In part 3 of this series, we focused on the point of care team as a vital source of organizational learning and innovation. In part 4 of this post, we will talk about how point of care clinicians can lead from the front lines through clinician-driven networks of knowledge exchange and the right data tools to address the needs of the local population and to transform the way we work.
As one of the most complex sectors of the U.S. economy, the work of health care is often ambiguous, uncertain, and demanding; requiring higher levels of mindfulness, critical thinking and creativity. There is also a growing gap between our assessment capacity and the plethora of available therapy options and disease management strategies which has contributed to a growing disconnect, isolation and distrust about what constitutes “best care” (IOM, 2007). David M. Seo, MD, UHealth’s chief information officer, recently stated, “We need a data environment that can do complex statistical analysis to help us move away from reactive medicine and toward proactive medicine, in which we get to patients before they get sick and prevent the disease from occurring” (Healthcare ITNews, 2018 June 8). More than ever, the gap between the “data scientist” and the “bedside” must shrink.
The Institute for Healthcare Improvement (IHI) (Peden, 2018) acknowledges that clinicians are driven by data for understanding and for rallying others around a common cause. One way to leverage clinicians in improvement is giving them access to the data--but just as important is their ability to use that data to improve the care of patients and influence the work environment. All too often, when clinicians are given benchmarks or statistics, they are not given the time, tools, resources or skillsets to put data into action and make care better for their patients. This is challenging for organizations that must find ways to cut cost --with salaries often being at the top of the list.
Point of care clinicians desire to be an integral driver in closing gaps in evidence-based care, quality and cost. Clinicians by necessity are integrative thinkers. They triage disparate information coming from multiple sources, such as the patient, labs, radiology and the medical record, then integrate and filter this information into a differential. A hypothesis is tested, and iterative course corrections are made to arrive at the correct diagnosis and treatment plan. However, clinician insight and skillsets remain untapped and underutilized when addressing systems problems. They often lack the time, connections, data, or influence to construct viable solutions to present to their administrative leaders. Healthcare can no longer afford to operate in isolation, scramble for a quick-fix or run faster on a hamster wheel going nowhere. With strategic vision and the right tools, there are powerful ways to organize and connect like-minded clinicians striving to leverage system-wide change.
First, we need to organize and act as part of an integrated, multi-level approach to quality improvement (individual, group, organization and system) that employs a population-based focus (McHugh et al., 2012). Second, learning as a collaborative effort is dependent on networks and communities of practice and should be leveraged by healthcare organizations as an important means of diffusing best practice across organizational boundaries (IOM, 2011a; IOM, 2011b). The goal is to facilitate mindfulness, problem solving and innovation; driving “best practices” toward actual implementation in a specific practice setting. For example, there are several federally funded Quality Improvement organizations (QIOs) such as the Quality Innovation Network (QIN) that provide opportunities to leverage resources around data-driven initiatives to increase patient safety, better coordinate post-hospital care and improve clinical quality. Practice-based research networks (PBRNs) are another example of a quality improvement initiative that brings together academic and community clinicians, researchers, patients, and various other partners, such as QIOs, health departments, and community resources to engage grass-roots efforts in care transformation.
Traditional barriers that separate the academic researcher and the IT expert from the point of care team are disappearing. There are examples of point of care clinicians strategically engaging to promote change locally and across networks of care in diverse areas such as health information exchange policy. The Atlantic Quality Innovation Network (AQIN) is an example of a QIO comprised of professionals, to include pharmacists, nurses, physicians and IT developers, from all care settings fostering strategic partnerships to address high priority quality initiatives such as reduction of Adverse Drug Events (ADEs), care coordination and technology-enhanced care. For example, the AQIN anticoagulation coalition, led by IPRO, is addressing 3 priority barriers to improving anticoagulation management, to include limitations in electronic health record (EHR) capabilities, inadequate tools for peri-procedural management, and suboptimal communication between care settings. There are ways to get connected to real solutions and reaching out could change your practice.
We need to do a better job ensuring the technical requirements and relational connections are hardwired into the workflow so clinicians can learn, collaborate and contribute in real time, and target the specific needs of their population. Point of Care Decision Support (PCDS) believes that connecting the point of care team to actionable, specialty-focused information promotes analytic approaches to best practices, patient engagement and systems-supported collaborative efforts as a vital part of patient safety and value across systems of care. By combining real-time intelligence, the latest disease management tools and interoperability, PCDS gives clinicians the technical and relational connections they need to merge patient data with the best evidence, and to construct a personalized patient point of care therapy program while focusing on total patient and population health risk reduction.
Developing strategic partnerships that engage clinicians at the point of care and implementing decision support technology that can facilitate focused technical and relational connections are strategic levers to accelerate understanding of what constitutes “best care,” detect medical risks, generate cost savings and provide sustainable value. We want to hear about your experience collaborating with other like-minded clinicians through networks to leverage change locally and across your network of care. What were the challenges you face leading from the point of care?
Healthcare ITNews. (2018, June 8). Data analytics: Leveraging analytics and EHRs to power better healthcare. Retrieved from http://www.healthcareitnews.com/news/data-analytics-leveraging-analytics-and-ehrs-power-better-healthcare
Institute of Medicine (IOM). (2007). The learning healthcare system: Workshop summary. Washington, DC: National Academies Press.
Institute of Medicine (IOM). (2011a). Clinical practice guidelines we can trust. Washington, D.C.: National Academies Press.
Institute of Medicine (IOM). (2011b). The learning health system and its innovation collaboratives: Update report. Washington, D.C.: National Academies Press
McHugh, M. C., Harvey, J. B., Aseyev, D., Alexander, J. A., Beich, J., & Scanlon, D. P. (2012). Approaches to improving healthcare delivery by multi-stakeholder alliances. American Journal of Managed Care, 18, S156-162. Retrieved from http://search.ebscohost.com
Peden, C. (2018, April 25). A New Way to Engage Physicians. Retrieved from http://www.ihi.org