- Describe your topic.
- What is the issue or question? Question 1: What interventions can be used to influence and change clinician and clinical staff behavior and help clinicians provide evidence-based care? • What are the elements of these interventions? - Which elements must be implemented to have fidelity? Which elements can be adapted to reflect the local context without losing fidelity? • What interventions are most effective to whom? • What is the cost-effectiveness of the interventions? • What resources are required to implement these interventions and what are the associated costs? • What strategies support sustainment of the changes after implementation? - Which personnel are responsible for maintaining the change? - How should organizations train current and new staff to ensure the changes are sustained? Question 2: What interventions are most effective for adult learning? • How can adult learning strategies from other industries be adopted to the clinical setting? Identify the population of interest, including details such as age range, gender, coexisting diagnoses, and reasons for therapy. • Clinicians and clinical staff in ambulatory care settings that serve a range of patient populations including vulnerable populations • Information in the evidence report would be for healthcare leaders/administrators so that they can effectively implement and sustain behavioral changes among the frontline staff providing direct patient care Identify the interventions (treatments, tests, or strategies) that you want to know more about, and what are the appropriate comparisons. • System-level and clinician-staff level interventions to change how clinical care is provided. This may include: - Clinical decision support (CDS), with an emphasis on how best to present clinical evidence in a manner so that frontline staff will want to change how they deliver care to their patients, i.e., in other words they will believe that the evidence does apply – or could apply – to their patient population - Other interventions that support behavioral change for healthcare providers in adapting evidence into practice (e.g., education, audit and feedback, dashboards of provider-specific quality scores, financial incentives, etc.) • Comparative-effectiveness of these different interventions to ideally provide a “menu” of interventions that practices can choose from to align with their workforce, local culture, and patient population (Note: If available, LHSs would like the results stratified by patient populations to better understand which interventions work best for clinicians serving specific subpopulations, for example, vulnerable populations.) Identify the important outcomes (health related benefits and harms) in which you are interested, such as improvements in symptoms or problems with diagnosis. • Clinician/staff behavior change (e.g. process measures) including sustainability of the change • Change in health outcomes for patient population • Cost to implement the change • Costs/Value (cost-effectiveness of implementing and maintaining a change in how direct care is provided to patients and who get the financial return, for example, health systems, payers?) • Provider satisfaction with quality of care • “Joy in work”
- Describe why this topic is important.
- • Generational Gap: Health systems recognize that there is a generational gap between "older" and "younger" clinicians and staff in terms of how they learn. In addition, one panel member noted clinician burnout related to EHRs generally, and in particular, CDS in EHRs, as well as differences in the level of support needed by a Year 1 resident and a triple board-certified clinician, for example. The LHSs on the panel noted (during the kickoff meeting) that they are specifically looking for evidence on how “to do” change management in those systems that have a large population of physicians who are adult learners and may need “help” adapting to a new way of accessing, using, and disseminating evidence to inform decisions, and ultimately improving care delivery. Thus, understanding how to bridge the gap between older and younger generations of healthcare providers to implement and sustain evidence-based changes in the delivery of clinical care is critical to providing high-value care. • Regulatory and Financial Measurement Saturation: Learning health systems are struggling to implement and sustain changes in the delivery of clinical care – based on evidence – due in part to the increasing number of quality measures that they are required to collect and report, many of which are tied to financial payments (see Question 3). The non-required evidence-based changes can become a secondary concern given the required regulatory and financial changes.
- Tell us why you are suggesting this topic.
- The learning health systems (LHSs) noted several barriers to implementing and sustaining changes at the frontline: • Simply providing evidence is not enough to promote a change in the delivery of clinical care. More specifically, health systems “need to know where it [the evidence] applies and where to fit it in” at various levels of the health system. • The Perceived Evidence Gap: There is often a perception that an “evidence gap” exists, meaning clinicians often believe that the evidence does not apply to their patient population – regardless of the strength of evidence. • Measurement Saturation: The overwhelming number of quality measures that health systems are required to report – many of which are tied to financial payments in the form of incentives or penalties – affects the ability of health systems to implement and sustain changes. “We’re [the government] pushing these on people who are already saturated.” Complicating matters further, some measures are retracted or changed over time as the evidence of their efficacy evolves. Additionally, many of these measures are process measures that are tied to financial payments – which makes it even harder to implement and sustain changes in the delivery of care. To help create buy-in for changes in the delivery of clinical care, the LHSs stressed the importance of: (1) demonstrating to clinicians that the evidence does apply to their patient population and (2) accessing data about their patient population. Understanding how to achieve these two things as part of a change management intervention will at least prompt clinician and frontline staff to have a conversation about change, and potentially reduce variability in clinical practice to improve quality and safety.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- • One LHS on the panel shared that currently they are providing tools to clinicians without first evaluating the current workflow and implementing an effective process change which creates a “roadblock” in implementation. As a result, the process “change” is not yielding the desired results. In addition, the panel members noted that in some cases, they are “ignoring” the evidence because they don’t believe that it applies to their patient population. • On the positive side, the panel members did note that they are using LEAN to help improve their processes and that they are using their own generate evidence to inform clinical care decisions. They also noted the importance of involving “people who deliver care… from the very beginning…. The best way is to have people in the frontline come to us and ask us to help them.” Thus, evidence about which change management strategies/interventions are most effective in clinical settings will further help LHSs that use LEAN (or 6 Sigma) to be even more efficient with their resources and processes.
- How will you or your group use the information from a new evidence report?
- The LHSs represented on this panel will use this evidence report to inform operational decisions related to implementing change management interventions including which interventions to implement and how to adapt them to account for local context and available resources. This evidence report can also be used to inform and support management strategies and very practical decisions that, again, may be driven by the extent of resources available (for example, having a central clinical coordinator across medical offices v. a clinical coordinator at each office to help with diabetes management).
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Many of the organizations represented on the LHS Panel are members of the High Value Healthcare Collaborative (HVHC) and could potentially distribute this report to other HVHC members. The HVHC is a provider learning network committed to improving healthcare value through data and collaboration. To accomplish this, the HVHC measures, innovates, tests, and continuously improves value-based care. Rapidly disseminate and facilitate adoption of proven high value care models across HVHC members and beyond. Within the LHSs represented on this panel, this evidence report will be most relevant to leaders at all levels of the organization, including the members of the executive teams and Boards of Directors, as they decide how to prioritize resources and how to implement change management interventions in the most cost-effective manner. Additionally, several of the LHS panel members are members of the Health Care Systems Research Network (HCSRN), an innovative consortium of research centers based on community-based health delivery systems. Thus, the LHS panel members could potentially disseminate this report to other HCSRN members.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Senior Vice President and Chief Quality Officer, Northwell Health
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- <names> AIR <email address>, <phone number>
- Please tell us how you heard about the Effective Health Care Program.
