fe06d331-51c1-4f05-bbd7-1344276207c2/5-0
00:00:03.314 --> 00:00:08.520
of Johns Hopkins All Children's Hospital.
Paola is the Medical Director for

fe06d331-51c1-4f05-bbd7-1344276207c2/5-1
00:00:08.520 --> 00:00:13.384
Utilization Management. And Paola,
thank you so much for welcoming us,

fe06d331-51c1-4f05-bbd7-1344276207c2/5-2
00:00:13.384 --> 00:00:15.234
for joining us on the show.

fe06d331-51c1-4f05-bbd7-1344276207c2/6-0
00:00:15.154 --> 00:00:18.354
Thank you so much.
It's an honor to join you.

fe06d331-51c1-4f05-bbd7-1344276207c2/8-0
00:00:17.354 --> 00:00:20.924
As background,
Johns Hopkins Medicine is a health system

fe06d331-51c1-4f05-bbd7-1344276207c2/8-1
00:00:20.924 --> 00:00:24.495
based in Baltimore, MD,
with 6700 providers supporting 7

fe06d331-51c1-4f05-bbd7-1344276207c2/8-2
00:00:24.495 --> 00:00:29.318
hospitals in Maryland, DC and Florida,
of which Johns Hopkins All Children's

fe06d331-51c1-4f05-bbd7-1344276207c2/8-3
00:00:29.318 --> 00:00:33.828
Hospital is one with 259 beds.
The topic today that we'll be discussing

fe06d331-51c1-4f05-bbd7-1344276207c2/8-4
00:00:33.828 --> 00:00:37.274
with Doctor Ballister is bridging data
and operations.

fe06d331-51c1-4f05-bbd7-1344276207c2/11-0
00:00:37.274 --> 00:00:41.535
We're going to cover documentation
optimization review and then we're going

fe06d331-51c1-4f05-bbd7-1344276207c2/11-1
00:00:41.535 --> 00:00:46.132
to speak about some early discharges and
how that affects patient flow. So Paola,

fe06d331-51c1-4f05-bbd7-1344276207c2/11-2
00:00:46.132 --> 00:00:50.337
would you like to introduce us with what
you're doing on bridging data and

fe06d331-51c1-4f05-bbd7-1344276207c2/9-0
00:00:46.914 --> 00:00:47.474
Perfect.

fe06d331-51c1-4f05-bbd7-1344276207c2/11-3
00:00:50.337 --> 00:00:50.954
operations?

fe06d331-51c1-4f05-bbd7-1344276207c2/12-0
00:00:51.154 --> 00:00:54.349
Absolutely.
It's a pleasure to join you today.

fe06d331-51c1-4f05-bbd7-1344276207c2/12-1
00:00:54.349 --> 00:00:59.720
And I think I'm just excited to talk
about how we are internally in our system

fe06d331-51c1-4f05-bbd7-1344276207c2/12-2
00:00:59.720 --> 00:01:04.955
really trying to shift from a reactive
data review focus to a more proactive

fe06d331-51c1-4f05-bbd7-1344276207c2/12-3
00:01:04.955 --> 00:01:10.258
utilization of data so that we can try to
help intervene at the point of care

fe06d331-51c1-4f05-bbd7-1344276207c2/12-4
00:01:10.258 --> 00:01:11.074
rather than.

fe06d331-51c1-4f05-bbd7-1344276207c2/13-0
00:01:11.154 --> 00:01:14.394
Simply leveraging data as a tool for
retrospective review.

fe06d331-51c1-4f05-bbd7-1344276207c2/16-0
00:01:14.794 --> 00:01:14.914
OK.

fe06d331-51c1-4f05-bbd7-1344276207c2/17-0
00:01:15.514 --> 00:01:20.268
Appreciate that. So jumping right in here,
I understand you've been working on

fe06d331-51c1-4f05-bbd7-1344276207c2/17-1
00:01:20.268 --> 00:01:24.962
clinical documentation and building your
physician advisor program to support

fe06d331-51c1-4f05-bbd7-1344276207c2/14-0
00:01:21.314 --> 00:01:21.914
Yeah.

fe06d331-51c1-4f05-bbd7-1344276207c2/15-0
00:01:23.314 --> 00:01:24.194
You got it.

fe06d331-51c1-4f05-bbd7-1344276207c2/17-2
00:01:24.962 --> 00:01:29.476
documentation optimization review.
You're shifting away from your reliance

fe06d331-51c1-4f05-bbd7-1344276207c2/17-3
00:01:29.476 --> 00:01:33.869
on external vendors and leveraging
internal expertise to build education

fe06d331-51c1-4f05-bbd7-1344276207c2/17-4
00:01:33.869 --> 00:01:35.434
feedback loops with which.

fe06d331-51c1-4f05-bbd7-1344276207c2/18-0
00:01:35.514 --> 00:01:39.930
External vendors can't match.
Can you tell us more about what you're

fe06d331-51c1-4f05-bbd7-1344276207c2/18-1
00:01:39.930 --> 00:01:44.858
doing with that project to move towards a
more proactive utilization of data

fe06d331-51c1-4f05-bbd7-1344276207c2/18-2
00:01:44.858 --> 00:01:45.434
approach?

fe06d331-51c1-4f05-bbd7-1344276207c2/19-0
00:01:45.394 --> 00:01:48.717
Yeah. So for us,
when we looked at opportunities, right,

fe06d331-51c1-4f05-bbd7-1344276207c2/19-1
00:01:48.717 --> 00:01:52.916
there are cost opportunities.
And when you look at the expansion of our

fe06d331-51c1-4f05-bbd7-1344276207c2/19-2
00:01:52.916 --> 00:01:56.589
physician advisor program, you know,
even just on the surface,

fe06d331-51c1-4f05-bbd7-1344276207c2/19-3
00:01:56.589 --> 00:02:00.730
we were able to leverage internal
resources rather than using external

fe06d331-51c1-4f05-bbd7-1344276207c2/19-4
00:02:00.730 --> 00:02:03.354
vendors for a cost saving right off the
bat.

fe06d331-51c1-4f05-bbd7-1344276207c2/20-0
00:02:05.194 --> 00:02:08.846
But for us,
we really looked at it as an opportunity

fe06d331-51c1-4f05-bbd7-1344276207c2/20-1
00:02:08.846 --> 00:02:14.428
to build our internal program because the
benefits of having an internal program

fe06d331-51c1-4f05-bbd7-1344276207c2/20-2
00:02:14.428 --> 00:02:17.529
really supersede just the financial
margins.

fe06d331-51c1-4f05-bbd7-1344276207c2/20-3
00:02:17.529 --> 00:02:22.422
So we have shifted to now having the
opportunity to improve education,

fe06d331-51c1-4f05-bbd7-1344276207c2/20-4
00:02:22.422 --> 00:02:23.594
improve feedback.

fe06d331-51c1-4f05-bbd7-1344276207c2/22-0
00:02:24.754 --> 00:02:29.838
Improve communication and training within
our CDI teams, our coding teams,

fe06d331-51c1-4f05-bbd7-1344276207c2/22-1
00:02:29.838 --> 00:02:35.058
leveraging these two experts that we have
that we're already working for our

fe06d331-51c1-4f05-bbd7-1344276207c2/22-2
00:02:35.058 --> 00:02:38.379
institution, Dr. Jesse Huang, Dr.
Mayuri Jindal.

fe06d331-51c1-4f05-bbd7-1344276207c2/22-3
00:02:38.379 --> 00:02:44.074
And so we're super excited because we're
seeing the return on that investment very.

fe06d331-51c1-4f05-bbd7-1344276207c2/21-0
00:02:40.234 --> 00:02:40.714
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/23-0
00:02:44.874 --> 00:02:45.154
Quickly.

fe06d331-51c1-4f05-bbd7-1344276207c2/25-0
00:02:45.354 --> 00:02:48.571
Right.
So I mean from the perspective of moving

fe06d331-51c1-4f05-bbd7-1344276207c2/25-1
00:02:48.571 --> 00:02:53.532
from reactive to proactive data
management and using the use case of this

fe06d331-51c1-4f05-bbd7-1344276207c2/24-0
00:02:52.194 --> 00:02:52.914
You got it.

fe06d331-51c1-4f05-bbd7-1344276207c2/25-2
00:02:53.532 --> 00:02:57.688
documentation review,
can you describe how you've been moving

fe06d331-51c1-4f05-bbd7-1344276207c2/25-3
00:02:57.688 --> 00:03:00.168
from,
how you've been moving towards

fe06d331-51c1-4f05-bbd7-1344276207c2/25-4
00:03:00.168 --> 00:03:04.794
proactively using this documentation
review and what the impact has?

fe06d331-51c1-4f05-bbd7-1344276207c2/26-0
00:03:04.874 --> 00:03:09.259
And what sort of data sources are you
looking at and how are you aggregating

fe06d331-51c1-4f05-bbd7-1344276207c2/26-1
00:03:09.259 --> 00:03:12.903
them and normalizing them?
And what's the operational impact of

fe06d331-51c1-4f05-bbd7-1344276207c2/26-2
00:03:12.903 --> 00:03:14.954
taking this more proactive approach?

fe06d331-51c1-4f05-bbd7-1344276207c2/28-0
00:03:15.074 --> 00:03:19.504
So there's a there are a lot of different
use cases for how we're doing it.

fe06d331-51c1-4f05-bbd7-1344276207c2/28-1
00:03:19.504 --> 00:03:24.108
I think one that really tells the story
is how we're using it in our length of

fe06d331-51c1-4f05-bbd7-1344276207c2/28-2
00:03:24.108 --> 00:03:26.848
stay.
So length of stay is something that many

fe06d331-51c1-4f05-bbd7-1344276207c2/27-0
00:03:24.914 --> 00:03:25.514
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/28-3
00:03:26.848 --> 00:03:29.996
health systems,
many healthcare executives are really

fe06d331-51c1-4f05-bbd7-1344276207c2/28-4
00:03:29.996 --> 00:03:33.435
focused on, right.
It seems to be a benchmark not only for

fe06d331-51c1-4f05-bbd7-1344276207c2/28-5
00:03:33.435 --> 00:03:34.834
kind of quality of care.

fe06d331-51c1-4f05-bbd7-1344276207c2/29-0
00:03:35.074 --> 00:03:39.534
But also you know your margins and
telling the story of how you are able to

fe06d331-51c1-4f05-bbd7-1344276207c2/29-1
00:03:39.534 --> 00:03:43.936
maximize your revenue and and and keep
your doors open and your lights on.

fe06d331-51c1-4f05-bbd7-1344276207c2/29-2
00:03:43.936 --> 00:03:48.220
But when you really peel back the layers
of understanding length of stay

fe06d331-51c1-4f05-bbd7-1344276207c2/29-3
00:03:48.220 --> 00:03:51.155
management,
a number in isolation of just what is

fe06d331-51c1-4f05-bbd7-1344276207c2/29-4
00:03:51.155 --> 00:03:54.794
your average length of stay does not
actually tell the story.

fe06d331-51c1-4f05-bbd7-1344276207c2/31-0
00:03:54.954 --> 00:03:58.040
And so first of all,
you have to understand your data to

fe06d331-51c1-4f05-bbd7-1344276207c2/31-1
00:03:58.040 --> 00:04:02.318
understand which metrics really peel back
and really get to telling the story.

fe06d331-51c1-4f05-bbd7-1344276207c2/31-2
00:04:02.318 --> 00:04:05.459
Because if you just look at an unadjusted
length of stay,

fe06d331-51c1-4f05-bbd7-1344276207c2/31-3
00:04:05.459 --> 00:04:09.845
you're really looking at your patient mix.
You're not really looking at are they

fe06d331-51c1-4f05-bbd7-1344276207c2/31-4
00:04:09.845 --> 00:04:14.394
staying as long as they should be staying.
So first of all, you have to understand.

fe06d331-51c1-4f05-bbd7-1344276207c2/32-0
00:04:14.514 --> 00:04:18.607
And what data is available.
So for us looking at our observed to

fe06d331-51c1-4f05-bbd7-1344276207c2/30-0
00:04:17.434 --> 00:04:17.554
OK.

fe06d331-51c1-4f05-bbd7-1344276207c2/32-1
00:04:18.607 --> 00:04:23.455
expected length of stay helps us get a
better understanding of not only that

fe06d331-51c1-4f05-bbd7-1344276207c2/32-2
00:04:23.455 --> 00:04:27.108
risk adjustment to to account for the
patient complexity,

fe06d331-51c1-4f05-bbd7-1344276207c2/32-3
00:04:27.108 --> 00:04:31.956
but are we performing where we should be
performing and looking at that data

fe06d331-51c1-4f05-bbd7-1344276207c2/32-4
00:04:31.956 --> 00:04:33.594
further for opportunities.

fe06d331-51c1-4f05-bbd7-1344276207c2/33-0
00:04:34.514 --> 00:04:38.749
So when you look at the healthcare system
and how it operates as a whole,

fe06d331-51c1-4f05-bbd7-1344276207c2/33-1
00:04:38.749 --> 00:04:42.642
all of your quality metrics,
all of your data at the end of the day

fe06d331-51c1-4f05-bbd7-1344276207c2/33-2
00:04:42.642 --> 00:04:46.821
really in healthcare come from your
documentation when it comes to those

fe06d331-51c1-4f05-bbd7-1344276207c2/33-3
00:04:46.821 --> 00:04:49.511
quality metrics like length of stay,
etcetera.

fe06d331-51c1-4f05-bbd7-1344276207c2/33-4
00:04:49.511 --> 00:04:53.518
You know what's your case mix index,
what's your severity of illness,

fe06d331-51c1-4f05-bbd7-1344276207c2/33-5
00:04:53.518 --> 00:04:54.434
what's the risk?

fe06d331-51c1-4f05-bbd7-1344276207c2/34-0
00:04:54.514 --> 00:04:59.041
Of mortality, et cetera.
So if you don't invest in strengthening

fe06d331-51c1-4f05-bbd7-1344276207c2/34-1
00:04:59.041 --> 00:05:02.314
that clinical documentation on the front
line,

fe06d331-51c1-4f05-bbd7-1344276207c2/34-2
00:05:02.314 --> 00:05:06.702
you are missing the opportunity to
accurately tell your story.

fe06d331-51c1-4f05-bbd7-1344276207c2/34-3
00:05:06.702 --> 00:05:11.786
So by investing in having internal
experts that can now not only give us

fe06d331-51c1-4f05-bbd7-1344276207c2/34-4
00:05:11.786 --> 00:05:14.154
feedback in real time to say, hey.

fe06d331-51c1-4f05-bbd7-1344276207c2/36-0
00:05:14.474 --> 00:05:18.289
We as clinicians,
as physicians see opportunities in the

fe06d331-51c1-4f05-bbd7-1344276207c2/36-1
00:05:18.289 --> 00:05:23.510
documentation where we can leverage
compliant methods like queries to help us

fe06d331-51c1-4f05-bbd7-1344276207c2/36-2
00:05:23.510 --> 00:05:29.066
clarify the documentation in the medical
record because the the goal at the end of

fe06d331-51c1-4f05-bbd7-1344276207c2/35-0
00:05:28.274 --> 00:05:28.634
Hmm.

fe06d331-51c1-4f05-bbd7-1344276207c2/36-3
00:05:29.066 --> 00:05:34.354
the day is really it's not up coding,
it's not down coding, that's absolutely.

fe06d331-51c1-4f05-bbd7-1344276207c2/37-0
00:05:34.434 --> 00:05:34.914
Not.

fe06d331-51c1-4f05-bbd7-1344276207c2/38-0
00:05:34.914 --> 00:05:37.917
The goal,
the goal is to capture an accurate and

fe06d331-51c1-4f05-bbd7-1344276207c2/38-1
00:05:37.917 --> 00:05:40.676
complete medical record.
So when we do that,

fe06d331-51c1-4f05-bbd7-1344276207c2/38-2
00:05:40.676 --> 00:05:44.906
we're able to see that our expected
length of stay is typically more

fe06d331-51c1-4f05-bbd7-1344276207c2/38-3
00:05:44.906 --> 00:05:49.871
optimized because we're telling the story
of the complexity and why that patient

fe06d331-51c1-4f05-bbd7-1344276207c2/38-4
00:05:49.871 --> 00:05:54.714
may be needed to stay for four days
rather than three days or two days and so.

fe06d331-51c1-4f05-bbd7-1344276207c2/40-0
00:05:54.914 --> 00:05:58.677
Because we've strengthen strengthen that
internal program,

fe06d331-51c1-4f05-bbd7-1344276207c2/40-1
00:05:58.677 --> 00:06:03.143
we and we are really investing in
improving our feedback loops to our

fe06d331-51c1-4f05-bbd7-1344276207c2/40-2
00:06:03.143 --> 00:06:07.672
frontline clinical teams to give them
concrete examples from the data.

fe06d331-51c1-4f05-bbd7-1344276207c2/40-3
00:06:07.672 --> 00:06:12.456
What are your most queried topics?
What are the topics that are generating

fe06d331-51c1-4f05-bbd7-1344276207c2/39-0
00:06:10.314 --> 00:06:10.794
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/40-4
00:06:12.456 --> 00:06:14.434
the most impact on severity of?

fe06d331-51c1-4f05-bbd7-1344276207c2/41-0
00:06:14.634 --> 00:06:18.133
Illness, risk of mortality,
when those clinical indicators are

fe06d331-51c1-4f05-bbd7-1344276207c2/41-1
00:06:18.133 --> 00:06:20.854
present,
we've had some phenomenal conversations

fe06d331-51c1-4f05-bbd7-1344276207c2/41-2
00:06:20.854 --> 00:06:25.409
with our frontline clinical teams to say,
hey, we're seeing these topics come up.

fe06d331-51c1-4f05-bbd7-1344276207c2/41-3
00:06:25.409 --> 00:06:30.019
Let's talk about the clinical indicators
so that we're all on the same page and we

fe06d331-51c1-4f05-bbd7-1344276207c2/41-4
00:06:30.019 --> 00:06:34.074
can also provide that feedback to our CDE
specialists and to our coders.

fe06d331-51c1-4f05-bbd7-1344276207c2/42-0
00:06:34.434 --> 00:06:39.245
So there's really a lot of impact
throughout the system and data that

fe06d331-51c1-4f05-bbd7-1344276207c2/42-1
00:06:39.245 --> 00:06:43.506
really stem from that quality
documentation and investing and

fe06d331-51c1-4f05-bbd7-1344276207c2/42-2
00:06:43.506 --> 00:06:49.074
increasing the accuracy and the thorough
and completeness of that documentation.

fe06d331-51c1-4f05-bbd7-1344276207c2/46-0
00:06:49.594 --> 00:06:54.000
I love how you're getting very specific
about the differences between observed

fe06d331-51c1-4f05-bbd7-1344276207c2/46-1
00:06:54.000 --> 00:06:58.518
and expected length of stay and the many
different implications of understanding

fe06d331-51c1-4f05-bbd7-1344276207c2/43-0
00:06:56.314 --> 00:06:56.714
Correct.

fe06d331-51c1-4f05-bbd7-1344276207c2/46-2
00:06:58.518 --> 00:07:01.251
the severity, the risk, mortality,
the case mix.

fe06d331-51c1-4f05-bbd7-1344276207c2/46-3
00:07:01.251 --> 00:07:05.601
You mentioned something interesting.
You said that internal experts through I

fe06d331-51c1-4f05-bbd7-1344276207c2/46-4
00:07:05.601 --> 00:07:09.394
think documentation optimization review
are able to give real time.

fe06d331-51c1-4f05-bbd7-1344276207c2/44-0
00:07:08.154 --> 00:07:08.634
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/47-0
00:07:09.514 --> 00:07:13.919
Feedback. Obviously there has,
I'm assuming that that that involves some

fe06d331-51c1-4f05-bbd7-1344276207c2/45-0
00:07:10.474 --> 00:07:10.954
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/47-1
00:07:13.919 --> 00:07:16.997
sort of automation, right?
Because I'm interested,

fe06d331-51c1-4f05-bbd7-1344276207c2/47-2
00:07:16.997 --> 00:07:21.281
can you speak about how some how
providers are receiving and providing

fe06d331-51c1-4f05-bbd7-1344276207c2/47-3
00:07:21.281 --> 00:07:23.394
feedback in real or near real time?

fe06d331-51c1-4f05-bbd7-1344276207c2/49-0
00:07:24.034 --> 00:07:27.659
Right.
And so the this process specifically is,

fe06d331-51c1-4f05-bbd7-1344276207c2/49-1
00:07:27.659 --> 00:07:31.510
you know,
heavily regulated and there are a lot of

fe06d331-51c1-4f05-bbd7-1344276207c2/49-2
00:07:31.510 --> 00:07:35.966
compliance elements to providing feedback.
So for example,

fe06d331-51c1-4f05-bbd7-1344276207c2/48-0
00:07:33.274 --> 00:07:33.754
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/49-3
00:07:35.966 --> 00:07:41.404
our physician advisors can't just reach
out to a doc and say, hey, you,

fe06d331-51c1-4f05-bbd7-1344276207c2/49-4
00:07:41.404 --> 00:07:43.594
you know you if you say this.

fe06d331-51c1-4f05-bbd7-1344276207c2/50-0
00:07:44.034 --> 00:07:49.121
You know then you can increase that's
absolutely non-compliant and we would

fe06d331-51c1-4f05-bbd7-1344276207c2/50-1
00:07:49.121 --> 00:07:54.275
never want to risk that or do that.
But we can leverage compliant queries to

fe06d331-51c1-4f05-bbd7-1344276207c2/50-2
00:07:54.275 --> 00:07:59.229
say the physicians have reviewed this
chart, they see opportunities. Hey,

fe06d331-51c1-4f05-bbd7-1344276207c2/50-3
00:07:59.229 --> 00:08:03.714
could you clarify you know if these if
these additional diagnoses.

fe06d331-51c1-4f05-bbd7-1344276207c2/52-0
00:08:03.794 --> 00:08:07.858
Were present or not,
and obviously there are a lot of very

fe06d331-51c1-4f05-bbd7-1344276207c2/52-1
00:08:07.858 --> 00:08:13.300
structured and templates that we use to
ensure that the queries are compliant.

fe06d331-51c1-4f05-bbd7-1344276207c2/52-2
00:08:13.300 --> 00:08:18.054
But that's one way that we can help
clarify the medical record while

fe06d331-51c1-4f05-bbd7-1344276207c2/52-3
00:08:18.054 --> 00:08:23.083
maintaining A compliant process and
ensuring that we are optimizing that

fe06d331-51c1-4f05-bbd7-1344276207c2/51-0
00:08:20.314 --> 00:08:21.114
Mm-hmm.

fe06d331-51c1-4f05-bbd7-1344276207c2/52-4
00:08:23.083 --> 00:08:23.634
medical.

fe06d331-51c1-4f05-bbd7-1344276207c2/53-0
00:08:23.794 --> 00:08:24.194
Doctor.

fe06d331-51c1-4f05-bbd7-1344276207c2/54-0
00:08:24.194 --> 00:08:29.562
Another example is we leverage on the
utilization management side and the case

fe06d331-51c1-4f05-bbd7-1344276207c2/54-1
00:08:29.562 --> 00:08:33.232
management side.
We leverage data from our concurrent

fe06d331-51c1-4f05-bbd7-1344276207c2/54-2
00:08:33.232 --> 00:08:36.698
coding that our CDI specialists and our
coders do.

fe06d331-51c1-4f05-bbd7-1344276207c2/54-3
00:08:36.698 --> 00:08:42.406
So the patient's actively in the hospital
and they are already working towards code

fe06d331-51c1-4f05-bbd7-1344276207c2/54-4
00:08:42.406 --> 00:08:43.154
assignment.

fe06d331-51c1-4f05-bbd7-1344276207c2/56-0
00:08:44.194 --> 00:08:49.080
So we leverage that data to say, hey,
what is the expected length of stay for

fe06d331-51c1-4f05-bbd7-1344276207c2/56-1
00:08:49.080 --> 00:08:53.026
this patient concurrently while they're
still in the hospital.

fe06d331-51c1-4f05-bbd7-1344276207c2/56-2
00:08:53.026 --> 00:08:57.160
So that the utilization management and
the case management teams,

fe06d331-51c1-4f05-bbd7-1344276207c2/56-3
00:08:57.160 --> 00:09:01.859
we huddle then every week we review
potential and active outliers based on

fe06d331-51c1-4f05-bbd7-1344276207c2/56-4
00:09:01.859 --> 00:09:04.114
that concurrent data so that we can.

fe06d331-51c1-4f05-bbd7-1344276207c2/55-0
00:09:03.314 --> 00:09:03.794
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/58-0
00:09:04.194 --> 00:09:08.344
Actively mitigate and say, hey,
what are the barriers to safe discharge?

fe06d331-51c1-4f05-bbd7-1344276207c2/58-1
00:09:08.344 --> 00:09:10.959
What are the barriers to progression of
care?

fe06d331-51c1-4f05-bbd7-1344276207c2/58-2
00:09:10.959 --> 00:09:15.734
What can we do while the patient is still
here to help them safely move through the

fe06d331-51c1-4f05-bbd7-1344276207c2/58-3
00:09:15.734 --> 00:09:18.690
system towards discharge or the next
level of care,

fe06d331-51c1-4f05-bbd7-1344276207c2/58-4
00:09:18.690 --> 00:09:23.124
rather than only getting that feedback
after they've already been discharged?

fe06d331-51c1-4f05-bbd7-1344276207c2/57-0
00:09:19.714 --> 00:09:19.794
The.

fe06d331-51c1-4f05-bbd7-1344276207c2/58-5
00:09:23.124 --> 00:09:24.034
And we can't do.

fe06d331-51c1-4f05-bbd7-1344276207c2/59-0
00:09:24.154 --> 00:09:27.088
Do anything to intervene.
So as we're reviewing case,

fe06d331-51c1-4f05-bbd7-1344276207c2/59-1
00:09:27.088 --> 00:09:31.109
reviewing our long length of stay
outliers with our case managers and our

fe06d331-51c1-4f05-bbd7-1344276207c2/59-2
00:09:31.109 --> 00:09:34.749
utilization review nurses,
we can also take that step back to say,

fe06d331-51c1-4f05-bbd7-1344276207c2/59-3
00:09:34.749 --> 00:09:38.389
hey, this patient is super sick, right?
They're they're intubated,

fe06d331-51c1-4f05-bbd7-1344276207c2/59-4
00:09:38.389 --> 00:09:41.813
they're ventilated,
they're still on drips, they're, you know,

fe06d331-51c1-4f05-bbd7-1344276207c2/59-5
00:09:41.813 --> 00:09:42.954
they're nowhere near.

fe06d331-51c1-4f05-bbd7-1344276207c2/60-0
00:09:43.874 --> 00:09:48.166
Or medical stability, let alone discharge.
So then we can give feedback to the

fe06d331-51c1-4f05-bbd7-1344276207c2/60-1
00:09:48.166 --> 00:09:50.557
coders and the CDI specialists to say,
hey,

fe06d331-51c1-4f05-bbd7-1344276207c2/60-2
00:09:50.557 --> 00:09:54.795
let's take a second look at this chart
because somehow they're falling to our

fe06d331-51c1-4f05-bbd7-1344276207c2/60-3
00:09:54.795 --> 00:09:59.196
length of say outlier report when they're
actually really sick and we think that

fe06d331-51c1-4f05-bbd7-1344276207c2/60-4
00:09:59.196 --> 00:10:03.434
the maybe the coding is has not been
optimized yet. Can we take another look?

fe06d331-51c1-4f05-bbd7-1344276207c2/62-0
00:10:03.474 --> 00:10:07.613
and see if maybe they have not captured
those additional diagnoses that are

fe06d331-51c1-4f05-bbd7-1344276207c2/62-1
00:10:07.613 --> 00:10:12.078
telling the story of why it's completely
appropriate for that patient to still be

fe06d331-51c1-4f05-bbd7-1344276207c2/62-2
00:10:12.078 --> 00:10:15.074
in the hospital.
So there's a lot of bidirectionality.

fe06d331-51c1-4f05-bbd7-1344276207c2/61-0
00:10:12.554 --> 00:10:13.034
So.

fe06d331-51c1-4f05-bbd7-1344276207c2/67-0
00:10:14.754 --> 00:10:19.171
I think a lot of our listeners are
hearing this story and are wondering how

fe06d331-51c1-4f05-bbd7-1344276207c2/67-1
00:10:19.171 --> 00:10:23.066
you measure success of being more
proactive in your data approach,

fe06d331-51c1-4f05-bbd7-1344276207c2/67-2
00:10:23.066 --> 00:10:27.716
specifically with regards to length of
stay. And I know that you're working on,

fe06d331-51c1-4f05-bbd7-1344276207c2/64-0
00:10:23.634 --> 00:10:24.034
Yeah.

fe06d331-51c1-4f05-bbd7-1344276207c2/67-3
00:10:27.716 --> 00:10:30.565
as I mentioned at the beginning of this
episode,

fe06d331-51c1-4f05-bbd7-1344276207c2/67-4
00:10:30.565 --> 00:10:34.634
patient flow and developing processes
that do safe discharges before.

fe06d331-51c1-4f05-bbd7-1344276207c2/65-0
00:10:32.114 --> 00:10:32.474
Yeah.

fe06d331-51c1-4f05-bbd7-1344276207c2/69-0
00:10:34.874 --> 00:10:39.514
Or noon alleviating your bottlenecks and
getting more people from the Uh and or

fe06d331-51c1-4f05-bbd7-1344276207c2/66-0
00:10:35.594 --> 00:10:35.914
Yes.

fe06d331-51c1-4f05-bbd7-1344276207c2/69-1
00:10:39.514 --> 00:10:43.459
ICU's transferred into bed.
So can you talk about what your metrics

fe06d331-51c1-4f05-bbd7-1344276207c2/68-0
00:10:41.634 --> 00:10:42.554
Yeah.

fe06d331-51c1-4f05-bbd7-1344276207c2/69-2
00:10:43.459 --> 00:10:46.765
are for success?
We've moved from reactive to being more

fe06d331-51c1-4f05-bbd7-1344276207c2/69-3
00:10:46.765 --> 00:10:49.433
proactive within the length of stay use
case.

fe06d331-51c1-4f05-bbd7-1344276207c2/69-4
00:10:49.433 --> 00:10:52.914
What are you doing about it and how are
you measuring that?

fe06d331-51c1-4f05-bbd7-1344276207c2/71-0
00:10:53.354 --> 00:10:56.670
So we could go in a lot of different
directions there,

fe06d331-51c1-4f05-bbd7-1344276207c2/71-1
00:10:56.670 --> 00:11:00.469
but I think one of the key outputs that
we have been tracking,

fe06d331-51c1-4f05-bbd7-1344276207c2/71-2
00:11:00.469 --> 00:11:05.113
not only looking at our observed to
expected length of stay and seeing if we

fe06d331-51c1-4f05-bbd7-1344276207c2/71-3
00:11:05.113 --> 00:11:08.068
are moving towards maintaining an optimal
ratio,

fe06d331-51c1-4f05-bbd7-1344276207c2/71-4
00:11:08.068 --> 00:11:13.194
right with something like length of stay,
if you drive it down too far, you're risk.

fe06d331-51c1-4f05-bbd7-1344276207c2/73-0
00:11:13.834 --> 00:11:18.318
Increasing your readmissions, right?
The goal is a safe discharge when the

fe06d331-51c1-4f05-bbd7-1344276207c2/73-1
00:11:18.318 --> 00:11:22.026
patient is ready and they have had an
optimal length of stay.

fe06d331-51c1-4f05-bbd7-1344276207c2/73-2
00:11:22.026 --> 00:11:25.733
Too short can have just as many drawbacks
as too long, right?

fe06d331-51c1-4f05-bbd7-1344276207c2/73-3
00:11:25.733 --> 00:11:29.620
So we're looking at that.
We're looking at there are other tools

fe06d331-51c1-4f05-bbd7-1344276207c2/73-4
00:11:29.620 --> 00:11:31.594
that we leverage using Fizz data.

fe06d331-51c1-4f05-bbd7-1344276207c2/75-0
00:11:33.234 --> 00:11:36.964
From CHA and that helps us with
benchmarking against like peers,

fe06d331-51c1-4f05-bbd7-1344276207c2/75-1
00:11:36.964 --> 00:11:39.834
other academic freestanding children's
hospitals.

fe06d331-51c1-4f05-bbd7-1344276207c2/75-2
00:11:39.834 --> 00:11:44.195
So that work that data story is apples to
apples and not apples to oranges.

fe06d331-51c1-4f05-bbd7-1344276207c2/75-3
00:11:44.195 --> 00:11:48.270
Because even within Pediatrics,
which is inherently different to adult

fe06d331-51c1-4f05-bbd7-1344276207c2/75-4
00:11:48.270 --> 00:11:51.197
medicine,
we want to make sure that that data that

fe06d331-51c1-4f05-bbd7-1344276207c2/75-5
00:11:51.197 --> 00:11:53.034
we're using is comparing to our.

fe06d331-51c1-4f05-bbd7-1344276207c2/76-0
00:11:53.154 --> 00:11:57.392
Our peers. So we use that.
We look at their also metrics like excess

fe06d331-51c1-4f05-bbd7-1344276207c2/74-0
00:11:54.274 --> 00:11:54.754
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/76-1
00:11:57.392 --> 00:12:01.753
days that Fizz reports out and allows us
to look at our opportunities.

fe06d331-51c1-4f05-bbd7-1344276207c2/76-2
00:12:01.753 --> 00:12:06.483
How many days above and beyond that
expected length of stay are our patients

fe06d331-51c1-4f05-bbd7-1344276207c2/76-3
00:12:06.483 --> 00:12:10.475
staying? What pockets,
what diagnosis groups are they falling in

fe06d331-51c1-4f05-bbd7-1344276207c2/76-4
00:12:10.475 --> 00:12:12.994
so that we can really drill down further?

fe06d331-51c1-4f05-bbd7-1344276207c2/78-0
00:12:13.074 --> 00:12:18.243
To see where our opportunities kind of
process wise and operationally lie.

fe06d331-51c1-4f05-bbd7-1344276207c2/77-0
00:12:18.154 --> 00:12:18.834
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/78-1
00:12:18.243 --> 00:12:23.551
But I think you know when it comes to
kind of that discharge in that patient

fe06d331-51c1-4f05-bbd7-1344276207c2/78-2
00:12:23.551 --> 00:12:26.790
flow,
we're using a different lens and we kind

fe06d331-51c1-4f05-bbd7-1344276207c2/78-3
00:12:26.790 --> 00:12:32.235
of took a step back when in in the height
of COVID when a lot of the community

fe06d331-51c1-4f05-bbd7-1344276207c2/78-4
00:12:32.235 --> 00:12:32.994
pediatrics.

fe06d331-51c1-4f05-bbd7-1344276207c2/79-0
00:12:33.034 --> 00:12:37.074
Units shut down around us,
we had a sudden kind of pressure to our

fe06d331-51c1-4f05-bbd7-1344276207c2/79-1
00:12:37.074 --> 00:12:41.777
system where we actually were starting to
have to decline patients because we

fe06d331-51c1-4f05-bbd7-1344276207c2/79-2
00:12:41.777 --> 00:12:46.661
didn't either have the bed or the nursing
or the capability to take care of them

fe06d331-51c1-4f05-bbd7-1344276207c2/79-3
00:12:46.661 --> 00:12:49.194
and that was something new for our system.

fe06d331-51c1-4f05-bbd7-1344276207c2/80-0
00:12:49.554 --> 00:12:54.129
So we took a step back and we looked at
our patient flow and how do we, you know,

fe06d331-51c1-4f05-bbd7-1344276207c2/80-1
00:12:54.129 --> 00:12:57.477
optimize because the answer is not always
right, more beds.

fe06d331-51c1-4f05-bbd7-1344276207c2/80-2
00:12:57.477 --> 00:13:01.829
So how do we optimize the beds that we
have and the flow within our system so

fe06d331-51c1-4f05-bbd7-1344276207c2/80-3
00:13:01.829 --> 00:13:06.293
that we alleviate those bottlenecks so
that when we have post-ops coming out of

fe06d331-51c1-4f05-bbd7-1344276207c2/80-4
00:13:06.293 --> 00:13:09.474
the ORS and we have patients that need a
lower level of.

fe06d331-51c1-4f05-bbd7-1344276207c2/81-0
00:13:09.554 --> 00:13:14.079
Care transferring out of our IC US or
patients coming up from our EC that we

fe06d331-51c1-4f05-bbd7-1344276207c2/81-1
00:13:14.079 --> 00:13:18.133
have beds available for them.
So we use data to take a step back and

fe06d331-51c1-4f05-bbd7-1344276207c2/81-2
00:13:18.133 --> 00:13:21.072
look at.
We mapped out our average admission time

fe06d331-51c1-4f05-bbd7-1344276207c2/81-3
00:13:21.072 --> 00:13:24.304
so that we could see were there any
trends, any peaks,

fe06d331-51c1-4f05-bbd7-1344276207c2/81-4
00:13:24.304 --> 00:13:28.594
valleys throughout the day and we did the
same with our discharge times.

fe06d331-51c1-4f05-bbd7-1344276207c2/82-0
00:13:29.914 --> 00:13:34.028
And what we saw was a very,
very persistent pattern that there was a

fe06d331-51c1-4f05-bbd7-1344276207c2/82-1
00:13:34.028 --> 00:13:37.844
huge peak of discharges.
And I think this is probably common to

fe06d331-51c1-4f05-bbd7-1344276207c2/82-2
00:13:37.844 --> 00:13:40.587
many healthcare systems very late in the
day.

fe06d331-51c1-4f05-bbd7-1344276207c2/82-3
00:13:40.587 --> 00:13:44.046
So the end of the day shift like between
4:00 to 6:00 PM,

fe06d331-51c1-4f05-bbd7-1344276207c2/82-4
00:13:44.046 --> 00:13:48.816
we would see a huge spike in discharges
when the admissions had been relatively

fe06d331-51c1-4f05-bbd7-1344276207c2/82-5
00:13:48.816 --> 00:13:49.234
stable.

fe06d331-51c1-4f05-bbd7-1344276207c2/83-0
00:13:49.314 --> 00:13:53.078
Throughout the day.
And so as we peeled back the the layers

fe06d331-51c1-4f05-bbd7-1344276207c2/83-1
00:13:53.078 --> 00:13:55.965
of understanding why was that peak
happening,

fe06d331-51c1-4f05-bbd7-1344276207c2/83-2
00:13:55.965 --> 00:14:00.859
what can we do to safely redistribute,
flatten the curve a little bit and and

fe06d331-51c1-4f05-bbd7-1344276207c2/83-3
00:14:00.859 --> 00:14:05.691
safely redistribute those discharges
throughout the day to more evenly match

fe06d331-51c1-4f05-bbd7-1344276207c2/83-4
00:14:05.691 --> 00:14:08.954
the admissions.
That's when we started to use data.

fe06d331-51c1-4f05-bbd7-1344276207c2/84-0
00:14:09.074 --> 00:14:09.514
Really.

fe06d331-51c1-4f05-bbd7-1344276207c2/85-0
00:14:09.554 --> 00:14:12.857
Understand where the process was not
optimized, right?

fe06d331-51c1-4f05-bbd7-1344276207c2/85-1
00:14:12.857 --> 00:14:16.641
Rather than asking physicians and nurses
work harder, do more.

fe06d331-51c1-4f05-bbd7-1344276207c2/85-2
00:14:16.641 --> 00:14:21.386
It's how can we rethink the system and
how it's set up so that we can optimize

fe06d331-51c1-4f05-bbd7-1344276207c2/85-3
00:14:21.386 --> 00:14:25.890
for earlier safe discharge planning and
the patients that are ready in the

fe06d331-51c1-4f05-bbd7-1344276207c2/85-4
00:14:25.890 --> 00:14:29.434
morning can go in the morning rather than
waiting for the.

fe06d331-51c1-4f05-bbd7-1344276207c2/86-0
00:14:29.554 --> 00:14:33.316
Late afternoon.
So that's where we really started to tell

fe06d331-51c1-4f05-bbd7-1344276207c2/86-1
00:14:33.316 --> 00:14:37.274
that story and understand our
opportunities for improvement.

fe06d331-51c1-4f05-bbd7-1344276207c2/87-0
00:14:36.594 --> 00:14:41.321
Have you been able to measure the impact
on patient satisfaction with HEDIS

fe06d331-51c1-4f05-bbd7-1344276207c2/87-1
00:14:41.321 --> 00:14:45.924
measures regarding allowing patients to
be discharged when they're ready?

fe06d331-51c1-4f05-bbd7-1344276207c2/87-2
00:14:45.924 --> 00:14:50.652
And also what kind of how have you been
evaluating provider adoption versus

fe06d331-51c1-4f05-bbd7-1344276207c2/87-3
00:14:50.652 --> 00:14:52.954
pushback to changing their workflows?

fe06d331-51c1-4f05-bbd7-1344276207c2/88-0
00:14:51.554 --> 00:14:57.132
Right. Yeah. Change management is also,
it's such a huge part of anything that we

fe06d331-51c1-4f05-bbd7-1344276207c2/88-1
00:14:57.132 --> 00:15:00.601
do, right.
We have not seen any negative impact in

fe06d331-51c1-4f05-bbd7-1344276207c2/88-2
00:15:00.601 --> 00:15:04.819
patient satisfaction. First of all,
I think that's important.

fe06d331-51c1-4f05-bbd7-1344276207c2/88-3
00:15:04.819 --> 00:15:10.125
We have found that telling the story and
engaging not only clinicians and our

fe06d331-51c1-4f05-bbd7-1344276207c2/88-4
00:15:10.125 --> 00:15:10.874
physicians.

fe06d331-51c1-4f05-bbd7-1344276207c2/90-0
00:15:11.074 --> 00:15:16.948
And our resident physicians who are a big
percentage of our workforce and in our

fe06d331-51c1-4f05-bbd7-1344276207c2/90-1
00:15:16.948 --> 00:15:21.953
particular healthcare system.
But it was critical to engage not only

fe06d331-51c1-4f05-bbd7-1344276207c2/90-2
00:15:21.953 --> 00:15:27.247
nursing counterparts and our colleagues
and nursing leadership for us to

fe06d331-51c1-4f05-bbd7-1344276207c2/89-0
00:15:24.194 --> 00:15:24.394
3.

fe06d331-51c1-4f05-bbd7-1344276207c2/90-3
00:15:27.247 --> 00:15:30.874
understand how these late discharges
impact them.

fe06d331-51c1-4f05-bbd7-1344276207c2/91-0
00:15:30.994 --> 00:15:35.528
All the way to speaking with our
dietitians, our clinical pharmacists,

fe06d331-51c1-4f05-bbd7-1344276207c2/91-1
00:15:35.528 --> 00:15:40.191
our environmental services staff,
we realize by this process and working

fe06d331-51c1-4f05-bbd7-1344276207c2/91-2
00:15:40.191 --> 00:15:45.492
through the data and really understanding
how everybody's individual workflows all

fe06d331-51c1-4f05-bbd7-1344276207c2/91-3
00:15:45.492 --> 00:15:49.133
impact and what the downstream effects
are. For example,

fe06d331-51c1-4f05-bbd7-1344276207c2/91-4
00:15:49.133 --> 00:15:50.794
I practice as a pediatric.

fe06d331-51c1-4f05-bbd7-1344276207c2/93-0
00:15:50.914 --> 00:15:53.972
Hospitalist.
So I I have myself gone to the bedside to

fe06d331-51c1-4f05-bbd7-1344276207c2/93-1
00:15:53.972 --> 00:15:58.588
discharge a patient and EVS is in there
cleaning the room. So I'll tell them, hey,

fe06d331-51c1-4f05-bbd7-1344276207c2/93-2
00:15:58.588 --> 00:16:01.647
we're actually,
I'm about to discharge this patient so

fe06d331-51c1-4f05-bbd7-1344276207c2/92-0
00:15:58.674 --> 00:15:59.274
Mhm.

fe06d331-51c1-4f05-bbd7-1344276207c2/93-3
00:16:01.647 --> 00:16:05.985
that you could do one terminal clean
rather than doing a daily clean and then

fe06d331-51c1-4f05-bbd7-1344276207c2/93-4
00:16:05.985 --> 00:16:08.876
coming back two hours later to do a
terminal clean.

fe06d331-51c1-4f05-bbd7-1344276207c2/93-5
00:16:08.876 --> 00:16:10.434
That helps their efficiency.

fe06d331-51c1-4f05-bbd7-1344276207c2/94-0
00:16:10.514 --> 00:16:13.688
Tremendously.
So if they're turning the rooms over more

fe06d331-51c1-4f05-bbd7-1344276207c2/94-1
00:16:13.688 --> 00:16:16.408
efficiently,
that's another critical element in

fe06d331-51c1-4f05-bbd7-1344276207c2/94-2
00:16:16.408 --> 00:16:21.112
alleviating that patient flow bottleneck.
So we engage them in the process so that

fe06d331-51c1-4f05-bbd7-1344276207c2/94-3
00:16:21.112 --> 00:16:25.703
they could understand and better plan for
what are our anticipated discharges in

fe06d331-51c1-4f05-bbd7-1344276207c2/94-4
00:16:25.703 --> 00:16:29.954
the morning versus the afternoon or the
evening, so they can also map out.

fe06d331-51c1-4f05-bbd7-1344276207c2/96-0
00:16:30.194 --> 00:16:35.122
About their own workflows for nursing,
it was critical because they also because

fe06d331-51c1-4f05-bbd7-1344276207c2/96-1
00:16:35.122 --> 00:16:39.990
of the work that we've done with really
trying to prioritize safe discharges by

fe06d331-51c1-4f05-bbd7-1344276207c2/96-2
00:16:39.990 --> 00:16:44.188
noon in clinically ready patients,
they've been able to adjust their

fe06d331-51c1-4f05-bbd7-1344276207c2/95-0
00:16:41.714 --> 00:16:42.314
Mm-hmm.

fe06d331-51c1-4f05-bbd7-1344276207c2/96-3
00:16:44.188 --> 00:16:48.387
staffing because now it's become
ingrained in part of our culture to

fe06d331-51c1-4f05-bbd7-1344276207c2/96-4
00:16:48.387 --> 00:16:48.874
discuss.

fe06d331-51c1-4f05-bbd7-1344276207c2/97-0
00:16:48.914 --> 00:16:53.388
When these potential discharged by noon
who they are the day prior so that when

fe06d331-51c1-4f05-bbd7-1344276207c2/97-1
00:16:53.388 --> 00:16:57.639
the and we also communicate overnight
with any updates on those anticipated

fe06d331-51c1-4f05-bbd7-1344276207c2/97-2
00:16:57.639 --> 00:17:01.498
early discharges so that the nursing
leadership team can also adjust

fe06d331-51c1-4f05-bbd7-1344276207c2/97-3
00:17:01.498 --> 00:17:05.301
assignments so that one nurse isn't
getting you know a four patient

fe06d331-51c1-4f05-bbd7-1344276207c2/97-4
00:17:05.301 --> 00:17:08.154
assignment and they're all going to be
discharged.

fe06d331-51c1-4f05-bbd7-1344276207c2/99-0
00:17:08.914 --> 00:17:13.700
In the morning because we know that will
be a system barrier to safely effectuate

fe06d331-51c1-4f05-bbd7-1344276207c2/99-1
00:17:13.700 --> 00:17:17.902
all four of those discharges.
So it's really been powerful for our team

fe06d331-51c1-4f05-bbd7-1344276207c2/99-2
00:17:17.902 --> 00:17:22.338
to learn the impact of what I used to
think was my individual decision as a

fe06d331-51c1-4f05-bbd7-1344276207c2/99-3
00:17:22.338 --> 00:17:25.374
clinician,
but how that impacts all the other teams

fe06d331-51c1-4f05-bbd7-1344276207c2/98-0
00:17:24.194 --> 00:17:24.434
1.

fe06d331-51c1-4f05-bbd7-1344276207c2/99-4
00:17:25.374 --> 00:17:28.234
so that we really got that buy-in from
everyone.

fe06d331-51c1-4f05-bbd7-1344276207c2/100-0
00:17:28.754 --> 00:17:32.215
This is important information,
not just for our patients,

fe06d331-51c1-4f05-bbd7-1344276207c2/100-1
00:17:32.215 --> 00:17:37.227
but for other members of our team so that
we can all work together more efficiently

fe06d331-51c1-4f05-bbd7-1344276207c2/100-2
00:17:37.227 --> 00:17:39.674
to provide that really high quality care.

fe06d331-51c1-4f05-bbd7-1344276207c2/102-0
00:17:39.714 --> 00:17:44.219
I appreciate you going into depth about
the contextual implications of making

fe06d331-51c1-4f05-bbd7-1344276207c2/102-1
00:17:44.219 --> 00:17:48.031
these data-driven decisions.
There are real human implications on

fe06d331-51c1-4f05-bbd7-1344276207c2/102-2
00:17:48.031 --> 00:17:51.728
every decision you make.
As we approach the end of this podcast

fe06d331-51c1-4f05-bbd7-1344276207c2/101-0
00:17:49.634 --> 00:17:50.474
Absolutely.

fe06d331-51c1-4f05-bbd7-1344276207c2/102-3
00:17:51.728 --> 00:17:54.154
episode, I'd like to ask a final question.

fe06d331-51c1-4f05-bbd7-1344276207c2/103-0
00:17:54.834 --> 00:18:00.782
You know you're well into this journey of
moving from reactive to proactive

fe06d331-51c1-4f05-bbd7-1344276207c2/103-1
00:18:00.782 --> 00:18:06.261
data-driven decision making.
What advice would you give to yourself a

fe06d331-51c1-4f05-bbd7-1344276207c2/103-2
00:18:06.261 --> 00:18:09.314
few years ago, earlier in this process?

fe06d331-51c1-4f05-bbd7-1344276207c2/104-0
00:18:09.234 --> 00:18:15.398
I think that what we often see and what I
often see as it relates to data and

fe06d331-51c1-4f05-bbd7-1344276207c2/104-1
00:18:15.398 --> 00:18:21.958
operations is there is a tendency to want
to take a data element and then go solve

fe06d331-51c1-4f05-bbd7-1344276207c2/104-2
00:18:21.958 --> 00:18:27.096
a problem with that data.
But just like as a clinician when I am

fe06d331-51c1-4f05-bbd7-1344276207c2/104-3
00:18:27.096 --> 00:18:28.914
meeting a patient they.

fe06d331-51c1-4f05-bbd7-1344276207c2/105-0
00:18:29.114 --> 00:18:33.717
Presenting to me with a problem and a
concern. I don't order a lab panel,

fe06d331-51c1-4f05-bbd7-1344276207c2/105-1
00:18:33.717 --> 00:18:38.507
a standard lab panel for every patient,
and then based on their lab results,

fe06d331-51c1-4f05-bbd7-1344276207c2/105-2
00:18:38.507 --> 00:18:41.929
go find the diagnosis, right?
You have to use context.

fe06d331-51c1-4f05-bbd7-1344276207c2/105-3
00:18:41.929 --> 00:18:44.790
You have to understand the patient's
history.

fe06d331-51c1-4f05-bbd7-1344276207c2/105-4
00:18:44.790 --> 00:18:48.834
What are their presenting symptoms?
What is their physical exam?

fe06d331-51c1-4f05-bbd7-1344276207c2/106-0
00:18:48.914 --> 00:18:53.777
And based on that information,
find the right data to help you make that

fe06d331-51c1-4f05-bbd7-1344276207c2/106-1
00:18:53.777 --> 00:18:57.108
diagnosis.
And I think the same applies with data

fe06d331-51c1-4f05-bbd7-1344276207c2/106-2
00:18:57.108 --> 00:19:01.372
and operations. You can't just find, OK,
here's length of stay.

fe06d331-51c1-4f05-bbd7-1344276207c2/106-3
00:19:01.372 --> 00:19:06.235
Our average length of stay is 7 days and
therefore we need to reduce it.

fe06d331-51c1-4f05-bbd7-1344276207c2/106-4
00:19:06.235 --> 00:19:08.834
That's not how it works. You've got to.

fe06d331-51c1-4f05-bbd7-1344276207c2/108-0
00:19:08.914 --> 00:19:14.625
To understand a is it the right data and
what do you do with that data so that you

fe06d331-51c1-4f05-bbd7-1344276207c2/108-1
00:19:14.625 --> 00:19:18.548
can make impact?
Because there's a tendency to over rely

fe06d331-51c1-4f05-bbd7-1344276207c2/108-2
00:19:18.548 --> 00:19:22.746
on data in isolation.
When you really need clinical context,

fe06d331-51c1-4f05-bbd7-1344276207c2/108-3
00:19:22.746 --> 00:19:28.114
you need to understand what is the right
data, who am I benchmarking against?

fe06d331-51c1-4f05-bbd7-1344276207c2/107-0
00:19:24.274 --> 00:19:24.474
3.

fe06d331-51c1-4f05-bbd7-1344276207c2/110-0
00:19:28.594 --> 00:19:34.140
So much context to data and then you find
the right data to help you tell the story

fe06d331-51c1-4f05-bbd7-1344276207c2/110-1
00:19:34.140 --> 00:19:37.243
of your problem and then you go fix it,
right?

fe06d331-51c1-4f05-bbd7-1344276207c2/110-2
00:19:37.243 --> 00:19:42.459
So I think that's the key for me is is
the finding the right data in the right

fe06d331-51c1-4f05-bbd7-1344276207c2/109-0
00:19:38.154 --> 00:19:38.394
OK.

fe06d331-51c1-4f05-bbd7-1344276207c2/110-3
00:19:42.459 --> 00:19:47.874
context to tell your story and help you
solve a problem rather than just blindly.

fe06d331-51c1-4f05-bbd7-1344276207c2/111-0
00:19:48.354 --> 00:19:52.514
grabbing a piece of data and then trying
to solve a problem with it.

fe06d331-51c1-4f05-bbd7-1344276207c2/113-0
00:19:51.474 --> 00:19:55.334
I I love, Paula,
your emphasis on the data narrative and

fe06d331-51c1-4f05-bbd7-1344276207c2/113-1
00:19:55.334 --> 00:19:59.126
on the context.
I think hearing our conversation today,

fe06d331-51c1-4f05-bbd7-1344276207c2/113-2
00:19:59.126 --> 00:20:04.815
I'm hearing the emphasis on data context
for data-driven operational interventions.

fe06d331-51c1-4f05-bbd7-1344276207c2/113-3
00:20:04.815 --> 00:20:09.962
You can't just take things in isolation.
You can't take teams in isolation.

fe06d331-51c1-4f05-bbd7-1344276207c2/112-0
00:20:05.554 --> 00:20:06.514
You got it.

fe06d331-51c1-4f05-bbd7-1344276207c2/113-4
00:20:09.962 --> 00:20:11.114
You can't remain.

fe06d331-51c1-4f05-bbd7-1344276207c2/115-0
00:20:11.274 --> 00:20:14.439
Remain siloed within the healthcare
delivery system,

fe06d331-51c1-4f05-bbd7-1344276207c2/115-1
00:20:14.439 --> 00:20:17.605
but in order to understand you need a
comprehensive,

fe06d331-51c1-4f05-bbd7-1344276207c2/115-2
00:20:17.605 --> 00:20:22.144
holistically approach any organization or
any system before recommending an

fe06d331-51c1-4f05-bbd7-1344276207c2/115-3
00:20:22.144 --> 00:20:26.384
intervention and take various data
sources collectively to inform your

fe06d331-51c1-4f05-bbd7-1344276207c2/115-4
00:20:26.384 --> 00:20:28.714
decisions. Does that sound about right?

fe06d331-51c1-4f05-bbd7-1344276207c2/114-0
00:20:28.674 --> 00:20:31.114
Absolutely couldn't agree more.