For Holland Hospital in Holland Michigan, when you’re using data to drive change, “everybody wins, especially the patient.” That was one of the main takeaways from this year’s #LeadingVBHC Conference, and nobody knows that better than Kristie Dennett, Orthopedic Service Line Coordinator.
For some background, Holland Hospital is an early adopter when it comes to data-driven decision making. After years of collecting data, Holland has been able to use it to drive change. One example Dennett cited was the use of tranexamic acid to decrease bleeding in surgery. Using this data, Holland’s Orthopedic team was able to convince key multidisciplinary team members – from pharmacy and anesthesia – to pursue a trial that eventually lead to a dramatic decrease in transfusion rates. Specifically, from a range of 15%-18% down to 1%-2%.
While these numbers definitely show success, there’s always room for improvement. Enter the #LeadingVBHC Conference. Dennett was in attendance, and spoke with CODE Technology about how her orthopedic service line is moving towards value-based care. You can watch the full video here or below.
How to drive change
In almost a serendipitous set up at the end of the #LeadingVBHC conference, Dr. Sonia Szlyk challenged the audience with the question: “What’s the one thing you can do next week to make a change?
For Dennett, it’s improving communication across the different departments of the hospital, specifically the Orthopedic Service Line and Holland’s anesthesiologists.
“At the conference we had a couple of our anesthesiologists there, unbeknownst to me until I got there. That was a really nice opportunity for us to connect and say, ‘We need to start working together a little more closely on this’” she told CODE. “Building trust and creating partnerships so we can work together on common goals is in the best interest of the patient.”
CODE caught up with Dennett one month post-conference to talk about the progress she has made towards her goal, and what else the Holland team is doing to move towards value-based care.
Full Interview Transcript
For more details on how Holland will be working towards its goals after #LeadingVBHC, The follow-up interview between Dennett and CODE Technology CEO Breanna Cunningham is transcribed below:
Breanna Cunningham: In the final wrap-up session of the Leading VBHC Conference, Dr. Sonia Szlyk asked, “What do we do next?” She challenged the audience to take one piece of information they learned to make one change, small or large, that they could do next week. What’s the change that you’ve made in your practice, or that your team has made, as a result of this conference?
Kristie Dennett: The thing that really jumped at me is the importance of collaboration and communication. We had a couple of our anesthesiologists in attendance, unbeknownst to me until I got there. That was a really nice opportunity for us to connect and say, “We need to start working together a little more closely on this.”
Next, we decided that we will start with anesthesia protocols and with our multimodal pain pathway. There’s not a standardization amongst anesthesia providers for that. That’s one thing that we’ll be working on right away.
We’ve got a meeting coming up where we’ll sit down and look at a number of multimodal protocols, including our own, which has been pretty effective. In that meeting we’ll say, “What do we want to do to tweak this?” Then we’ll bring that to anesthesia to say, “How are you feeling about this? Can we decide on one protocol that’s consistent?”
Cunningham: The conference emphasized the importance of interdisciplinary approach and how that’s key to success in value-based care. What has your organization done to foster an interdisciplinary approach? More specifically, how did you go about setting up your team and who is it comprised of?
Dennett: We have representatives from surgery, the pre-op or pre-admission testing environment, the pre-op and the post-op environment. Also our CNO, our director for MEDSURG nursing, the manager from the spine and orthopedic unit, a representative from home healthcare, a couple representatives from physical therapy, and the surgeons are also invited. Attendance in meetings is a little bit spotty sometimes, but usually we have at least one or two physicians there.
Our team has been set in place for six or seven years already, but it has been a pretty standard team that meets quarterly to address certain issues. I would say our program is pretty mature. But as you know, there’s always opportunity for enhancing interdisciplinary relationships and improving the messages shared, and then operationalizing those things.
Cunningham: Do you have a finance person as part of your interdisciplinary team?
Dennett: At the executive level, yes. Not at the multidisciplinary clinical level.
Cunningham: Communication is one of the biggest challenges associated with interdisciplinary work. In your situation, it’s really refreshing but also unique to see a hospital working with a private practice group with staff so engaged in everything.
Dennett: That has not come without pain. I will tell you that much. It’s been a journey, it truly has been. Building trust and creating partnerships with those physicians so we can work together on common goals is in the best interest of the patient.
I often go back to the thought that no matter what we’re dealing with, if it’s pain or if it’s mobility or if it’s spats between providers or different opinions or whatever, the bottom line is what’s the best thing for the patient in this scenario? Everything else takes second place.
Cunningham: Another challenge that we always see is scheduling meetings and coordinating schedules with these interdisciplinary approaches. Can you share any strategies your team uses for effective meetings?
Dennett: We do our meetings quarterly rather than monthly. We had worked with a vendor a few years back to help us take our joint replacement program to the next level. They strongly recommended monthly meetings and we just knew that that wouldn’t be effective in our setting, so we opted to go with quarterly.
I think that’s important to be respectful of people’s time, encourage their engagement when they are there. If you don’t have an agenda or things that require eyeballing that, it’s okay to cancel those meetings.
We have a fairly standard format for these meetings. Usually we send out an agenda within the week before with some thoughts on discussion topics. We encouraged folks to send additional topics, prior to the meeting if they had them. Then, we bring issues and concerns at a global level, and then we do a round table approach. We really highlight those different disciplines that are present on the team. Home care, surgeons, office staff, surgery staff and so on – just to see if they had any particular issues to bring to the group.
Cunningham: How do you decide on the big topics that you’re going to tackle at these meetings? Does it come from one larger organizational goal? Or is it just picked by different people and what’s happening?
Dennett: I coordinate that agenda. We usually do a quick market share update, we do the review of the hospital outcomes data, the length of stay and number of cases, rehab metrics, process things, trends in therapy. A lot of day-to-day stuff drives the conversation, as well as the data.
But, if there’s news things coming down the pike, like the conversation about value-based care and bundled payments and everybody’s piece in that, it’s been something that we’ve batted around a bit.
Cunningham: How does your team measure progress?
Dennett: We work with an outside vendor that helped develop a dashboard, helped us assemble that data, looking at things like transfusion rates and distance walked in therapy and length of stay and all of those hospital-reported outcomes.
That was a good basis for this group to be able to share that data on a regular basis and then address any concerns or trends that we saw in the data. Or if we instituted a change, being able to monitor that over time. We are very data-driven and, even if there weren’t changes, we could celebrate that success as well and, if there were, that was important.
Cunningham: The conference emphasized the benefits of having informative data that you can monitor and improve in communicating your performance. We know that you’re collecting outcome data, and you just listed off some really great pieces of clinical data that you’re measuring. Does your organization collect cost data?
Dennett: We monitored that over a period of time as we were building our program. But we don’t review it as a group anymore. That will become increasingly important, in a value-based care conversation, especially as we move towards a bundled payments system.
However, it’s really important to understand, what do these things cost? What does it cost to deliver care? What do all of these pieces and parts and supplies and processing cost the organization? Those are all things that we’re talking about within the group, and we started some initial work on that.
We are not currently part of a bundled payment structure, but all of us know that that’s coming. Taking the opportunity that we have now to start exploring, picking apart, looking for opportunities we’ve really owned in our organization and continue to move forward with that.
Cunningham: Have you had any challenges putting all this great data that you’re collecting to use?
Dennett: The answer, I guess, is really how do you define you? Using the data to drive change I think is important. In our experience we found that data to be a leveling force, if you will.
I’ll use the example of implementing the use of tranexamic acid within our organization to help decrease bleeding with surgery. When we first started reading that information we said, “This is something we’d really like to try.”
We immediately got pushback from pharmacy because it’s off-label use, and we immediately got pushback from anesthesia because they weren’t comfortable with it from a risk standpoint. It wasn’t something that they had heard about or read about.
Starting from a deficit into building our case for using tranexamic acid, then being able to monitor when we finally got the approval to do it in a limited number of cases, and then able to share that data back with the group to say, “Here’s what we found so far. Let’s expand this.” Then being able to monitor that over time, we’ve seen our transfusion rates go from 15% to 18% down to around between 1% and 2% on a daily basis.
Cunningham: That’s huge! It sounds like your team does a great job of taking this information and then using it to drive change.
Dennett: If you’ve got data to support the practice, it’s a really effective tool. For example, you can do a search and say this is what other places are doing to use as your foundation. Then set it up in your organization and monitor the progress. You’re going to have some disagreements. You’re going to have some arguments on a clinical debate level. But when you can share that success, when you take a chance, it’s huge and everybody wins, especially the patient.
Cunningham: What did you learn about cost and outcome data at the conference that could be used to help improve your organization’s performance and value propositions?
Dennett: One of the things that we’ve been working on the last maybe three months now is getting a better handle on what some of our things cost.
For example, we have a project going on right now looking at the items that are used in an operating room, based on preference cards, and items that may need to be used during the course of the procedure. But then you’ve also got to factor wear and tear on those instruments and processing costs and assembling trays and all of that.
So what we did was take one surgical procedure with one surgeon and looked at what he uses every time, occasionally, and rarely. By looking at this, we were able to go from six trays to three trays.