QUERI

1. QUERI Robert L Jesse, MD, PhDChief Consultant Medical Surgical Service

3. Transforming Healthcare • Transactional Quality and Management: a healthcare redesign process through which clinical practices are both enhanced and ensured by real-time insights into their systems. • Quality is integrated into the workflow • Data is aggregated through the process • Quality and safety are driven by efficiency

4. Transactional Quality and Management Guiding Principle #1: If data is important enough that it is needed to manage the patient and/or the system, then it must be acquired as an integral part of the work process and not through retrospective data collection.

5. Transactional Quality and Management • Guiding Principle #2: “Solutions” must make the work easier, and not impose undue burden or require re-work. • No pain for the gain • Technology must facilitate the workflow and not encumber it.

6. Transactional Quality and Management • Guiding Principle #3: Real-time visibility into the system must be available, and it must be transparent across the enterprise: • Manage all patient-health system interactions • location and times - waits and delays • Manage patient-staff relationships • Include patient-staff transitions (handoffs) • Manage all tests and procedures in real-time • From scheduling to completion • Concurrent documentation

7. Transactional Quality and Management • Guiding Principle #4: • In order to deliver evidence-based care we must have evidence-based management. • Clinical processes support • Administrative processes support • IT support • Materials management • Equipment • Beds • Staff Management • Point of service logistical support

8. Transactional Quality and Management • Guiding Principle #5: In order to ensure that we effectively manage the delivery of evidence-based care we must manage complexity Data Information Knowledge Wisdom

9. Hierarchy of Healthcare Systems Structure and Function VHA Strategies Characteristics Goals Fully Integrated Health System Predictive Analytics Longitudinal Health Management Distributed Healthcare Patient as node on Wide Area Health Network Value Optimizing Clinical Performance Clinical Decision Support Engineering Care Delivery Integrated Hospital/Clinic Efficiencies Effectiveness Level of Implementation Complexity Integrated Workflow Processing Evidence Based Management VHA Systems Redesign Efficiency Accessible Health Data Electronic Health Record Responsiveness System Model Service Offering Information Process Performance Improvement Levers

10. Healthcare From a Systems Perspective • Engineering Principles Apply • Supply must always exceed demand • Erlang’s law (?) • Any service delay is unacceptable • Action when and where needed • Just-in-time supply chain management • Multiple steps and processes are involved • Map processes and pre-specify the plan • Parallel process when ever possible • Complexity must be managed

11. Summary • Data must be acquired as an integral part of the workflow process. • Adoption is dependant on workload burden. • Real-time visibility into- and transparency across the enterprise are required. • Evidence-based management is needed to ensure evidence-based care. • Knowledge and complexity management are crucial to moving forward.