Rolling out a healthcare improvement initiative and getting buy-in from clinicians can be tricky. Paul Revere’s midnight ride shows how finding and using key influencers can help prompt action. This knowledge can be used to drive success of hospital data-driven improvement initiatives too. Achieving buy-in of new best practices and process across an organization is not easy, but it is imperative to success. Picking the right people for these teams means picking the innovators and early adopters in the organization, as the Paul Revere example illustrates. Once these people are identified, putting them into three key teams (the Guidance team, the Workgroup, and the Clinical Implementation team) will get the organization the right deployment system to drive successful improvement initiative on a system-wide basis.

1. Successfully Rolling
Out Healthcare
Improvement Initiatives
with Key Influencers
— Tom Burton

2. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Picking the Right Influencers
Listen my children and you
shall hear. Of the midnight
ride of Paul Revere…”
— Henry Wadsworth Longfellow
The story of Paul Revere’s
ride is a powerful illustration
of how to use key
influencers to bring success
to your hospital’s data-driven
improvement initiatives.

3. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Deploying Analytics Systematically
When using data to drive
quality and cost improvement,
one of the biggest challenges
that organizations face is taking
small, successful initiatives and
implementing them across the
entire organization.

4. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Deploying Analytics Systematically
Achieving buy-in of new practices
and processes system-wide is
imperative to success.
The key to doing it well lies in
establishing an effective
deployment system that
standardizes organizational work.
It involves implementing team
structures that will enable
consistent, enterprise-wide
deployment of best practices.

5. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Importance of the Right
Influencers
Because Longfellow’s poem made
Paul Revere so famous, people
sometimes forget that Revere
wasn’t the only rider that night.
Another man, William Dawes, also
undertook the dangerous ride.
On the night of April 18, 1775,
Revere and Dawes rode through
the Massachusetts countryside,
marking the beginning of the
American Revolution.

6. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Importance of the Right
Influencers
Dawes covered more territory
than Revere, but Revere was
far more effective in spreading
the word and driving action
among the populace.
Malcolm Gladwell, in his book,
The Tipping Point: How Little
Things Can Make a Big Difference,
and Everett M. Rogers, in his
book, The Diffusion of Innovations,
explain the difference between
Revere and Dawes. …the man with the biggest
Rolodex in colonial Boston”
— Malcolm Gladwell
on Paul Revere

7. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Revere & Dawes: The Difference
Everett Rogers explains:
Revere knew exactly which doors to
pound on during his ride …. As a
result, he awakened key individuals,
who then rallied their neighbors to
take up arms against the British.”
In comparison, Dawes did not know
the territory as well as Revere. As he
rode through rural Massachusetts on
the night of April 18, he simply
knocked on random doors. The
occupants in most cases simply
turned over and went back to sleep.”

8. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Choosing Key Influencers to Drive
Effective Analytics Deployment
In his book, Rogers provides
what has become a very familiar
Bell curve of five major groups
involved in the diffusion of any
new idea throughout an
organization:
Innovators
Early adopters
Early majority
Late majority
Laggards

9. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Choosing Key Influencers to Drive
Effective Analytics Deployment
Innovators
early
adopters
early
majority
laggards
(never adopters)
* Adapted from Rogers, E. Diffusion of Innovations. New York, NY: 1995.
late
majority
Innovators. Recruit
innovators to re-design
care delivery processes
(like Revere)
Early adopters. Recruit
early adopters to chair
improvement and to lead
implementation at each site.
(key individuals who can
rally support)
TheChasm
N = number of individuals in group
N
N = number needed to influence group
(but they must be the right individuals)

10. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How Key Influencers Fit Team Structure
These innovators and
adopters need to fit into
three key team structures
for health systems to
drive successful change:
Guidance Team
Workgroup
Clinical Implementation Team

11. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How Key Influencers Fit Team Structure
Guidance Team: Provides
governance over all the workgroups
under a clinical program.
For example, a guidance team for the
Women and Children’s clinical
program might oversee three separate
workgroups focusing on gynecology,
pregnancy, or normal newborn.
The guidance team takes into account
resources, readiness, and political
climate to determine which
workgroups receive priority.

12. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How Key Influencers Fit Team Structure
Workgroup: A small, representative
sampling of clinical staff that actively
delivers care around a given work
process (such as gynecology,
pregnancy, or normal newborn) within
a clinical program.
The group typically consists of a
physician lead, an RN, and an
operations manager. Based on the
data and their own knowledge of
clinical workflow, the workgroup
determines improvement projects.

13. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How Key Influencers Fit Team Structure
Clinical Implementation Team:
This group consists of represent-
atives of all the practicing clinicians
who will participate in a data-driven
improvement initiative.
It hears the workgroup’s findings
and makes recommendations back
about which ideas to prioritize and
how to roll out a best practice.

14. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How Key Influencers Fit Team Structure
Workgroups must consist of innovators.
Clinical implementation teams must be
staffed by early adopters.
Governance teams should consist of both
early adopters and innovators.

15. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
W&N
How Key Influencers Fit Team Structure
Workgroups (Designs Innovation) • Meet weekly in iteration planning meeting
• Build DRAFT processes, metrics, interventions
• Present DRAFT work to Broader TeamsInnovators
Guidance Team (Prioritizes Innovations)
• Meet quarterly to prioritize allocation of technical staff
• Approves improvement AIMs
• Reviews progress and removes road blocksOB Newborn GYN
W&N
Innovators
Innovators
Early Adopters
Clinical Implementation Teams (Implements Innovation)
• Broad RN and MD representation across system
• Meet monthly to review, adjust and approve DRAFTs
• Lead rollout of new process and measurement
OB W&N
W&N
Innovators
Early Adopters
Early Adopters
OB
W&N
= Subject Matter Expert
= Data Capture
= Data Provisioning & Visualization
= Data Analysis
W&N

16. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 16
How to identify innovators
and early adopters
• Ask
 Innovators (inventors)
- Who are the top three MDs in our group who are
likely to invent a better way to deliver care?
 Early Adopters (thought leaders)
- When you have a tough case who are the top three
MDs you trust and would go to for a consult?
• Fingerprinting selection process
 Invite innovators to choose identify their top three
MD choices from the early adopters to lead the
Clinical Program
16

17. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
More about this topic
It’s Time for Clinicians to Engage
Dr. John Haughom, Senior Advisor
Improve Quality Through Clinical Teamwork
A success story from Texas Children’s Hospital
The Difficulty of Change
Dr. David Burton, Senior Vice President of Future Product Strategy
A Time for Revolutionary Thinking: Three Things Clinicians Can Do
Dr. John Haughom, Senior Advisor
Clinical Quality Improvements that Get Results (presentation, video, transcript, & slides)
Tom Burton, Co-founder, Senior Vice President of Product Development
Link to original article for a more in-depth discussion.
Successfully Rolling Out Healthcare Improvement Initiatives with Key
Influencers

18. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
For more information:
Download Healthcare: A Better Way.
The New Era of Opportunity
“This is a knowledge source for clinical and
operational leaders, as well as front-line
caregivers, who are involved in improving
processes, reducing harm, designing and
implementing new care delivery models, and
undertaking the difficult task of leading
meaningful change on behalf of the patients
they serve.”
– John Haughom, MD, Senior Advisor, Health Catalyst

19. © 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Tom Burton is a co-founder of Health Catalyst and former President of the company. He
brings 14 years of process improvement and IT experience to the company. Mr. Burton
was a member of the team that led Intermountain Healthcare's nationally recognized
improvements in quality of care delivery and reductions in cost. He has taught courses in
the Toyota Production System, Agile Software Development and currently teaches in the
Advanced Training Program at Intermountain Healthcare's Institute for Health Care Delivery
Research. Mr. Burton holds an MBA and a BS in Computer Science from BYU.