Why are we choosing the wrong metrics?

For several years, I have had the fortune of studying healthcare organizations up close – some of them high performing in terms of patient care, cost and experience while others are not. One of the common element that unites the management teams in these organizations regardless of their actual performance is the fact that they prioritize safety over any other outcomes. That is, patient (and sometimes provider) safety climate is the first and foremost metric over cost of care and patient experience. Of course, these outcomes are not completely independent since safe care can lead to better experience and low cost over time.

Numerous times I have heard people suggest that this industry can learn from other industries such as manufacturing and services on how to create processes and good operations. I agree – but let me also tell you that other industries can certainly learn one thing from healthcare. The industry’s undivided focus on safety over anything else. I am writing this blog after observing the shocking line of events that occurred at Boeing. Just a simple google search using the words “Boeing” and “safety” would fill your browser with series of articles on how this organization prioritized shareholder value over customer safety. On numerous occasions they had ample evidence on the design and the safety issues of the 737-Max product line but this was ignored repeatedly by the leadership citing that delays and additional testing would result in bad market performance and lowering of shareholder value. I refer to shareholder value, market performance and profitability as an outcome metric (also sometimes referred to as lagged metric). The fundamental issue is that focusing on outcome metrics by themselves alone would result in short term gains but long term losses. Rather a focus on process metric such as safety may in the short term create some pain but over the long term is undoubtedly the best strategy for the organization. History has taught us this lesson repeatedly. A great example that shows this work is the leadership of Paul O’Neill at Alcoa. He transformed the company from being the worst productive organization to the best productive and profitable organization by focusing on one process measure – i.e. – worker safety. The culture at Alcoa was transformed into one that prioritizes worker safety over anything else. The results in terms of the outcomes followed through this transformation. That is, processesàculture & behaviorsàprocess measures à Outcome measures. So why are other organizations missing this link?

I am writing this blog not just reflecting on the Boeing’s troubled management focus but also hearing that the new CEO Dave Calhoun getting appointed today. What is troubling is the wrong way to incentive the leader, his hefty compensation package ($26.5 million) is focused on getting the 737 max out of the crisis – an outcome based measure in my opinion. Are we making the same mistake again? Wouldn’t this tradeoff with other product line priorities at Boeing? Why are we not thinking on process baffles me as an academic researcher!

Does Office of Patient Experience Matter in Improving the Delivery of Care?


Source: @IBCMED

Improving the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores has always been a challenge for US hospitals. Hospitals with poor HCAHPS scores can lose up to 2% of their Medicare reimbursements, which equates to a several million dollars for an average sized hospital. Using data from over 3615 hospitals between the years 2007-2014, we studied how hospitals improve their HCAHPS scores. We found that it is common from hospitals to use resources from their existing administrative offices such as office of quality and patient safety to improve HCAHPS but are less successful. This is because, elements of HCAHPS such as communication with the nurses and physicians are often considered less tangible and hence difficult to improve when compared to evidenced-based measures such as length of stay reduction. Performing well on HCAHPS therefore requires hospitals to change their operating routines and organizational culture.  To accomplish these tasks, we found that a certain proportion of hospitals are undertaking a number of initiatives that are unique to this industry. One such initiative includes setting up the Office of Patient Experience (OPX). An OPX is generally tasked with developing and implementing best patient experience practices to ensure that the hospital delivers consistent patient-centered care. It is different from other entities such as “Patient Council” and “Patient Relations Office,” which historically have been responsible for interfacing with the patients, surveying patients and resolving patient issues.  One example of this office and how it operates can be found at the Cleveland Clinic

Our Findings

We collected extensive data on the setting up and operations of these offices in the US. Between 2007 and 2014, we found that there were 132 hospitals that had an OPX within their organizational structure. We also find that this number continues to grow in recent years. Our results suggest that hospitals with an OPX are associated with 1.95% higher HCAHPS for each year of operation. We also found that hospitals that have higher residents and treating high acute patients (measured using case mix index) benefit from these offices to manage patient and provider variations.  Specifically, for hospitals with high CMI, we observe a 6.5% improvement in HCAHPS for each year increase in operation of the OPX, with no significant impact observed for hospitals with low CMI. Similarly, for hospitals with high resident intensity, we observe a 1.8% improvement in HCAHPS for each year increase in operation of the OPX, and only 0.9% improvement observed for hospitals with low resident intensity. Hence greater benefits of an OPX are realized by hospitals with high CMI or high resident intensity. This estimate offers the first empirical evidence to the efficacy of these administrative innovations. The significance of these improvements in HCAHPS are better highlighted when compared to only a 0.85% annual improvement in HCAHPS for hospitals that did not have an OPX.

Given the effectiveness of OPXs in improving HCAHPS, we conducted additional analyses  to investigate the cost of implementing these offices. We find that the operating costs, which include expenses incurred in every aspect of a hospital’s operations, reduce by 1.4% for each year of its existence.  These are also sizable improvements in operating efficiencies, especially given the low margins of operation for a vast majority of hospitals – the median operating margin for hospitals in 2018 was 1.7% .

Finally, taking cues from our interviews with the OPX and hospital staff at a prominent teaching hospital, we also investigated the impact of the background of the CXO (medical vs. non-medical) on the effectiveness of an OPX. In our dataset, we find that only a small proportion of the CXOs (14.5%) had a medical background, i.e., a nursing (RN, BSN) or MD/DO degree. Preliminary evidence suggests that a CXO with a medical background is more effective at improving EQ than a non-medical CXO. Specifically, a hospital with a medical CXO observes a 1.6% improvement in HCAHPS, compared to a 0.1% improvement in HCAHPS for a non-medical CXO, with each year of OPX operation. This suggests an interesting managerial insight on how to lead these offices in a hierarchical industry such as healthcare. Taken together, these results offer preliminary insights on the role and efficacy of these new administrative innovations in the healthcare industry. It also offers important policy implications to CMS on how to prioritize and manage HCAHPS.

 

How to transition care after surgery? Insights from research

Some anxiety is perfectly normal for kidney transplant patients, but new research suggests that medical staff can help patients feel more at ease when they leave the hospital and that could decrease the chances they’ll be readmitted.

High levels of anxiety a week after a kidney transplant patient went home more than doubled the chances he or she would be readmitted within 30 days of release, researchers found.

And anxiety was higher for patients who received inconsistent directions related to post-discharge care while in the hospital and who reported less-than-optimal empathy on the part of nurses, doctors and other caregivers, researchers from The Ohio State University Fisher College of Business and Wexner Medical Center report in September’s Journal of Surgical Research.

Aravind Chandrasekaran

“The more patient-centric the care, the more trust the patient had in the information provided, the lower the anxiety level after discharge,” said Aravind Chandrasekaran, study co-author and an associate professor of operations and associate director of Fisher’s Center for Operational Excellence.

“If you’re anxious, you’re going to come back.”

Readmissions can happen for true medical reasons – such as a patient taking the wrong medications or not adhering to post-transplant safety measures.

Susan Moffatt-Bruce

They can also arise when the worried well return unnecessarily, said Susan Moffatt-Bruce, study co-author, cardiothoracic surgeon and chief quality and patient safety officer at Ohio State’s Wexner Medical Center.

“Sometimes we can make ourselves unwell because we’ve been so anxious,” she said.

Standardizing post-transplant care and training caregivers to convey more empathy during their educational interactions could go a long way toward keeping new kidney recipients well and out of the hospital, the study concluded.

“It comes down to understanding the whole patient,” Moffatt-Bruce said. “With some simple interventions, including being kind and being present, we can make a difference.”

About 17,000 people receive kidney transplants each year in the United States and more than 100,000 are on the waiting list, according to 2014 data from the Health Resources and Services Administration. More than 30 percent of them are readmitted within 30 days of their release, previous research has found.

When patients head home, good self-care – including taking medications properly and avoiding infection risks – is critical for maintaining good health.

But the list of instructions for transplant patients is long and it can be confusing, Chandrasekaran said. On top of that, patients sometimes hear conflicting advice from different members of their care team.

Prior to beginning the study, he and his collaborators reasoned that anxiety after discharge could be a significant player in the high rate of readmissions.

Ohio State’s research team first interviewed 20 patients who received a transplant at the Wexner Medical Center to get a handle on the quality of care delivered during hospitalization. In general, the interviews suggested that information conveyed to patients varied depending on the caregiver and was delivered “in a somewhat rushed manner.”

Researchers also shadowed the care team to listen first-hand to the instructions they gave transplant patients after their surgeries.

One example of inconsistent advice they witnessed: One nurse recommended “a lot of fluids,” another said to drink two liters a day and another told the patient to consume 100 ounces.

“There must have been 16 different ways to tell them to drink a lot of water,” Chandrasekaran said, adding that this wasn’t because the nurses weren’t following protocol. Rather, they were passing along various guidelines they’d been told over the years.

The researchers then used information from those shadowing experiences and the initial 20 interviews to develop surveys given to another 77 kidney recipients, 24 of whom were readmitted within 30 days.

“We wanted to see what was it that caused them to have anxiety and what could we do to alleviate that,” Moffatt-Bruce said.

“We asked patients, ‘What went right, what went wrong?’ ”

The researchers assessed the consistency of patient education using a five-item test that measured the ease of getting information and the level of understanding of symptoms and procedures. To evaluate empathy, they used a three-item scale that asked patients about their comfort level when they interacted with caregivers.

The researchers worked closely with the entire transplant team at Ohio State’s medical center, including 24 nurses and several physicians.

They found a strong association between anxiety levels a week after discharge and readmission within a month. They also found that the odds of getting readmitted increase by 110 percent for a one-unit increase in anxiety levels.

They did not find a direct link between consistency and empathy measured in the surveys and readmissions. But they did find that those elements appeared to play a clear role in raising anxiety, which was linked to readmissions.

The researchers took into account factors that could skew their findings – including age, ethnicity, preexisting health conditions and the function of the transplanted organ upon discharge.

Since conducting this work, the researchers and transplant staff designed interventions to improve pre-discharge care and attempt to reduce preventable readmissions.

The discharge nurses, in particular, played a key role in the changes, which have cut the number of individual instructions given to patients from about 80 to 25, Moffatt-Bruce said.

“When you go home you’re going to be more confident, you’re going to be safer and you’re going to be less likely to come back to the hospital,” she said.

Overcoming barriers to distributed innovation

 

There was a time not long ago when design teams for products ranging from computer hardware to aircraft carriers were housed within the same four walls of a company. Within the last decade or so, firms began moving away from a centralized design approach to innovation in favor of specialized strategic partners — oftentimes scattered in different locations across the globe.

But with the shift away from centralized design to what is known as the distributed innovation model, what challenges do companies face in the product-design process?

That was the question posed by Dr. Aravind Chandrasekaran, associate professor of operations in the Department of Management Sciences at The Ohio State University Max M. Fisher College of Business, and colleagues Professor Edward G. Anderson Jr., of the University of Texas McCombs School of Business; Professor Alison Davis-Blake, of the University of Michigan’s Ross School of Business; and Geoffrey G. Parker, of Tulane University’s Freeman School of Business.

The researchers’ findings appear in the journal Information Systems Research in a new paper titled Managing Distributed Product Development Projects: Integration Strategies for Time Zone and Language Barriers.

The shift to distributed project teams began in the software development field, but it quickly spread to other industries, including a wide range of physical product manufacturers. To achieve design efficiencies and cost savings, today’s companies often seek out strategic partners with the expertise they need, which typically means working with partners on the other side of the world from various cultures who speak different languages.

The researchers examined some of the challenges inherent among these distributed teams. The main obstacles they discovered were time zone differences, which typically lead to delays in email response times, and language differences, especially with non-native English speakers understanding jargon-heavy engineering concepts.

“We wanted to study what can be done to minimize these barriers within the design process,” Chandrasekaran said.

The research team studied 20 multinational firms that span a variety of industries including aerospace, IT, medical device, commercial goods and food processing. The researchers analyzed some of the tactics these firms employed to overcome the challenges inherent with distributed innovation.

Some common methods firms use include co-locating workers, whereby members from strategic partner teams spend time with teams from the focal company; modularization of product design, which involves producing components in modules and then bringing the respective parts together later for assembly; and IT solutions, such as video conferencing. The researchers’ findings validate what many managers have discovered, which is that these solutions often do little to minimize the challenges of distributed product development.

What does work?

Two tactics stood out to the researchers. First, they found that firms using standardized design-specific IT systems have greater success in their product development projects. For example, firms that use a design structure matrix process to capture the interactions between distributed development teams fared better than those that did not.

The second, often more successful strategy was having a designated person or an entity within the organization serve as the single point of contact between two geographically separated teams. Known as a supply chain integrator, this entity serves as a pivot point between the two locations, even if there are multiple teams within each country. This strategy minimized coordination challenges, the researchers found.

With funding from the National Science Foundation, the team interviewed supply chain integrators and discovered common traits, including an understanding of cause and effect, an ability to coordinate the work, systems thinking ability, and bilingual or multilingual skills.

“They do more than span the geographical boundaries; they have a macro or systems view of the world,” Chandrasekaran said. “They understand that if they’re making a small change to one aspect of the project, they know how that change will affect other teams. That skill of helping people coordinate the work was very unique to these individuals.”

However, the researchers are quick to acknowledge that there is no silver bullet for overcoming the challenges of distributed projects, noting that firms must anticipate the tradeoffs when using distributed product development.

Citing previous research by Professor Kim Clark, former dean of Harvard Business School, Chandrasekaran said his team’s research also found that “heavy weight project managers” have an edge in distributed workforces because they tend to have access to high levels of their organizations’ management and can use that access to resolve issues efficiently.

For firms considering the use of supply chain integrators, Chandrasekaran notes some things to consider. Supply chain integrators are typically employed by the product manufacturing companies, rather than being third parties. In addition to systems knowledge, they often have design and procedural knowledge, as well as an understanding of procurement.

Most importantly, the researchers found that supply chain integrators need to understand that when they’re working with their counterparts, it’s not just that they’re working on a particular aspect of the project, they have to understand how that project actually affects the bigger picture.

“If your firm works on distributed projects, you’re bound to have a lot of coordination issues,” Chandrasekaran said. “The common mechanisms that managers might already be employing may not be effective. Firms will likely have to invest in people with these types of specialized supply chain skills.”

Grand Challenges…Here we come!

What comes to your mind when we say “grand challenge”? People think about big issues such as ending world hunger and curing cancer.  These are certainly big problems that takes several thousand people working every minute for the betterment of the society. We all want to be part of these grand challenges, but either have limited capabilities or the time, given our day-to-day schedule. What if we use these grand challenges as learning opportunities? Perhaps this may allow us to make some incremental contributions and also learn at the same time.

This was the main idea when we started our conversations with the Mid-Ohio Food Bank regarding a “learning lab” for our MBOE students. Mid-Ohio Food Bank is one the largest food bank in the United States primarily catering to the 20 counties surrounding the Columbus region. They are an amazing organization with great talent yet have really complex challenges in serving the community. Think about this for a statistic:

“There are over 400,000 people in Franklin community who live under 200% of the poverty line and miss over 15% of their meals. In other words, over 400,000 people are going without food for an entire day each week.”

This is not because Mid-Ohio Food Bank or their agencies have a shortage of food. It is because as Mark Mollenkopf – Strategic Solutions Developer – so eloquently puts – “Our problem is to get the right food to the right people at the right place and the right time”  

This is a perfect learning opportunity for our incoming MBOE students to scope down this larger complex problem into manageable problems in distribution, access, population health, nutrition and consumer behaviors. Our incoming class of students will spend time at the Mid-Ohio Food bank understanding and solving this problem over 5 months beginning November 2019.  They will first learn to break the complexity down to workable “chunks”, where to make impactful changes, how to measure and sustain these changes over 4 different learning sessions. Our students won’t be able to eradicate human hunger in 5 months, but they can certainly make a difference and make substantive improvements in this given time.

Our MBOE and Fisher Management Science team are really excited to use this amazing learning opportunity and help our community along the way!

Come and see what we do in our MBOE program at: https://fisher.osu.edu/graduate/mboe

Operational Excellence Systems – How to Create a Perpetual Learning Organization?

Have you ever worked for an organization that is always successful in its mission whose employees are highly committed to its purpose? Anyone reading this article would question the existence of such an organization. Through our research, teaching and outreach, we found that managers from various industries such as healthcare, information technology, manufacturing and hospitality services are constantly searching for the answer to the question on how to create a perpetual learning organization where everyone continuously learns, improve and remain committed to its purpose every day (similar to the perpetual moving machine shown below).

 

 

Think about the following example of a healthcare system that personifies such a learning organization where a small problem faced by one unit becomes a great learning opportunity for the entire system.

“In a Tier 6 daily huddle using visual management, the senior leaders (including the CEO, Chief Medical Officer, Chief Nursing Officer, Chief Financial Officer and Chief Quality & Safety Officer) of Apollo Hospital systems were informed on a “near-miss” caregiver fall injury that had happened in one of their regional surgical units previous day, 60 miles from their main hospital. The attending nurse almost tripped on a wire from a new computer terminal recently installed due a system wide rollout of electronic medical records. After a quick discussion, it was decided to prioritize this issue and offer support to the care team at the surgical unit to solve this problem. The next week, the CEO attended their tier 1 huddle at the regional hospital listening to how the team was planning on solving this issue. Thirty days later, the countermeasure developed and vetted by the team in the surgical unit was spreading all across the 24 hospital systems involving more than 30,000 caregivers to avoid similar near miss injuries. What is fascinating is that every unit in Apollo is adapting the solution to their appropriate unit needs, tracking them and improving them on a daily basis. Six months later, Apollo continues to maintains a zero-fall injury rate for both their caregivers and patients”

  • Information about a close-encounter from a regional unit within the hospital system percolates all the way up to the C-suite within 24 hours. It is important to note that action follows immediately after the reporting process.
  • The hospital system tracks caregiver outcomes (e.g. near-miss accident) and prioritizes them along with patient (customer) outcomes.
  • The CEO of the hospital system makes time to travel 60-miles to offer her support to the team in the unit the next week.
  • There are no specialists solving the problem at Apollo. Rather, the team who encountered this problem is tasked to come up with a countermeasure and report on the efficacy of this measure after experimentation.
  • The countermeasure developed in this unit (i.e. process of problem solving and not the solution) is rolled out across all 24 hospitals within 30-days. This process of problem solving results in customized solutions across other units adapted to their needs (i.e. there is no single silver bullet for problems).
  • The entire organization is learning every day and improving from smaller experiments that are happening throughout the system. These lessons are made available to those facing similar problems in a way that same problems do not get solved over and over.

Our research with several organizations, including Toyota, Mayo Clinic, Nationwide, Cleveland Clinic, Thedacare Systems, IBM, General Electric and 3M etc. reveals that creating a perpetual learning organization such as the one described in Apollo requires creating four distinct learning systems. They include Alignment & Adaptability Systems, People Development Systems, Problem Solving Systems, and Daily Management Systems. We refer to them collectively as Operational Excellence Systems.  See Figure 1 that describes these systems.

Figure 1: Operational Excellence Systems

Dimensions of the Operational Excellence Systems

  • Alignment & Adaptability Systems – Systems that allow everyone in the organization to understand the value and purpose of the work they do and how it relates to the higher level strategy. This allows them to guide their actions as well develop adaptive skills to change for the future.
  • People Development Systems – Extent to which the firm invest in practices that add skills and capabilities to employees at all levels that allows them to continuously experiment, reflect, learn and innovate and become change agents.
  • Problem Framing & Solving Systems – The approaches taken by everyone when a problem arises in way the problem framing and solving processes are standardized across all levels of the organization and the learning permeate through the entire organization.
  • Daily Management Systems – The practices leaders at all levels use every day to identify potential issues and ensure all activities are on track and create accountability and cadence to the functioning of their units.

It is important to note that these systems are leader independent and sustains even after the departure of the architect responsible for creating them. They are also independent of the processes and business functions and has to exist at every level within the organization.

Our findings are not only informed through our research but also through our experience developing 300+ change leaders through the Master of Business of Operational Excellence (MBOE) program at the Fisher College of Business. In this program, executives from various industries develop their own operational excellence systems over a year. Through this journey, they document some of their challenges and opportunities when creating these systems back in their organizations.

What became evident to us through this learning journey is that even exemplar organizations don’t have all four systems at all levels within their organizations. The answer to creating a perpetual learning system may involve creating “isomorphic” structures of these systems at all areas in your organization.

Interested in knowing how to develop these systems in your organizations? See how our students and organizations partnering in MBOE program do by visiting https://fisher.osu.edu/graduate/mboe

Skeptics – We have Proof that Operational Excellence Works in Healthcare!

I’ve written a number of times on the skepticism and lack of understanding surrounding operational excellence (Op-ex) deployments in healthcare. Under the op-ex umbrella, there are several change management initiatives such as lean, Six Sigma, Total Quality Management, etc. All of these emphasize the importance of a systemic approach toward the sustainable improvement of key performance metrics.

Although there are several books and research on the benefits from these initiatives in healthcare context, skeptics dismiss them as mostly anecdotal and devoid of the rigor necessary for causal inferences (i.e., the presence of op-ex leads to healthcare improvements). In this regard, the skeptics are right. Many existing inferences in this area come from surveys (i.e., asking healthcare leaders about op-ex and correlating results to performance) or are based on secondary data that may not adequately capture op-ex elements.

Recent research Peter Ward & I conducted with Dr. Susan Moffatt-Bruce and other collaborators at The Ohio State University Wexner Medical Center leaves little room for skepticism about the impact of op-ex deployment in healthcare. Our quasi-experimental investigation permitted us to compare care delivery performance before and after deployment, using a control group from the same setting to account for any variations in the system beyond our experiment. Results show that op-ex deployment reduced 30-day readmissions, decreased monthly operating costs, improved patient satisfaction and also improved the quality of work among caregivers. In short, it works.

The Quasi-Experiment

Our experimental intervention was conducted over a period of three years and used op-ex principles to change the way patients were discharged after a kidney transplant. We specifically looked at a fundamental op-ex element: Standard work during patient discharge. This represents the set of activities standardized in terms of content, sequence, timing and outcome but still able to “flex” based on patient characteristics. An important feature of standard work is that it should be designed and developed by people doing the work and continuously monitored for improvement. In our study, more than 40 nurses, physicians, social workers, IT specialists and nurse managers responsible for discharging the patients designed and developed the new standard work over a nine-month period.

We focused on the kidney transplant discharge process because these recipients require prolonged periods of care after discharge. In fact, one in three U.S. kidney transplant patients  is readmitted within 30 days, resulting in higher hospitalization costs, resource utilization (i.e. longer wait times for other wait-listed recipients), and – more importantly – poor quality of life for the patient post-procedure. When looking closely at the discharge process, we found patients were taking in an overwhelming amount of information in the four days prior to discharge. In this short period, caregivers covered more than 45 topics, including medication, infection prevention, lab compliance, fluid intake, exercise, and dental hygiene, among many others. Some of these instructions – dental hygiene, for one – were not critical to patients’ immediate well-being and could have been given post-discharge. Nurses, we found, also varied their delivery of instructions, adding to confusion and anxiety. Figure 1 represents the current state of discharge process prior to our intervention. As seen from this figure, variability during the discharge process confused the patients and heightened anxiety levels after discharge, triggering readmissions.

Figure 1

 

The new standardized discharge work sought to resolve these inconsistencies. The caregiving team developed specific instructions on the content, sequence, timing, and delivery outcome for each element of discharge, drawing from data on 15 former transplant patients. The team also decided to adopt a two-part instructional approach, with inpatient nurses giving the most essential discharge instructions during the hospital stay (Part I Instructions), while outpatient nurses gave other instructions (Part II Instructions) 48 hours after discharge. This resulted in a formal handoff process between the inpatient and outpatient caregiving teams. After implementing this new process, the team also adopted 10-minute “huddles,” or standing meetings, to continuously monitor and improve communication at inpatient (bi-weekly) and outpatient (weekly) units by focusing on problem solving and best practice-sharing. These huddles have been going on for more than a year, with full participation from the caregiving teams. The entire op-ex implementation, launched in May 2015, took about a year. Figure 2 represents the process after the op-ex implementation.

Figure 2

To validate the benefits of the Op-Ex implementation, we tracked the discharge process outcomes for more than 700 kidney transplant patients for four years (two years prior to, and one year after, implementation). To ensure our data weren’t skewed by factors such as discharge procedure changes or electronic medical record implementation, we collected patient discharge process data from 180 heart and liver transplants, using them as a control group. Patients undergoing heart and liver transplants experience similar outpatient issues as kidney transplant recipients and have very similar discharge instructions (as seen in Figure 1). We also controlled for patient factors such as age, preexisting conditions, length of stay, functioning of transplanted organ at the time of discharge, ethnicity, 30-day mortality rates, etc. In addition, we adjusted for any other changes to the process that were not a part of our experiment (e.g. adding new technologies)

After accounting for all these effects, we used a difference-in-difference (DID) approach to estimate the causal effects of our implementation on readmission outcomes. Our analyses suggest that the likelihood of getting readmitted to the hospital was about 35% lower for the treatment group (kidney transplant process after Op-Ex implementation) compared to the control group and pre-implementation group (See Figure 3).  On average, this accounted to a 25% reduction in the overall readmission rates after the intervention for the treatment group, resulting in a conservative savings estimate of $85,000 due to hospitalization expenses for the unit. This doesn’t capture savings from the overall patient well- being after the surgery.

We also found a 10% increase in the overall patient experience quality score, measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Interestingly, the control group unit experienced an 11% decline in these scores during the same time period (see Figure 4). Improving the scores from this survey has been a key objective for hospital administrators as Medicare/Medicaid reimbursements are now tied to them.

 

Figure 3

Figure 4

Our study shows that Op-Ex transformation indeed can result in improvement across multiple outcomes. The real challenge is how to initiate and sustain this journey. All these results were possible due to the hard work of all the front-line nurses in this unit. They truly are the miracle workers who continue to sustain this journey and innovate as they move along.