Hospitals and health systems are standardizing processes to reliably meet quality and cost goals over time. Covenant Health in Lubbock, Texas, has created clinical excellence teams to identify variation and establish evidence-based standards to reduce this variation and improve outcomes. To standardize practices in a certain department, the hospital works with physicians and nursing staff in the department to "create a battle plan, a blueprint for how we ought to be addressing patients' needs in more standardized fashion," says Craig Rhyne, MD, CMO of the system. Dr. Rhyne describes several projects Covenant is implementing to increase standardization.
Clinical excellence teams
One area the clinical excellence teams have looked at is overwhelming infections, or sepsis. Covenant realized that sepsis outcomes are greatly improved with early identification of the infection and prompt treatment. To identify sepsis earlier, physicians looked for certain signs that indicated a possible infection. Covenant applied this strategy for early identification of stroke and improved the morbidity and mortality of stroke by standardizing processes.
When the clinical excellence teams develop evidence-based standards, they create clinical excellence bundles that define appropriate processes. For instance, there are bundles for congestive heart failure, and there are plans to create pulmonary infection bundles.
Covenant is also working on standardizing processes for joint replacement surgery, ventilator management and gastrointestinal medicine. "There was significant variation in practice habits and practice patterns among various gastroenterologists in regard to bleeding from the GI tract and other types of inflammation, such as gastritis," Dr. Rhyne says. "All of those variations in practice patterns contributed to huge amount of variation in patient outcomes and length of stay. By standardizing in an evidence-based fashion the pathway the patient follows, we can produce better outcomes."
Changing behavior
One of the challenges in standardizing practices is persuading people to change their behavior after practicing a certain way for many years. Hospitals can overcome this challenge by showing physicians the evidence of better outcomes with the new standard approach to care, according to Dr. Rhyne. Supporting a policy with real data is often effective in convincing physicians to change because they are trained to look to evidence and proven practices when delivering care. However, some physicians have not kept up with the literature and have not adapted their practices accordingly, Dr. Rhyne says. It is important to expose these physicians to the new literature and show them the different outcomes to encourage them to change out-of-date habits.
"We don't want to be heavy handed with this; we don't want to create institutional mandates," Dr. Rhyne says. "We realize that an individual physician has the right and responsibility to practice medicine the best way he [or she] sees fit. It is our responsibility, however, as an institution, to help identify the safest, most appropriate pathway of any particular disease and make that pathway available to that physician to utilize."
Clinical excellence teams
One area the clinical excellence teams have looked at is overwhelming infections, or sepsis. Covenant realized that sepsis outcomes are greatly improved with early identification of the infection and prompt treatment. To identify sepsis earlier, physicians looked for certain signs that indicated a possible infection. Covenant applied this strategy for early identification of stroke and improved the morbidity and mortality of stroke by standardizing processes.
When the clinical excellence teams develop evidence-based standards, they create clinical excellence bundles that define appropriate processes. For instance, there are bundles for congestive heart failure, and there are plans to create pulmonary infection bundles.
Covenant is also working on standardizing processes for joint replacement surgery, ventilator management and gastrointestinal medicine. "There was significant variation in practice habits and practice patterns among various gastroenterologists in regard to bleeding from the GI tract and other types of inflammation, such as gastritis," Dr. Rhyne says. "All of those variations in practice patterns contributed to huge amount of variation in patient outcomes and length of stay. By standardizing in an evidence-based fashion the pathway the patient follows, we can produce better outcomes."
Changing behavior
One of the challenges in standardizing practices is persuading people to change their behavior after practicing a certain way for many years. Hospitals can overcome this challenge by showing physicians the evidence of better outcomes with the new standard approach to care, according to Dr. Rhyne. Supporting a policy with real data is often effective in convincing physicians to change because they are trained to look to evidence and proven practices when delivering care. However, some physicians have not kept up with the literature and have not adapted their practices accordingly, Dr. Rhyne says. It is important to expose these physicians to the new literature and show them the different outcomes to encourage them to change out-of-date habits.
"We don't want to be heavy handed with this; we don't want to create institutional mandates," Dr. Rhyne says. "We realize that an individual physician has the right and responsibility to practice medicine the best way he [or she] sees fit. It is our responsibility, however, as an institution, to help identify the safest, most appropriate pathway of any particular disease and make that pathway available to that physician to utilize."
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