Modern Practice Podcast

Achieving a highly reliable organization — Part 1

Over twenty years ago, the landmark report To Err is Human shook all of health care with its focus on medical errors causing patient deaths. It cast a light on the systems that failed to ensure high-quality, safe clinical care. Yet, today, errors continue, and on this episode of Modern Practice, two leading experts discuss the principles of high reliability that address system failures and the errors they cause.
 
Guest speakers:
David Munch, MD
Senior Principal
Vizient
 
Bradley Schultz, MBA
Principal
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[01:26] Costs of medical errors – to hospitals, patients and caregivers
[02:47] Overall costs to the health system
[03:52] Need to sustain efforts
[05:10] Applying high reliability to health care
[08:15] Need for standard work
[09:58] Staff roles in the high reliability organization
[13:04] The problem is not with the front-line staff
 
Links | Resources:
Evidence Brief: Implementation of High Reliability Organization Principles (NIH) Click here
HRO Development Services – Achieving a high reliability organization (Munch) Click here
The Future of Health Care (Vizient page) Click here
High Reliability (AHRQ) Click here
 
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Fit for the future: challenges facing health care systems in a pandemic era and how to solve them — Part 2

On this episode, we continue our discussion on declining operating margins in health care and what we need to do in addressing the challenge through a phased strategic approach to improve margin optimization.
 
Guest speaker:
Celina Burns
Principal
Financial Performance Solutions
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:29] Operating margins
[01:37] Improving operating margins
[02:51] Stabilizing and preparation phase of growth strategy
[03:20] Managing your “portfolio”: having the right service-line mix
[03:49] Acquisition: not a strategy but a strategy enabler
[05:00] Focus on scaling
[07:06] Importance of analytics
[07:42] What should operations look like?
[09:13] Examples of organizations successfully optimizing margins
[10:34] Resist the urge to go back to “normal”
 
Links | Resources:
Creating a sustainable business model in an emerging value-based care market Click here
Hospital operating margins decline in 2019 (HFMA) Click here
Hospital margins fell 174% in April Click here
 
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Fit for the future: challenges facing health care systems in a pandemic era and how to solve them — Part 1

Before the COVID outbreak, decreasing margins and other challenges were bringing health care to a tipping point, and after the pandemic, health care passed that tipping point. Hospitals and hospital systems were experiencing a fundamental shift in their business models. On this episode, we discuss how health care organizations can address the financial headwinds they face in this new era.
 
Guest speaker:
Celina Burns
Principal
Financial Performance Solutions
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[01:33] Landscape of health care today
[02:58] Passing the tipping point
[04:19] Five critical areas of opportunity
[05:42] Hospital-physician partnership
[06:26] Need for urgency
[06:55] A different business model
[07:54] Depletion of Medicare funds driving innovation
[08:53] What the recovery period looks like
[10:31] Radical transformation
[11:22] A necessary change in attitude
 
Links | Resources:
Creating a sustainable business model in an emerging value-based care market Click here
Hospital operating margins decline in 2019 (HFMA) Click here
Hospital margins fell 174% in April Click here
 
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Machine learning and AI in medicine – Part 2

This episode continues our discussion of artificial intelligence, or AI. We examine how to overcome the common pitfall of bias, both statistical and social, and how to use AI innovatively. We describe what AI, which encompasses machine learning and other functions, can do in chronic care management.  Finally, we’ll detail how you can help make it more viable in your organization.
 
Guest speaker:
Shannon Sims, MD, PhD
Vice President
Data Intelligence and Interoperability
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:25] Bias in AI
[02:32] Perpetuating bias
[02:58] Mitigating bias
[04:04] Does AI inhibit innovation?
[04:43] Changing provider behavior
[05:55] Changing patient behavior
[06:36] Chronic care management: where AI shines
[07:53] Developing AI capability in the organization
 
Links | Resources:
Machine Learning in Medicine (NEJM—April 4, 2019) Click here
HYPE Randomized Clinical Trial Click here
Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data (JAMA Internal Medicine—Nov 2018) Click here
On Deep Learning for Medical Image Analysis (JAMA—Sept 18, 2018) Click here
Artificial Intelligence in Health Care: Will the Value Match the Hype? (JAMA—June 8, 2019) Click here
Artificial Intelligence in Health Care: A Report from the National Academy of Medicine (JAMA—Feb 11, 2020) Click here
Artificial Intelligence: Promise, Pitfalls and Perspective (JAMA—June 23/30, 2020) Click here
 
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Machine learning and AI in medicine – Part 1

For years relegated to science fiction, as exemplified when the HAL 9000 had a speaking role in 2001: A Space Odyssey, artificial intelligence (AI) now has become practical reality and in medicine, a long-hoped-for remedy in areas from pathology to electronic medical records. Yet, artificial intelligence, which encompasses machine learning and other functions, has limitations. In this episode, learn about the current state of artificial intelligence and what it can realistically achieve for your practice.
 
Guest speaker:
Shannon Sims, MD, PhD
Vice President
Data Intelligence and Interoperability
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:56] Understanding concepts around AI
[02:28] Two main functions of AI
[03:33] Importance of prescriptive analytics
[04:26] Enabling clinicians make better decisions
[05:13] Machine learning and EMRs
[06:10] AI and the coronavirus
[07:52] Structural challenges
[09:01] AI and quality
[10:09] Role of clinicians in developing solutions
[11:04] Successes and limitations
 
Links | Resources:
Machine Learning in Medicine (NEJM—April 4, 2019) Click here
HYPE Randomized Clinical Trial Click here
Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data (JAMA Internal Medicine—Nov 2018) Click here
On Deep Learning for Medical Image Analysis (JAMA—Sept 18, 2018) Click here
Artificial Intelligence in Health Care: Will the Value Match the Hype? (JAMA—June 8, 2019) Click here
Artificial Intelligence in Health Care: A Report from the National Academy of Medicine (JAMA—Feb 11, 2020) Click here
Artificial Intelligence: Promise, Pitfalls and Perspective (JAMA—June 23/30, 2020) Click here
 
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How clinical leadership can access usable data to drive meaningful change – Part 2

For data to be effective, the information needs to be current. It needs to reflect what is truly significant in patient care. And it needs to encourage consistency in practice. On this episode, a leading analytics expert continues his discussion on how you and your organization can shape the wealth of data you collect to guide the care you deliver.
 
Guest speaker:
David Levine, MD, FACEP
Group Senior Vice President
Advanced Analytics and Project Management
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:23] The issue of data validity
[02:09] The issue of timeliness
[02:55] Data from the Wild, Wild West (ambulatory arena)
[04:03] Getting to the data—clinical data more valid than claims data
[05:10] Encouraging consistency
[06:22] Steps we can take now to better data
[06:46] Understand the data before refuting it
[08:12] The meaningless quest for an overall clinical score
[09:08] The sea of data
 
Links | Resources:
Transparency: A Critical Component in Advancing Health Care Improvement Click here
Leveraging the Power of Data and Collaboration to Change Healthcare Click here
Electronic Health Records and Meaningful Use (AHRQ) Click here
Public Health and Promoting Interoperability Programs (CDC) Click here
How hospitals can use data to improve efficiency Click here
 
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How clinical leadership can access usable data to drive meaningful change – Part 1

Big data has the potential to provide clinicians with the information they need to improve the value of their care. Yet, the challenges are in how to find the right metrics, out of all the information available, and then putting the metrics to the best use. On this episode, a leading expert in clinical analytics will discuss using data that provides a true picture of care and serves to improve care outcomes. He will also discuss what recent analysis is showing about trends during the COVID-19 outbreak.
 
Guest speaker:
David Levine, MD, FACEP
Group Senior Vice President
Advanced Analytics and Project Management
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[01:37] Elements of meaningful data
[03:06] The data will never be perfect
[03:34] Attribution challenge
[03:53] Hospitalist example
[04:53] Data from the pandemic
[07:28] Not a major investment but a major commitment
[08:52] Bringing clinicians to the table early
 
Links | Resources:
Transparency: A Critical Component in Advancing Health Care Improvement Click here
Leveraging the Power of Data and Collaboration to Change Healthcare Click here
Electronic Health Records and Meaningful Use (AHRQ) Click here
Public Health and Promoting Interoperability Programs (CDC) Click here
How hospitals can use data to improve efficiency Click here
 
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Leadership pitfalls during the pandemic – Part 2

Lack of communication and fear of telling the truth are common pitfalls for leaders, and these pitfalls lead to the staff losing trust. In this episode, we continue our discussion on how leaders can develop and hone skills to keep staff engaged. Effective leaders are coaches and foster team-based care. Their actions lead to trust and resilience, in this time of crisis and beyond.
 
Guest speaker:
David Munch, MD
Senior Principal
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:37] Need for leadership visibility where the work is done
[01:01] Need for inclusive communication: top-to-bottom and bottom-to-top
[02:37] Executives and middle managers average 65% of their time in meetings
[03:27] Leadership visibility in the surgical suite
[04:42] Give everyone the benefit of the doubt
[06:40] Make their job easier!
[07:45] What leaders can do today: four stages
[10:37] Having the right metrics
 
Links | Resources:
How to Succeed or Fail in Your Lean Improvement Efforts Click here
How Process Improvement Teams Can Help During the COVID-19 Crisis Click here
Lean Thinking during the COVID-19 Pandemic Click here
Resources to Support the Health and Well-being of Clinicians during the COVID-19 Outbreak Click here
 
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Leadership pitfalls during the pandemic – Part 1

This time of ongoing crisis has severely tested the resilience of clinical staff, increasing the risk of burnout and emotional exhaustion. Health care leaders must address the issue of resilience right now or the problem will accelerate. Leaders that do not engage their staff, that do not have visibility or transparency and do not give and receive feedback are risking loss of trust and even staff turnover. On this episode, we’ll consider ways to foster resilience among staff and avoid pitfalls in leadership.
 
Guest speaker:
David Munch, MD
Senior Principal
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes:
[01:30] Staff resilience during the pandemic
[02:23] Rounding as a leadership style
[04:25] Essential characteristics of leadership
[05:07] Dealing with staff emotions
[06:13] Addressing frustrations
[07:43] Accelerating trust
[08:59] Necessity of team-based care
 
Links | Resources:
How to Succeed or Fail in Your Lean Improvement Efforts Click here
How Process Improvement Teams Can Help During the COVID-19 Crisis Click here
Lean Thinking during the COVID-19 Pandemic Click here
Resources to Support the Health and Well-being of Clinicians during the COVID-19 Outbreak Click here
 
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COVID-19 impact on provider practices – Part 2

This episode continues our discussion on the impact of COVID-19 on clinical practices by examining a new framework for health care, with the idea that it must be more adaptable, flexible and reliable than in the past. Practice data should reflect what we need to know about access, quality and even productivity. Finally, we explore the best approach for creating and developing new ideas and practices, one that originates from those involved in the care every day and not imposed from the top down.
 
Guest speaker:
Lina Patel, MHA, FACHE
Associate Vice President
Product Strategy and Management
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes
[00:37] Future of the health care framework
[02:10] Using a nimble virtual care platform
[02:30] Leveraging practice data to look at access, quality and productivity
[03:42] Providers need options for developing new approaches
[04:06] How health care organizations should use practice data
[05:01] The Clinical Practice Solutions Center (CPSC): sharing data with clinicians
[05:27] Access and improvement insights
[06:19] Lessons learned from COVID-19
 
Links | Resources:
Clinical Practice Solutions Center—The Clinical Practice Solutions Center is a performance improvement solution focused on medical practices and developed in partnership with the Association of American Medical Colleges (AAMC) and Vizient. Find more information Click here
Using COVID-19 Learnings from Clinical Practice Solutions Center (CPSC) to Reimagine the System of Care Click here
Understanding the impact of big data on nursing knowledge (Nursing2020 Critical Care) Click here
It’s All about the Data in 2020 and Beyond Click here
 
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