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Making outcomes easier – leverage tools for transparency

Feedback.  Transparency.  Accountability.  These are the elements necessary to delivering outcomes.  Reliably. Consistently. Persistently.

Workflows are focused on doing things.  Delivering a service.  Creating a product.  Workflows that are 100% manual are inherently opaque, unless performed under direct observation of an owner or result accountable leader.  How many services or products are delivered in a single location, small enough to be under constant observation by result accountable management?  Not very many and almost none in healthcare services.

Result accountable management.  One might assume that all management are “result accountable”.  But in this age of specialization and economies of scale, most management are not really “result accountable” from an enterprise performance perspective at all.  Instead, management might be process, profession or unit accountable.  Enterprises of scale have long been described as complex machines, composed of an array of necessary, specialized cogs, each required to perform within a narrow set of expectations.  When each cog performs as specified, the whole meshes together with minimal friction to produce desired outcomes.  Managers are held accountable, not for desired outcomes, but for building, maintaining and running their assigned “cog” in the corporate machine.  Healthcare systems often follow this model.

Managers and staff are measured and judged on “cog performance” by senior leadership internally and their “cog colleagues” externally. If every “cog owner” and “cog team” are committed to having the very best cog possible, the enterprise engine quickly can become inefficient, unbalanced and dysfunctional.  A collection of great individual parts does not guarantee great outcomes.  Often quite the reverse is true.

Enter automation.  IT is primarily focused on enabling work flows to do things at lower costs, with greater speed and improved consistency.  Automation may enable new things to be done, not previously possible or economic when all tasks were performed by a worker.  But automation and IT technologies can do more.

IT can enable work flow execution transparency, accountability and performance feedback.  Systems can know who performed a task, when it was performed, what choices were made.  End to end measurement can be done for workflows to evaluate performance against specified expectations. With the addition of feedback through outcomes measurement, tools can match performance data to results.  Management at all levels and locations can track performance, execution compliance, productivity and other elements of work flow execution down to the individual performer, if needed and engineered.  Robust operating, compliance and performance governance can be established based on objective, credible data and sound analytics.  Each cog can be measured for sound execution as specified (no less and, certainly, no more).  Cog specification/design and cog interaction can be analyzed for contribution to enterprise performance and outcomes to guide improvement and investment.

Even “soft” workflows that are unsupported by enabling IT tools can be governed more effectively.  There are many governance tools deployed that organize and enable regular self-reporting for practices that are difficult to measure – things like regulatory compliance, professional practices (infection control, fall prevention and many other clinical practices are examples) and policy adherence are often monitored in this manner.  Such processes may be the best available solution in the near term (and are better than nothing, as they do communicate accountability and expectation), but they are not strong controls that should be relied on by themselves.  When such practices are necessary, effectiveness and credibility can be enhanced by coupling reported levels of compliance with actual, concrete outcomes data.  If hand washing and other infection risk controls are reported as highly compliant, then one would expect cases of hospital acquired infection to be reduced or minimal, for example.

Software automation can have dramatically positive impacts on work flows’ cost, speed, accuracy and capabilities.  Leveraging these investments to track and drive adoption, compliance, performance and quality by making these challenges objectively transparent and individually or collectively accountable can assure stakeholders that sound expectations are being met or are exposed to senior leaders for intervention and correction.

This is the essence of “system controls reliance” which is key to assurance of accounting integrity and regulatory compliance.  The same rigor can and often does drive clinical quality, performance and patient outcome improvement.  Transparency of performance coupled with result metrics makes the necessity of commitment and discipline obvious to all.

Contact BrightWork Advisory, LLC to request help with metric based management today.

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