Where health systems are finding areas for innovation

May 23—Some health systems have found ways to overcome persistent obstacles to implementing innovations that cut labor costs, improve value and advance consumerism.

The cost reduction goals driving innovation efforts at the Cleveland Clinic, according to William Morris, MD, associate chief information officer, include:

• Removing activities that don’t add value
• Cutting costs from the patient experience
• Implementing technology to remove human labor costs

Staff-oriented innovation efforts

Innovating to reduce persistently low productivity also can create staff stress, Morris told attendees May 23 at the Not-for-Profit Health Care Investor Conference. He highlighted the need to address staff disruption as new technology is applied.

For example, as kiosks and other digital registration tools are implemented, existing registration staff need to be retrained to come out from behind their desks and provide higher-level “concierge” services for visitors to the system’s physician offices. Staff retrained in this manner can both earn a larger salary and perform more personally rewarding work.

“You have to play a team sport; you can’t just unilaterally do technology for the sake of technology because it will fall flat,” Morris said.

The Hospital Corporation of America (HCA) found such reorientations also are important for high-level staff. For instance, implementation of a machine-learning system to scan cancer tests cut down on the need for specialists to do that work and improved efficacy by 2,260%. But the initiative also raised concerns that clinical expertise was becoming less important. So, the health system highlighted the greater satisfaction such clinicians could derive from spending that same amount of their time — 80% — instead counseling patients and guiding them through their care.   

“It means that patients with breast, prostate or other cancers get the support they need,”  said Jonathan Perlin, MD, PhD, president of clinical services and chief medical officer for HCA.

Additionally, Perlin credited that shift in roles with boosting retention of those clinicians —in the high 90% — through reduced burnout and greater job satisfaction.

Process-related innovations

Banner Health’s emergency departments (EDs) improved the patient experience through digital innovations that:

• Triage incoming patients to determine their best site of care
• Provide on-site digital triage to help patients avoid unnecessary costs before care is delivered
• Keep patients who are undergoing treatment updated on developments in their care through chatbots

“A lot of time, EDs can be chaotic, there’s a lot of stuff going on there and you can feel like you have been abandoned, and it is a time where you are in a pretty vulnerable situation,” said D. Scott Nordlund, chief strategy and growth officer for Phoenix-based Banner Health.

Banner also has improved consumer relations through low-tech innovations like “speed dating,” where expectant mothers get 10-minute interviews with all of their pediatric specialists.

“We need to have a nice portfolio of things we’re using to solve pain points in the organization, and that is the best approach for innovation,” Nordlund said.

At HCA, a machine-learning system that provided a “digital sniffer” for patients at risk of developing sepsis was credited with saving nearly 8,000 lives over five years. By providing sepsis diagnoses an average of 20 hours earlier, the system has saved tremendous costs for the system and changed lives.

“I can guarantee you that there are costs associated with not having to use extraordinary care resources because they weren’t necessary, but the ultimate gift to those patients is priceless,” Perlin said.

Sepsis-related innovation has headed in a somewhat different direction at the Cleveland Clinic, where alerts driven by artificial intelligence are funneled to a centralized monitoring unit instead of to busy floor physicians and nurses.

“Much like the [Federal Aviation Administration], how do we coalesce data? That way we can manage it centrally, drive value and actually help the care teams, as opposed to today where it feels punitive when you get a pop-up alert,” Morris said.

The approach allows the central unit to begin ordering confirmatory steps and let the treating physician know what is being done for the patient.

Guiding principles of innovation

An underappreciated risk of adding digital technology aimed at innovation is the possibility of increasing costs, Nordlund said.

To avoid that outcome, Nordlund said organizations need to base their innovation efforts on clear goals.

“It needs to be a means to an end of trying to achieve something,” Nordlund said.

Nordlund also underscored the discipline needed to apply technology and other types of innovation tools to specific problems that the provider has identified previously.