It was a fine, crisp morning. My Health Catalyst team and I were at a new partner hospital with a national reputation, known for its excellent coordinated care and its outstanding performance on key quality measures.
I was looking forward to a low-key presentation. After the meeting, I planned to escape and take a relaxing run and catch the early flight back home.
Unfortunately for me and my running plans, when we began showing some of the data Health Catalyst had compiled, the confrontational questions began:
“And what does that show?”
“What’s the point of this exercise?”
“Not my patients …”
It was all I could do to not duck behind my notepad and shield myself from the onslaught.
After several years of successful quality improvement initiatives and a string of successes that had the won the hospital national recognition, tensions between the administration and the doctors had reached a breaking point.
My team and I spent the next two and a half hours listening to the clinicians’ understand their frustrations and working to smooth things over. The clinicians I was listening to were frustrated, demoralized and in some cases even angry.
And as I listened to them talk, it became clear to me that every physician who got up to speak had one thing in common: they believed they were being judged and, singled out for criticism despite doing their jobs to the best of their ability, often going above and beyond the call of duty
Many clinicians had been eager participants in the early days when the hospital had rolled out its first quality initiatives. Now, their mood had changed to one of resentment and resistance.
For their part, management was equally frustrated. A senior hospital executive took me aside and confided, “Ed, these guys just don’t want to change. They have bad attitudes. They say they’re on board, but they don’t keep their promises. If things don’t change we’re going to have to start taking drastic action.”
We spent more time that afternoon trying to understand the problem. I met with senior managers. I spoke with individual physicians. I got a sense of what was going on.
We discovered what had happened. There wasn’t a learning environment where participants felt safe and questions and introspection were tolerated and encouraged. Data wasn’t used to drive positive change and improve the quality of care delivered.It was used in non-productive ways.
At the end of the day, Rather than driving the positive cultural change that the administration and clinicians alike hoped for, its quality initiatives were fomenting dissent and dissatisfaction throughout the hospital.
I sat down with several of the key doctors on the staff (I will not call them the ringleaders, but they were) and said “What if I could show you that this can make a difference in your day- to- day life? Will you take a look at the data then?”
We found an empty conference room. I rolled up my shirt sleeves and I asked them about the problems facing their patient population. What was going on? Complications were up slightly. The ED was a problem area. Diabetes was an issue, somebody said. We zeroed in on diabetes.
How could we get a better picture of what was going on?
Well, we could look for elevated hemoglobin A1c levels. We could look for missed follow-up appointments. We could look for patients with lifestyle-related conditions that we knew were associated with diabetes.
The data was there. It was just trapped in the hospital’s information systems, siloed across hundreds of thousands of patient records, lab data, billing and claims data, and pharmacy records. We used the Health Catalyst Late-Binding™ Data Warehouse to pull the data together. We sat with the physicians and modified patient registries for diabetes to identify a precise patient population. From there, we were able to use our analytics applications to compile a list of high-risk patients needing routine and preventive care. We found hundreds of patients with high blood sugars in the diabetic range that were not diagnosed diabetics. We found thousands of patients with blood sugars or other risk factors for prediabetes that we could flag for care improvement.
Aggregating multiple sources of data in the data warehouse allowed for rapid and unprecedented levels of granularity down to the patient level. As we sat with the physicians we were able to review their own specific patients and let them validate the data that we were pulling from the data warehouse. They could see up to date results without having to wait for months to get reports.
The doctors were impressed. They’d seen many reports over the years but this information was different. They had more personal ownership of the data. The data was fingerprinted to their needs. This was the sort of information they could actually understood. This could potentially save lives and prevent thousands of hours of unnecessary care.
More importantly, it got them excited.
They began to ask questions: Could we do the same thing with undiagnosed cases of asthma in pediatrics? We could. What about cardiology? Again, yes. What about finding people who needed follow ups for lifestyle-driven conditions? Sure.
And sure enough, once they began to think about the work we were doing as a medical problem, they began to diagnose solutions. Instead of staring at computer screens, they were practicing a new kind of medicine.
And once they got where we were going, the doctors became enthusiastic partners again. They started thinking about their own performance and finding ways to improve it. Their competitive natures emerged.
And guess what? The hospital’s already strong scores got even better.
The next time I visited, a senior hospital executive took me aside. “We’ve got such a good thing going now with our data, Ed,” he said.
“This wasn’t me. This was you, guys”, I smiled. “This is your data. It was here waiting for you all along. We just showed you how to get to it.“
Edward Corbett, M.D. is Chief medical officer at Health Catalyst. He earned his medical degree at the University of Texas Health Science Center in San Antonio where he also completed his residency in Internal Medicine.