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Success StoryOperating Room Excellence: How One HospitalSystem is Driving Improvements with the Use ofAdvanced AnalyticsHEALTHCARE ORGANIZATIONCommunity Hospital SystemTOP RESULTSImproved operating roomefficiency with integrateddata and analytics20 percentage-pointincrease in first-case ontime surgery starts85 percent reduction instaff hours to prepare andreport dataDriving transformation todata-driven, transparentcultureHEALTH CATALYSTPRODUCTS & SERVICESLate-Binding DataWarehouseAdvanced ApplicationSurgery WorkflowOperations DashboardInstallation ServicesClinical ImplementationServicesCopyright 2016 Health CatalystWhether providing school-based healthcare to help students behealthier and better learners, or extending primary care hours atarea practices to relieve hospital emergency department waitingtimes, Mission Health in North Carolina has always been dedicatedto expanding access to care. To preserve this commitment in an eraof declining reimbursement rates, Mission embarked on a strategicjourney it calls “Mission re:DESIGN.” The health system’s goalwas (and remains) nothing less than a radical redesign of clinicalprograms and processes so that patients receive the best possiblecare and experience with zero waste and harm.To achieve such excellence, Mission needed better access to data toenable quick and informed decision-making. And for that, the healthsystem would need an integrated, single source of truth to supplytimely and reliable data.THE OPERATING ROOM: A CLEAR OPPORTUNITY FORQUALITY IMPROVEMENTMission Health’s 47 operating rooms are the health system’s biggestrevenue generators, accounting for a substantial share of revenue andcost. Thus, knowing that improved access to data-driven insight into1

baseline measurement and opportunities for clinical and operationalimprovements could affect real change for the organization, Missionidentified surgery as an early priority to leverage analytics.As with most hospitals,1 the efficient use of Mission’s operatingrooms (ORs) was paramount to the entire organization’s financialsustainability. In a review of potential efficiency improvementopportunities, Mission identified scheduling and delegating resourcesas the critical first areas of focus.Optimal utilization of our47 operating rooms is reallyvaluable. They are open 24hours a day, at an averagecost of 58 per minute. TheHealth Catalyst OperatingRoom Dashboard hasprovided Mission Healthwith a strategic opportunityto identify and removewaste - and increaserevenue.Trent IbbotsonVice President, Surgical ServicesAlthough Mission had automated numerous processes over the years,a daily surgical workflow dashboard was not yet one of them. Instead,the health system relied on a manual data-preparation process frommultiple disparate systems—which was inefficient from a timingperspective and carried the risk of potential data quality issues. Pullingdata from different systems—about five in total, including the EHRand raw budget file—and generating operational reports for Mission’ssystem of ORs consumed nearly half a full-time employee (FTE).Despite all of this dedicated time and effort, many data gaps existed. Itwas difficult, if not impossible, to make quality, financial, and operationalimprovement decisions—especially with limited ability to quickly makechanges to queries, such as drilling down into the data. For example,Mission was unable to focus in on specific time periods to see whichcases were driving delays and other issues with scheduled surgeries.New tools for decision-making in the ORAn emerging best practice among leading hospitals is making use ofan operating room dashboard, a data-rich tool that helps clinicians andadministrators make the right call on allocating valuable resources.It also helps identify areas for efficiency improvements—and, notsurprisingly, one of the most profitable areas to start improving iswith first-case on-time starts. As most who have worked in the ORknow, when the first surgical case of the day is delayed, the restof the day is typically impacted with a series of late starts, as well.Among the chief reasons for the first (and subsequent) delays islack of timely and comprehensive data about each of the surgeriesscheduled. An automated workflow dashboard could improvevisibility to this information in and out of Mission’s operating rooms.Of course, technology alone would not fully drive improvementto meet quality goals. In the typical hospital environment, manydifferent employees and departments have a stake in the OR’slimited resources, and to embrace the use of an analytical ORdashboard, all must be committed to data-driven decision-making.For that to happen, Mission needed to drive a paradigm shiftthroughout the organization to embrace an evidence-based culture.The health system would need to educate and encourage people, atall levels, on the use and value of data automation and actionableinformation to make better care and operational decisions.Copyright 2016 Health Catalyst2

THE DATA-DRIVEN SOLUTION FOR OPERATING ROOMEFFICIENCYTo deploy analytics that would help make lasting improvements inthe operating room, Mission implemented the Surgery WorkflowOperations Dashboard and Late-Binding Enterprise Data Warehouse(EDW) platform by Health Catalyst. The EDW aggregates datafrom source systems throughout the organization to create a singlesource of truth that feeds the OR dashboard and other analyticalapplications being developed.Processes are data-drivenunto themselves, butuntil we can measurethe processes we can’tbe successful. Accuratedata removes the ‘I think’scenarios.Jon BrownVice President &Associate Chief Information OfficerMission’s Surgery Workflow Operations Dashboard was customizedto meet the health system’s needs. Its top features include:Clear metrics that align with the organization’s goals andobjectivesIntuitively displayed information for quick exploration andinsightSummary views, trends, and drill-down capabilities to filter intogreater detail on individual metric1236SAMPLE OR DASHBOARDSUMMARY VISUALIZATION1Case volume metrics2First-case on-timestart details by OR andagainst organizationaltargets3OR utilization rates andadd-on cases recordedby OR4Trended average ORturnover in minutes andphysician down-time5Itemization of reasonsfor case cancellation6Ability to filter by date,location, specialty, etc.Copyright 2016 Health Catalyst45Figure 1. Sample OR Dashboard summary visualization3

With new analytical capabilities, stakeholders across the hospitalcan more confidently make sounder decisions about one of thehospital’s biggest revenue generators and cost centers, theoperating room.SAMPLE OR DASHBOARDFIRST-CASE ON-TIME STARTDRILL-DOWN VISUALIZATION1Trended first-case ontime start percentages2Trended first-case ontime start percentagesby week where surgeondelay was not a factor3Trended count ofsurgeon delays4First-case on-time startdelay reason by type– count and overallpercentage of total1243Figure 2. Sample OR Dashboard first-case on-time start drill-down visualizationThe OR Dashboard providesus with an intuitive,centralized platform thatpresents the actionableinformation necessary tomake informed decisions– consumable at all levels,executives to front-lineemployees.Seth BataDirector Clinical Business AnalyticsTo promote adoption of this technology and realize the valueof self-service analytics, the health system assigned a smallwork team to collaborate on customizing the application andeducating end users. This designated work team containedrepresentation from key stakeholders, including senior and midlevel administrative staff, and front-line employees directly engagedin driving quality improvements in the OR. As the team rolls out theOR dashboard to additional hospitals in their organization, theirobjectives will include:Provide users with a deep understanding and of the value ofthe dataPresent information from a clinician’s perspective todemonstrate how the data could be used to improve processesfor better outcomesShow how self-service analytical tools replace tediousand inefficient manual processes with more meaningfulinformation—and more meaningful workCopyright 2016 Health Catalyst4

RESULTSAt last, Mission had valuable analytics at hand to drive major qualityimprovements in critical areas. The results were significant:Improved ability to drive care and operational improvements withintegrated data and analyticsBecause of the growingcomplexity and demandsof the healthcareenvironment (e.g.,clinical care, operations,regulatory environment,declining reimbursement,and the need to controlcosts), every healthcareorganization needs accessto good data. With theimplementation of ourEDW we now have a trulyintegrated, single source oftruth to support the bestpractices, care processmodels, and populationhealth management thathealthcare will only requireeven more in the future.Jill Hoggard Green, Ph.D., RNChief Operating OfficerQuick implementation of the EDW—which aggregated data from sixdata sources in just nine months—provided a single source of truthto guide improvement efforts. The OR Dashboard running on theEDW platform delivers drill-down and data visualization capabilitiesthat help the OR team identify important trends and potential gaps.This single source of truth not only resolves previous concernsabout the completeness and quality of the data used for ORanalytics, it also delivers data updates without requiring so manyvaluable resources to collect and report out. This timely processsupports quick and flexible decision-making.20 percentage-point increase in first-case on-time surgical startsIncreased access to complete and detailed information providedunprecedented visibility into the key drivers for first-case on-timesurgical starts. Insight from the OR Dashboard enabled monitoringof two key areas to address in order to improve this importantmetric: doctor on-time arrival and readiness of OR equipment.Efforts to address these two areas have resulted in dramaticimprovement—20 percent to date. The team reviews this datadaily to assess impact of initiatives and identify opportunities forcontinuous improvement.85 percent reduction in staff hours required for data preparationand reportingThe previous manual data preparation and reporting processrequired nearly half an FTE to maintain and accommodate -offreport requests. And, in many cases, reporting requests could notbe met at all based on the time required to meet the request or theinability to access the data needed.Now, data automation, powered by the EDW and analyticalapplications, has reduced staff time significantly. Less than a tenthof an FTE from a data architect is needed to sustain the automatedreporting process. Team members can now focus on analysis andenhancing the analytical platform, benefitting both the organizationand the employees.Copyright 2016 Health Catalyst5

Drove cultural transformation through engagement at all levelswithin the organizationThere’s a tremendousamount of excitementaround here now aboutgetting hands on data;we can’t get it to peoplefast enough. But that’s anice problem to have –people want what yourdepartment can offer them.Jon BrownVice President &Associate Chief Information OfficerStaff quickly recognized the potential of the new analyticalapplication, thanks to dedicated education and training from theimplementation team. In addition to detailed training, internalsocialization of OR dashboard successes to date has helped driveacceptance and adoption of the new, data-driven processes. Staffhave, in fact, made the OR dashboard an essential component oftheir everyday work.The fact that the solution presents information from a clinician’sperspective—showing how the data improves processes, whichthen translates to improved outcomes—has been key to engagingclinicians and establishing a data-driven culture. Self-serviceanalytical tools made available to all levels, from leadershipto clinicians on the frontlines of surgical care, also increaseengagement. Such data transparency and ease of access empowersusers to identify improvement opportunities and make decisions thatenhance clinical and operational effectiveness.WHAT’S NEXT“Mission anticipates a 5-7 million savings opportunity in their ORsupply chain, with the OR dashboard delivering the insight neededto drive these savings,” says Jon Brown, Vice President & AssociateChief Information Officer. With an eye on removing similar wasteand redundancy in other departments, the health system hasestablished teams to leverage advanced analytics to improve carein key areas including C-section, heart failure, sepsis, and newborn.Permanent work teams are being put in place to drive engagementin data-driven improvement initiatives, a cultural shift that is provingbeneficial to Mission. Additionally, work is underway to standardizedata definitions and the framework for consumption.As “Mission: reDESIGN” marches into the future with enhancedprocesses, quality improvements will also move forward, ablyassisted by analytics and a data-driven culture.References1. Park, Kyung W. M.D., M.B.A., Smalzt, Detley, Ph.D., McFadden, David, M.D.,Souba, Wiley, M.D., Sc.D., Ph.D. (2010). The Operating Room Dashboard{Abstract}. Journal of Surgical Research. 164(2), 294-300. Retrieved le/S0022-4804(09)00471-5/abstract.Copyright 2016 Health Catalyst6

ABOUT HEALTH CATALYSTHealth Catalyst is a mission-driven data warehousing, analytics,and outcomes improvement company that helps healthcareorganizations of all sizes perform the clinical, financial, andoperational reporting and analysis needed for population healthand accountable care. Our proven enterprise data warehouse(EDW) and analytics platform helps improve quality, add efficiencyand lower costs in support of more than 50 million patients fororganizations ranging from the largest US health system toforward-thinking physician practices.For more information, visit www.healthcatalyst.com, and follow uson Twitter, LinkedIn, and Facebook.Copyright 2016 Health Catalyst

information to make better care and operational decisions. Optimal utilization of our 47 operating rooms is really valuable. They are open 24 hours a day, at an average cost of 58 per minute. The Health Catalyst Operating Room Dashboard has provided Mission Health with a strategic opportunity to identify and remove waste - and increase revenue.