Performance Improvement Teams Unite UW Medicine as a System

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Comprised of Harborview Medical Center, the University of Washington Medical Center, Northwest Hospital and Medical Center, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest, UW Medicine has a broad footprint within the Evergreen State.

As the largest provider of charity care in the state, UW Medicine served 60,000 inpatient admissions and more than 2 million outpatient visits in 2014.

Johnese Spisso, RN, MPA, chief health system officer for UW Medicine, brings more than three decades of award-winning experience to her role. For the past 20 years, she has worked in several different capacities at UW Medicine. Seven years ago, however, she was asked to develop the brand-new position of chief health system officer.

At that time, the organization had decided to break down the silos among its various entities, she said, and unite as a full-fledged healthcare system. Paramount to their success was the implementation of performance-improvement initiatives across the entire UW system.

Developing performance-improvement teams

Three years prior to the creation of Spisso’s role, UW had begun developing performance-improvement teams that were stationed within each member organization.

As the chief health system officer role has evolved, Spisso has been able to improve the communication among these teams. Various methodologies have been tested at each member entity, and the performance-improvement teams consist of experts in such methods as Lean and 5S.

Meeting as a committee, each team is responsible for overseeing performance improvement (PI) and care transformation at their member organization, exploring ways in which costs can be reduced and the Triple Aim can be met. The teams focus on three areas in particular: transformation of care, supply-chain management, and revenue-cycle management.

“It’s really been a program that starts at the ground up,” she said. “We have physicians and staff at every level of the organization engaged in it, and we try to provide an efficient administrative structure so those great ideas and opportunities can be resourced. And once we establish a best practice, we can quickly roll it out to all of our sites.”

“The structure has been key,” she added. “At each site, we have one PI director and that individual works with all of the physicians and staff at that institution to make sure all of the projects are being implemented.”

Each team leader collaborates with a centralized committee of experts who understand Lean, 5s, and other system-improvement methods.

In 2014, UW successfully completed a PI plan with over 100 initiatives that ended up saving the system $100 million.

Discovering the importance of PI teams

Washington is one of the states that has opted to move forward with both Medicaid expansion and the establishment of a health information exchange (HIE). As a system, UW wants to support this effort by attracting new patients to sign up for healthcare.

By actively collaborating with social workers, medical students, financial counselors, and employee volunteers, UW Medicine’s community-outreach initiative resulted in approximately $10 million in improved revenue and an 11 percent reduction in self-pay patients (from 14 percent to 3 percent).

Within the emergency department, physicians led an initiative to reduce sepsis rates, saving UW $3 million. Another $3 million was saved through a series of pharmacy initiatives, and standardizing spinal-implant procedures yielded an additional $5 million in savings.

Furthermore, UW Medicine collaborated with community leaders on developing energy-efficiency opportunities that would reduce utility usage, which totaled over $1 million at Harborview Medical Center alone.

The key to these initiatives, Spisso said, was the team mentality behind the implementation.

“It is important, though, to have that entity ownership at each site when they establish the PI plan that we approve in the budget process,” she said. “That leadership team is held accountable for delivering on that $25 million book of business. Working together as a system, we really have the benefit of getting initiatives done much faster. Once we see it done at one site and we know it has value, we can quickly roll it out to all four. So it allows each entity to be working on different things that we can then share as best practices.”

The biggest challenge before UW Medicine, Spisso said, is providing physicians with accurate and reliable data and producing dashboards that define PI opportunities while using comparative benchmarks with other healthcare entities.

“Once we found that we could actually highlight the opportunity for people, the physicians and staff were really excellent in coming up with things that they could do differently and also talking with other organizations about best practices on what they were doing different to get to that cost level,” Spisso said. This included areas such as radiology that could yield a better return on investment.

Keeping more dollars at the bedside

As UW Medicine has grown, Spisso said the organization has become more skilled at consolidating various infrastructure services in cost-effective ways that “keep more dollars at the bedside.”

“Because of that motto, we have tremendous buy-in from physicians and staff,” she said. “They really feel like they’re leading that piece, since they should know the most about the care that’s needed and they have the ability to really identify things at the patient-contact level that could lead to reductions of waste and improvements in care and satisfaction.”

In the future, UW Medicine hopes to reduce variations in practices as evidence-based standardization and choosing wisely concepts are introduced. As the UW team continues to deploy information technology, they’re constantly dealing with the question of how to use multimillion-dollar IT investments in a way that transforms care delivery.

“We’re a health system that provides everything from prevention through primary, secondary, tertiary, and quaternary care,” she said. “Because of the services we provide, we have very high-cost patients. We have to make sure that the services we’re providing are also leading to better outcomes for patients so that they will over time be reducing their utilization of services.”

-by Pete Fernbaugh

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