One of the biggest challenges providers face in their quality improvement efforts is knowing where to get started. In my experience, one of the best ways to overcome that “where do we begin?” factor is by using data from an enterprise data warehouse to look for high-cost areas where there are large variations in how health care is delivered. Variation found through the KPA is an indicator of opportunity. The more avoidable variation that is reflected in a particular care process, the more opportunity there is to reduce that variation and standardize the process. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. You will also want to take into consideration the readiness/openness to change in each of those areas.

1. Quality Improvement in
Healthcare: Where is the
Best Place to Start?
-Eric Just
VP of Technology

2. Quality Improvement Challenges
© 2014 Health Catalyst
www.healthcatalyst.com
Where to start is the biggest
challenge providers face
when setting out on a quality
improvement initiative.
With so many processes
across healthcare systems,
determining where to get the
most benefit can be difficult.
Consider the following
analogy:
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

3. Quality Improvement Challenges
Eric Just and brother on commercial expedition
in Long Island Sound.
© 2014 Health Catalyst
www.healthcatalyst.com
Fisherman rely on, and
relish, intuition. Finding the
best spot is part of the sport.
Charter Skippers must
leverage their experience
and data to find the most
productive fishing spots for
their paying customers.
Most skippers use the best
fishing tool available to
them—the fish finder.
So what’s the “Fish Finder”
for healthcare providers?
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

4. Quality Improvement Challenges
© 2014 Health Catalyst
www.healthcatalyst.com
Many providers overcome that
“where do we begin?” factor by
using an enterprise data warehouse
to look for high-cost areas where
large variations in health care is
being experienced.
Using a Key Process Analysis (KPA)
allows you to quickly zero in on the
biggest opportunities for improve-ment
and waste elimination.
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

5. Why Variations Are Great Indicators
Variation found through the KPA
is an indicator of opportunity.
The more avoidable variation is
reflected in a particular care
process, the more opportunity
exists to reduce that variation
and standardize the process.
Generally, standardization is
an indicator of efficiency.
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

6. Why Variations Are Great Indicators
Efficiency hinges on scale and
repeatability. That’s why it’s more
efficient to build complex products
such as cars and appliances on an
assembly line.
The more you have everyone
following the same evidence-based
procedures and processes, the
more control you have – which
translates into higher-quality
outcomes.
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

7. The chart below shows a fictional analysis of the cost per case
of vascular procedures. As you can see, the bulk of the bubbles
in the chart fall right around the $20,000 range. That is the
established norm in this hospital.
With Dr. J’s surgical costs
three times the $20,000
average, a substantial
opportunity for
improvement exists.
At 15 surgeries a year the
cost savings would be
$600,000.
© 2014 Health Catalyst
www.healthcatalyst.com
Practical Example
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

8. © 2014 Health Catalyst
www.healthcatalyst.com
Impacts of Cost Variation
Wide variations in cost are
usually associated with wide
variations in health care
quality. Reducing variations in
cost will bring corresponding
increases in quality.
Using KPA methodology, look
at data from many different
areas, such as heart failure,
diabetes, obstetrics, and
orthopedic surgery, to
determine where first steps
should be taken.
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

9. © 2014 Health Catalyst
www.healthcatalyst.com
Adjusting for Severity
While a KPA provides a
valuable top-line view, you’ll
want to avoid the temptation to
use it as an excuse to punish
individual providers.
There may be a good reason
those outliers are showing up
where they are.
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

10. Looking back at Dr. J from our
example: Even though the
cost for procedures was 3X
the norm there may be valid
reasons.
He might be drawing the
toughest and most complex
cases from all over the world.
He may be a world renowned
surgeon and his international
reputation brings much
prestige to the hospital.
© 2014 Health Catalyst
www.healthcatalyst.com
Adjusting for Severity
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

11. Suppose after performing a
KPA you discover three areas
of opportunity. How do you
determine which one to
pursue, especially if it’s your
first journey into process
improvement?
The most obvious answer would seem to be the one with
the largest potential ROI. That may not always be the best
course to pursue, however.
Variation analysis is the voice of the data, but it must be
balanced with the voice of the institution.
© 2014 Health Catalyst
www.healthcatalyst.com
Determining Where to Start
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

12. You wouldn’t think of starting a
commercial fishing company
without a fish finder. The same
thinking should apply to a
process improvement initiative.
A KPA designed to uncover
significant variations can help
you identify your greatest
opportunities for improvement
and serve as the map to help
you get started.
© 2014 Health Catalyst
www.healthcatalyst.com
Let Variation Be Your Map
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

13. © 2014 Health Catalyst
www.healthcatalyst.com
Link to original article for a more in-depth discussion.
Quality Improvement in Healthcare: Where is the Best Place to Start?
More about this topic
Driving Out Waste: A Framework to Enhance Value in Clinical Care (HFMA)
Dr. David Burton, Senior VP and Former CEO
How Clinical Analytics Will Improve the Cost and Quality of Healthcare Delivery
Dan Burton, CEO
How Analytics Will Lower Waste and Reduce Costs for the Healthcare Industry
Bobbi Brown, VP of Financial Engagement
3 Steps to Prioritize Clinical Quality Improvement in Healthcare
Bobbi Brown, VP of Financial Engagement
Key Steps that help Clinical Improvement Projects Reduce Waste
Ann Tinker, VP for Customer Engagement
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

14. © 2014 Health Catalyst
www.healthcatalyst.com
For more information:
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

15. Other Clinical Quality Improvement Resources
Eric Just joined the Health Catalyst family in August of 2011 as Vice
President of Technology, bringing over 10 years of biomedical informatics
experience. Prior to Catalyst, he managed the research arm of the
Northwestern Medical Data Warehouse at Northwestern University's
Feinberg School of Medicine. In this role, he led the development of
technology, processes, and teams to leverage the clinical data warehouse.
Previously, as a senior data architect, he helped create the data warehouse technical
foundation and innovated new ways to extract and load medical data. In addition, he
led the development effort for a genome database. Eric holds a Master of Science in
Chemistry from Northwestern University and a Bachelors of Science in Chemistry
from the College of William and Mary.
© 2014 Health Catalyst
www.healthcatalyst.com
Click to read additional information at www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.