How to Achieve Clinical Excellence and Process Discipline

True clinical excellence is really tough.

There are no final destinations or definitive markers of success as professional standards, evidence-based practices, and medical science advance constantly. Clinical process evolution takes continuous dedication and discipline. However, fostering expectations and partnerships with medical staff and clinical employees that purposefully and organically change is healthy and necessary.

Part of this road to clinical excellence starts with good intentions, directed at operational success. However, you must ask the question:

Is a simple investment in tools and analytics designed to optimize processes enough to achieve the desired outcome of clinical excellence?

In a recent roundtable discussion sponsored by LogicStream, healthcare executives agreed that emphasizing clinical process improvements paved the way to enhancing both financial performance and patient outcomes. Though, from the onset, such clinical processes must undergo rigorous development in an effort to assure optimal performance and safety, both key ingredients to a positive patient experience.

When examining processes and their supplemental resources, healthcare leadership should be targeting designs that support continuous improvements and lead to reliable and routine care for every patient, every day.

Standardizing Clinical Processes in Work Products

Process design starts with a careful understanding of clinical work products and delivery standards that define excellence. Clinical excellence is no longer “in the eye of the beholder” or defined by collective agreement.

For example, regarding the issue of adopting industry wide interoperability, the American Hospital Association (AHA) notes that one of the reasons building a nationwide healthcare data network has been so challenging relates to a lack of defined work product standards.

On the other side of the spectrum, the American Nurses Association (ANA) has clearly outlined an “essential core practice,” designed to help them deliver patient-centered care. Their practice is informed by supporting mechanisms like care plans.

In this same sense, work products or processes and their delivery should be derived from current professional standards published by acknowledged, credible organizations like the AHA, ANA, and others.

Clinical Process Expectations

Process performance standards should also result from analysis and discovery of truly optimal expectations that may manifest in:

  • Consistent and effective performance
  • Reduction of mistakes and waste
  • Elimination of safety risk
  • Proper execution

These target achievements should be the goal for all clinicians every time, all the time, by everyone, without excuse.

How to Measure and Analyze Process Expectations

Achieving these goals requires processes that are supported by optimized tools, relevant metrics, and thorough training. Verification and layered validation at each step are necessities and should include the following actions:

  • Engineering language, orders, and clinical data capture in an effort to assure clarity and precision of communication and information.
  • Incorporating sufficient redundancy and verification of practice designed to positively assure sound execution.
  • Provisioning software tools possessing functionality and configurations which support clinically sound processes, standards, and goals.
  • Enabling tool-based processes that offer credible measurements as byproducts of performance.

These actions can work towards developing and creating reliable processes that help generate better data.

Commitment at the Managerial Level

Aspire to a culture of clinical excellence? Check. Define expectations, research best practices, and adopt standardized work products? Check. Provide clinicians with processes and training informed by analytics? Check!

With all those steps in our rearview, now the last hurdle must be cleared: Management’s Commitment and Discipline.

There must be clear, public commitment from all levels of management throughout the organization to drive individual and collective adoption of changed standards, processes, and performance expectations. Habits are hard to break and reestablish. Change is hard and can even be frightening and risky.

One way to reduce risk suggested by the Institute for Healthcare Improvement has been to first test changes on a smaller scale. If changes prove successful, gradually expand across clinical teams until widespread adoption seems most certain.

Regardless of how hospital leadership approach changes to clinical processes, smart leaders openly acknowledge challenges and provide temporary support to achieve safety and success with:

  • Active support at all points of care
  • Attention to key indicators, hyper-examination, and requests for feedback
  • Intensive status updates, support actions, and problem solving

The objective is to minimize missteps, avoid misinformation, swiftly resolve issues, and assure a successful transition.

Immediate expectations of robust adoption and compliance may be pragmatically modest. However, it must be clearly understood by all levels of management that there is no “going back.” Everyone must get with the new program.

Often a few will passively (or actively!) resist efforts to “raise the bar” on performance and quality. At this critical moment, when everyone is watching management closely, holdouts become unmistakable. However, if allowances and accommodations are made, general adoption will suffer.

A strong commitment to initiating change and an alert focus on the highest external professional standards is key to building and maintaining excellence in clinical care for the long-term.

To answer that initial question: It takes more than tool investment and good intentions to implement processes that breed clinical excellence. Process design cannot take a back seat to ideas and their solutions. Effective design process is a necessity. Designs should be based on credible standards and data with the support and buy-in from hospital leadership at all levels.

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