Is Healthcare the Most Complex IT Industry ?

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Is Healthcare the Most Complex IT Industry ?
Skip Valusek Quality Engineer, Director
Performance Improvement Childrens Hospitals
Clinics Minneapolis/St Paul The content of this
presentation and discussion is solely that of
the presenter.
skip.valusek_at_childrenshc.org 612 813-5876
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Exercise What Makes IT Complex ?

• Identify three dimensions of complexity

2. Pick the dimension you feel is the most
important contributor to IT complexity
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Complexity Components

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AGENDA

• Very Brief Review of IT Technical Dimensions of
  Complexity
• Brief discussion of DSS A Paradigm Addition
• Inter-active discussion of business dimensions of
  complexity

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Very brief IT Technical Dimensions

• Interfacing/Networking requirements
• Information security requirements
• Bandwidth
• Database requirements
• Structural fit
• Flat file
• Hierarchical ?
• Relational?
• Object ?
• Standardizing definitions
• Identifying acceptable values
• Application requirements
• Breadth
• Depth
• Volatility

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End-users as a dimension of complexity

• Number
• Types
• Range of End-User
• PC Maturity
• Expectations
• Rate of change of all the above

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Technology change

• Rate
• Impact on transaction processes
• Impact on decision processes

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Information Management Premise

• The purpose of managing information and knowledge
  is to improve decision making capability.
• More effective information/knowledge management
  requires a paradigm
• ADDITION for both IT and user communities.

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Predominant Metaphors Used in Organizations
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Decision-Making

• Decisions commit resources through
• judgment and choice processes
• There is process in decision-making
• Opportunity/Problem Detection Explanation
• Alternative Generation
• Analysis (value probability judgments)
• Selection among alternatives
• Implementation
• Can we model this process?
• Judgments (Value Likelihood)
• Choices

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Decision Categories
RETROSPECTIVE / ANALYTICAL TACTICAL
STRATEGIC DECISIONS
CONCURRENT CLINICAL OPERATIONAL DECISIONS

• RESEARCH ANALYSIS
• across
• accounts, customers, patients,
• channels, practices
• markets,
• periods, day of week, time of day
• Unstructured (little or no process)
• Find key variables
• Collaboration sharing.
• Design Refine protocols/pathways

• Quick LookJUDGMENTS CHOICES
• within
• a PATIENT view WHAM
• a PROVIDER rounding list
• a DEPARTMENT staff scheduling
• a MARKET assess event impacts
• Empower employees (within limits)
• Semi-structured process
• Apply protocols/pathways/guidelines

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Additional Bridges Required
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Transition to Decision Support

• Opportunity/Problem Detection Explanation
• Alternative Generation
• Analysis (Cost/Benefit judgments)
• Selection among alternatives
• Implementation

FUTURE Explanation Why is it
happening? Whats the best action ?
TODAY Detection Whats Going On?
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Projects Measures of the Business

• Start Small Grow The Decision Support
  Paradigm
• Healthcare PDSA Rapid Cycle model for change

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Managing Evolutionary Design Development
User Requirements Evolution
Time (weeks)
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Managing Evolutionary Design DevelopmentObtain
ing Sustaining Business Sponsorship

• Instill a sense of urgency (level of pain)
• A critical success factor of organizational
  change
• Manage expectations
• Provide and retain funding
• Recruit and retain skills

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AGENDA

• Very Brief Review of IT Technical Dimensions of
  Complexity
• Brief discussion of DSS A Paradigm Addition
• Inter-active discussion of business dimensions of
  complexity

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IT Complexity Framework Assess Business
Processes in Four Categories
Transaction (I-P-O)
Decision (Judgments Choices)
Financial Operational Regulatory Clinical Financial Operational Regulatory Clinical
Financial Operational Regulatory Clinical Financial Operational Regulatory Clinical
Real-Time/ Operational Retrospective/ An
alytical
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Real-time Transaction Financial Billing
complexity
Customer (patient) presents
Services provided
Discrepancies resolved
time
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Real-time decision complexity Safety

• Operational/Clinical
• Number of front-line employees with decision
  responsibility
• Number of judgment and choice processes for
• each participant
• Number of processes requiring communication
• Number of potential failure points

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One sample judgment process
Right customer ?
Complete record ?

• What are the customer expectations regarding a
  complete knowledge of their relationship ?
• Difficulty creating a complete customer record
  for accurate customer decisions.
• Who has the master patient record?

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Real time decision patient placement/flow

SUPPLY
DEMAND

Infection Control
Nurse Staffing
Historical Forecast
Ancillary Services
External Events
Housekeeping Staffing
Scheduling Admissions Forecast
Homecare
ER
Short Stay
ER
Isolation Beds
Family Needs
OR
BEDS
Referring Physicians
Discharge Forecast Status
Consulting Admitting Physicians
Sister Hospital Status
Childrens Physician Network
Other Hospital Status
Physician Referral Telephone Line
Interpreter Services
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Real-time decision Financial

• EMTALA doesnt allow financial considerations to
  enter the initial real-time decision process.
  Those who present to the ER must be assessed
  regardless of ability to pay.
• Forces the problem to the retrospective domain

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Real-time decision complexity Satisfaction

• What are customer dis-satisfiers?
• Parking
• Food
• Delays in treatment waiting time
• Double rooms
• Staffing
• Communication
• Poor transitions
• Inability to reach consulting physician
• Whos in charge?

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Retrospective Decision Dimensions for analysis
Patient
Date/Time Day
DRG or APR
Employer
ICD-9
Plans/ Payors
CPT-4
Facility
Practice Provider
Department/ Unit

• Example attributes of importance
• Age appropriate
• Culturally appropriate (44 languages/cultures)

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Measurement of Quality/Evaluation of Success

• Balanced Scorecard Components
• Safety
• Access
• Finance
• Experience
• Stakeholders
• Patients
• Families
• Physicians
• Nurses
• Ancillary Services
• Payers
• Regulators

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Retrospective Analysis Transaction

• Safety
• Labeling of specimens
• Labeling of medications
• Waiting time
• Access
• Length of stay
• Time to turn a room
• Waiting time
• Experience
• Billing
• Waiting time

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Difficulty properly attributing provider/servicer

• Team of service vs individual
• Practices (coverage)
• Roles
• PCP
• Attending
• Procedure
• Consult
• Resident
• Team services

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Retrospective Analysis Relationships
Community Efforts Action Groups
Schools
Childrens Services Provider Network
Community-based advocacy groups
Physician Groups
Hospitals
Families
Employers
Local State National Governments
Clinics
Social Service Providers
Local State Public Health

• MHHP,
• NACHRI,
• AAP,
• MCHP,
• CDF

Managed Care Payers
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Regulatory/Compliance/Accreditation (Number of
regulators Information intensity)
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Rate of content knowledge creationImpact on
real-time and retrospective decisions
Transaction (I-P-O)
Decision (Judgments Choices)
Clinical guidelines CPOE
Clinical guidelines CPOE
Real-Time/ Operational Retrospective/ An
alytical
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Review of Healthcare Complexity Change Process
Real-Time/ Operational Retrospective/ Ana
lytical
Ability to achieve agreement (across
within stakeholder groups)
Transaction (I-P-O)
Decision Intensity (Judgments Choices)