By George Vallillee

Value-based care is one of the hottest trends in health care these days. Organizations of every size are talking about how to make the services they provide both more affordable and effective. In the changing health care landscape, the most effective organizations with the best results will receive the highest levels of reimbursement.

As radiology transitions into a purely digital PACS environment, we’re able to deliver greatly improved quality to benefit patients and providers alike. Those improvements require substantial financial investment and tend to drive the cost of care higher. As we look to the future, improvements in quality must be accompanied with reductions in those costs.

The new digital domain offers many opportunities to achieve those kinds of results. One is “big data.” Analysis of the ever-growing streams of information produced by these digital systems is likely to become the next big step for radiology. The question then becomes, how do we exploit data generated by multiple systems -- from the EMR to PACS – and turn it into results that are both meaningful and actionable?

We don’t have to wait for Big Data to begin achieving the goals of value-based care. Employing what we already know, coupled with effective use of Lean processes, we can achieve incremental, but substantial progress within our organizations.

As we found at Spectrum Health, there are substantial opportunities for improved care with reduced cost across the enterprise. These improvements are sometimes small, but they allow us to move closer to the goal of value-based care. It is a continuous improvement process based on the foundational structures that are suggested by value-based care models and driven by a Lean approach to change.

The core idea of Lean is to maximize customer value while minimizing waste. It is a process that creates more value while using fewer resources. This process changes our thinking from optimizing separate technologies, assets, and departments to optimizing the flow of services.

Our primary goal then, becomes driving cost down while increasing value – without reducing quality. Quality is comprised of patient outcomes, safety and user experiences. At the end of the day, it’s the results that count.

There are four foundational principles in the affordable care model. They include:

• Leadership that comes from a shared vision
• Collaboration –not just within the organization, but with vendors and stake holders
• Communication – a process that gets people excited about the prospects for change
• Data – solid information to evaluate and analyze your risk

Value-based care initiatives must also be driven by a determination to get results and that means avoiding the “analysis paralysis” that often becomes a roadblock. We must not be drawn into the quicksand of data and fail to execute.

Innovation is key. Michael Schrage at MIT’s Sloan School of Management noted: “The cost of experimentation is now the same or less than the cost of analysis. You can get more value for time, more value for dollar and more value for Euro by doing a quick experiment than doing a sophisticated analysis. In fact your quick experiments can make your sophisticated analysis better.”

Most of us are working in large, complex environments in which it can be difficult to determine how to deal with specific problems. Trying to get your arms around what can be a big problem is well-served by the Lean process. This is the path to value-based care. Lean is about purposes, processes and people. You begin by identifying the value you’re seeking, mapping the value stream, creating flow, establishing a pull and seeking perfection.

We can begin to design once we understand the value stream and the problem. This is where we can move ahead and try something based upon our understanding of what Lean is telling us about the system and what we’re trying to fix. Here, we do preliminary explorations and design a process to address that waste in the value stream. At that point we move to standardize services.

A lean approach to value-based care Employing what we already know, coupled with effective use of Lean processes, we can achieve incremental, but substantial progress within our organizations.

IT Matters
Lean processes worked well as we moved toward value-based care at Spectrum Health. We began by looking at how we could improve quality and safety in the event of system failure. When a radiological system doesn’t work, the staff using it often finds themselves at a loss. They don’t have the proper guidance to continue providing care services during the failure. They often don’t have resources available to provide immediate response.

We asked: how can we put a process in place to ensure they have the right guidance when it is needed? How do we supplant that loss of technology? We used Lean processes to analyze the problem. We decided that the solution must be effective and affordable, but must not be reliant on technology. After all, a system failure represented a failure of technology.

The process included two vital elements. First, was an effective communication system to reach more than 900 personnel scattered at locations across Western Michigan. We developed a scrolling message that appeared at the top of the screen at each workstation. The message stays bright red until the technologist reads and acknowledges it. Then it becomes blue. The change in color was an important lesson learned when we experimented with this process.

When it stayed red, the user was less likely to notice an update or new message once he had acknowledged the first one. The change in color proved much more attention grabbing and ensured the message got through. Next, was an easy and available method to address the issues they faced during an outage.

As an airplane pilot, I was already familiar with the hardcopy placards used in the cockpit to outline procedures for dealing with the various problems that can crop up during flight. We developed a set of cards for each workstation and for personnel that outlined what they needed to do when a system failure occurred.

The key for us was if a system goes down, we want to make sure staff has the guidance needed to know what steps should be taken given the configuration of failure that we have had. Our solution also had to be role specific. A radiologist responds to a PACS outage differently than a technologist, support services staffer, or IT professional. Each has a different role and responsibility that must be pursued with precision and in synchronization with the timing of the event. The result was a step forward for value-based care and for higher quality at Spectrum Health.

George Vallillee is the Manager of Radiology Information Solutions at Spectrum Health in Grand Rapids, Michigan.