by giving them different access points for better care in the community, be it providing access to same-day specialists from primary care, doing hospital at home, setting up a virtual clinic from the ED, etc.
Reducing the labor costs and being able to free up units in the health system to create more surgical units, while empowering patient care outside of a hospital setting, helped UH “win in our ECO contracts and our fee-for-service and free up capacity to meet the unmet demand for things that need care in the hospital. It's this virtuous cycle - we turned our finances around from losing a whole lot last year to now being ahead of budget through this integrated approach.”
In a recent publication with Dr. Brian D'Anza at UH, Dr. Pronovost outlined a digital health framework to help system leaders better connect digital health to value transformation.
It names 3 categories of digital health: telehealth or direct care delivery, digital access tools, and digital monitoring. For Dr. Pronovost, adopting a problem-focused framework for connecting digital health to value in healthcare helps prioritize solving problems rather than getting distracted by trendy technologies.
He also emphasizes that health systems need to start thinking of innovation in terms of problems that need to be solved. For instance, Dr. Pronovost outlines a four-part strategy being implemented at UH to address the challenges of current labor constraints, the resulting costs, and the potential increase in safety risks. It includes identifying work that can be stopped, automated, outsourced, or kept sacred at the bedside.
Dr. Pronovost shares that “there's a lot of beliefs around the digital piece that we have to rethink” and challenge. This includes the overemphasis on technology rather than focusing on the problem, the notion that technology alone can succeed without rigorous usability testing, and the idea that pilots are enough without a clear plan of scaling.
He challenges the academic mindset that is often focused on grants and publications. The focus, he emphasizes, should be instead on the ultimate goal of bringing the benefits of learning to patients, which requires scalability.
“Health systems are riddled with pilots that work that never go anywhere and that’s because it's too often owned by the ventures or the innovators rather than operators,” he states. Instead, UH has a model that combines the two - innovators have a role in problem definition, diligence, and running the pilot, but operators have to commit to solving these big problems. Post pilot, there’s an ROI analysis, and operators are then entrusted to scale it.
He reiterates how “Every pilot that I do, every project, I think scale from the very beginning and why that's so helpful, it forces me to simplify. So many of these complex projects that you do in a pilot, they're either way too expensive to scale or they're not practical enough given the complexities. Then why do it? If it's not going to be a model you can scale, you're wasting your time. Let's focus on something that is scalable.”
It is aligned with the concept of having a problem-solving framework - whether that is understanding how it fits into the frontline care team’s workflow, whether it will drive revenue, does it solve a problem - all components that have to be solved for at scale, from the very beginning.
With a vision to shorten length of stay and thereby increase surgical throughput, Dr. Pronovost and his team at UH did a system-wide roll-out of Enhanced Recovery After Surgery (ERAS) programs. Even as COVID-19 hit during the planning stage, turning a crisis into an opportunity, Dr. Pronovost worked with the team to roll out ERAS across 15 service lines.
Utilizing a fractal structure for coordination across levels - where each service line had its own team and a lead, and each hospital had its own lead as well - the implementation was done in cohorts of 5 service lines. This fractal system allowed for rapid scaling.
Since implementation, the system has achieved impressive adherence rates, increasing adoption from ~25% to ~80%; reduced surgical length of stay from 6.2 days to 1.8 days; and significantly lowered complications, costs, and mortality across various service lines.
Dr. Pronovost emphasizes that even though setting a target of 15 service lines, vs starting with just one as health systems usually do, is a big ask, what enabled the success is the “shared accountability because it's not like I walk away and wash my hands. I say, ‘okay, here's how we're going to make this feasible’. Start with one to get the prototype and then get leaders for these other ones and they could use that [prototype] to go create it [service line plans].”
It enables sharing of best practices around protocols to implement, how to best engage people, etc. - and creates an iterative process where learnings, and consequent improvements, can be applied from one cohort to the next. It helps foster a “culture of learning and improving” that reduces the cycle times and builds a “management system that is then self-sustaining.”
As big tech companies such as Amazon and CVS enter the healthcare landscape, Dr. Pronovost outlines four key priorities to strategically navigate this competitive environment.
As more physicians are increasingly taking the leap to get into launching health tech startups, Dr. Pronovost advises the key to producing technology that adds value and stands out are:
With a mission to develop a patient-centered, high-value integrated program, Dr. Pronovost created the Centres of Excellence (CoE) at UH. Taking ERAS a step further, these CoEs look to optimize protocols, promote best practice guidelines, and eliminate unnecessary treatments and procedures.
At CoEs, comprehensive navigation, appropriateness criteria, and transparency in outcomes sharing result in enhanced value, appealing to both employers and payers. For instance, “within 48 hours of you getting scheduled, a nurse is on a call or on a digital call with you answering your questions, making sure you have your papers. They stay with you every step of the way of having appropriateness criteria because we know 30% of every procedure is not needed, but nobody does appropriateness where we say, no, that's a defect in value if you have an operation that you don't need.”
The overwhelmingly positive outcomes have since resulted in selling to commercial payers, private employers, and direct-to-employer contracting, which enables fulfilling cost margins from commercial payers.
For more insights from Dr. Pronovost, listen to the full interview here.
And if you’d like to learn more about the ERAS program at University Hospitals, watch our Best Practices for Deploying an ERAS Program webinar with Dr. Heather McFarland, Vice Chairman, Operations at UH, and Dr. Kevin Elias, President, ERAS USA and Gynecology ERAS Leader at Brigham & Women’s Hospital.
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