Future in Focus Article Swipe

2020 Virtual Summit Snapshot Total registered attendees 6206 Member registered attendees: 3856 Power Huddles: 84 Poster Presentations:61 Member overall meeting score (Continuing Education): 9.25/10.00 Vizient® members, suppliers, and others came together virtually at the 2020 Vizient Connections Education Summit to share and discuss innovative and creative solutions to meeting marketplace demands for cost reduction, better access to care, higher quality, and performance improvement. The first Vizient virtual summit drew record interest, with over 6200 attendees, more than doubling attendance at the 2019 in-person event. Attendees participated from across the country, including representatives from academic medical centers, large systems, community hospitals, children's hospitals, nonacute and ambulatory care providers, and supplier organizations. They had the opportunity to hear from—and in many cases share ideas and interact with—presenters and panelists in live plenary sessions and Power Huddles, and to access a multitude of prerecorded Power Huddles, poster sessions, and member stories. While the live telecast was held September 15–17, 2020, the virtual format provided a unique opportunity for the summit to live on long after those dates, providing members and suppliers with the opportunity to view summit materials and earn continuing education credits at their convenience. Access to the opening plenary and other educational content continues via vizientinc.com. The material represented the best of the best from Vizient members, who submitted a record-breaking 724 abstracts. This overwhelming response clearly demonstrates a heightened level of passion and dedication to sharing stories and helping others through the many challenges facing health care. A rigorous scoring and selection process, including careful review by multiple subject matter experts, helped identify the summit's member-driven educational content. Chosen before the pandemic, this year's theme, "Future in Focus: One Clear Vision," could not have been more appropriate for framing the sessions and discussions. As Byron Jobe, president and chief executive officer of Vizient, noted in his opening remarks, health care leaders and frontline workers are among the smartest, most innovative, and most collaborative people in the world. Amid this once-in-a-century crisis, they have come together in unprecedented ways to focus on the future. Recognizing health care workers as true heroes Jobe recognized and thanked member health systems and frontline workers for their extraordinary efforts, calling them "real heroes who have made enormous sacrifices and overcome monumental challenges to help others in need." Like firemen running into the flames, these workers risk everything on behalf of others, ignoring the potential consequences to themselves and their loved ones. They do so because of their unrelenting dedication and commitment to caring for patients. The nation understands their sacrifice, as evidenced by countless examples of people honoring frontline workers, such as the well-publicized story of a man standing outside an emergency room holding up a sign thanking staff for saving his wife. Sekou Andrews, CEO and founder of SekouWorld, Inc., put it best in his eloquent and moving final presentation. Talking about frontline health care workers, he noted: "The results are in and you test positive for a level of quiet courage that most of us could not bear…you are afflicted with a heroic, stubborn, almost delusional level of commitment to improving the world's health, wellness, and vitality." Supporting these heroes As frontline staff work heroically, the leaders of their organizations labor tirelessly to support them. For example, as part of the opening plenary panel, Janice Nevin, MD, MPH, president and CEO of ChristianaCare (a community-based system serving Delaware, Maryland, and New Jersey), highlighted the critical importance of "taking care of our people." Early in the pandemic, ChristianaCare treated over 1000 COVID patients. The physical and mental toll on staff became evident, including notable increases in depression, post-traumatic stress disorder, and general burnout. Five years earlier, the health system had created its Center for WorkLife Wellbeing, a program dedicated to helping caregivers flourish and thrive. As Nevin noted, "when we care for ourselves, we are better able to care for others." The center promotes a culture of well-being, including physical and psychological safety, connection and camaraderie, meaning and purpose, and choice and autonomy. During the pandemic, ChristianaCare quickly ramped up its services and capacity to meet the unique needs of staff during this pandemic. For example, leaders installed a sanctuary room for caregivers dealing with difficult challenges and directed peer supporters to seek out colleagues daily to provide support. Health system leaders are not the only ones stepping up to support frontline heroes. Many vendors, suppliers, and consultants are doing so as well. Since the pandemic outbreak, Vizient began partnering with multiple suppliers to dramatically expand the supply of personal protective equipment, vital drugs, and other supplies. Vizient has sourced staff from around the country to augment the workforce in areas facing surges in infections, including staff for newly constructed field hospitals in pandemic hot spots. Vizient has made clinical and operational resources available to deal with the pandemic, including disseminating emerging best practices for patient care (eg, testing, visitation), supply chain management, and demand forecasting (eg, intensive care beds, ventilators). Vizient also accelerated its advocacy efforts in Washington, DC, making recommendations on how to avoid drug and supply shortages and promote telemedicine and digital health. Vizient, with the analytic expertise of its company Sg2®, is taking the lead in supporting members in their strategic recovery and stabilizing operational, clinical, and financial performance, with publications such as "Guidance for Resumption of Electively Scheduled Surgery and Procedures in the COVID-19 Era" and tools such as the Sg2 Surge Demand Calculator and the Sg2 Financial Recovery Calculator. Focusing clearly on the future Health care has changed forever because of the coronavirus. As devastating as the pandemic has been, health care will emerge stronger and better because of it. Technologies such as virtual health that might normally take years to implement have achieved broad scale in a matter of months, thanks in part to federal and state governments taking actions to remove barriers to telehealth services during the pandemic. Virtual health, however, is just one example of what needs to be done to improve health and health care. As Nevin noted, the goal must be to provide "the right care, at the right time, in the right place, with the right people, so that people are healthier and care becomes affordable." Care must address not just the biological and medical issues faced by patients, but also mental health issues and underlying social determinants of health. Addressing social determinants of health will not be possible without efforts to enhance health equity, as too many racial and ethnic minorities lack access not only to care, but also to adequate housing, food, education, and recreational opportunities. To succeed, health systems need to invest in robust virtual and physical care platforms that reach underserved populations, along with data platforms that generate actionable insights for improving care. The result, according to Nevin, will be revolutionary, not evolutionary, creating a whole new world for health care. Success will not be easy. As Jobe commented, changing the world requires great minds and passionate hearts working together. The Secret Sauce of Achieving and Sustaining Top-Notch Performance Julie Cerese, PhD, RN, MSN Group Senior Vice President, Performance Management and National Networks, Vizient David Levine, MD, FACEP Group Senior Vice President, Advanced Analytics and Product Management, Vizient Supporting members in achieving and sustaining strong performance for the past 15 years, Vizient has developed a robust understanding of what it takes to succeed, including the specific organizational characteristics required. The University of Utah Health, for example, is an excellent case study in what an organization must do to produce sustainable top-notch performance in reducing preventable mortality. System leaders put in place a safety learning system around mortality that incorporates the following: a deep dive into every death to understand if and how it could have been prevented; a rapid response team tailored to the patient and unit that intervenes quickly with decompensating patients; an inpatient program that provides hospice care to patients without the need to change beds (ie, the bed is switched from inpatient to hospice care); and an intense focus on preventing hospital-acquired conditions, such as acute respiratory failure and catheter-related bloodstream infections. These activities make the University of Utah Health a high-reliability organization with a culture focused on performance and safety. Characteristics of high-performing organizations The University of Utah Health has much in common with other top performers. In fact, in its work, Vizient has identified 5 characteristics that generally exist within high-achieving organizations: Shared sense of purpose: From the board and CEO to frontline workers and support staff, everyone understands and can articulate the goals of the organization, knows how the organization is performing on those goals, and understands their role in achieving them. Cooperative leadership style and atmosphere: Leaders model desired behaviors and values and demonstrate the importance of cooperation and collaboration. Leaders are seen regularly on the floors, conducting rounds during which they talk to and engage with patients and staff to understand the issues and problems they face. Leaders also regularly celebrate successes (even small ones). They do this not only on the day shift, but also on the evening and overnight shifts to make sure these employees understand how important they are to the organization. Results-driven, striving for top performance: The top performers set high aspirational goals, such as zero harm to both patients and employees. They seldom remain content with average performance. Centralized and decentralized accountability structures: At the organizational level, the human resources department puts in place strict hiring standards to make sure that everyone fits into the culture. Similarly, the C-suite develops compensation systems that create incentives for employees at every level tied to the achievement of goals. Every employee has skin in the game. Leaders, middle managers, and frontline staff in every unit and department understand their roles and responsibilities and are held accountable for achieving top performance. Culture of collaboration and respect, with deference to expertise: Top-performing organizations recognize that everyone can and should contribute. Leaders and managers know that employees at lower levels of the organization, particularly those on the front lines, often have the best ideas. These ideas get implemented, regardless of who comes up with them.1 Organizations that exhibit these characteristics have the structures and mechanisms in place to identify problems, find sustainable solutions, and evaluate and adjust as necessary. Collectively, these characteristics represent the secret sauce of achieving top-notch performance. Sustaining performance over time Vizient recently initiated a study focused on how to sustain performance over time. The research is assessing organizations that have achieved top performance for multiple years, with the goal of determining if there is something different or special about them. While still preliminary, initial findings suggest that the key to sustained success seems to lie in large part with staff empowerment. Consistently providing a top-notch patient experience requires staff who understand what that experience looks like and who are empowered to deliver it. Empowering staff, in turn, depends on maintaining consistency in setting goals and reliability in evaluating performance. While specific measures may change, the structure and framework around setting quality, financial, and patient experience goals do not. This consistency gives frontline staff confidence in delivering on the mission and values, even as the nuances of specific metrics change. Further insights into what it takes to sustain performance can be gleaned by evaluating whether the unprecedented challenges created by COVID-19 have knocked high performers off their game. This year's Vizient Quality & Accountability (Q&A) study was divided into 2 parts: pre-COVID, with performance evaluated from July 1, 2019, to February 29, 2020, and post-COVID, with performance having thus far been evaluated from March 1 2020, to June 30, 2020 (Q&A Awards for 2020 are based only on the pre-COVID period). A preliminary comparison between the 2 periods shows that the top performers before the pandemic generally continued their success afterwards, while middle performers also tended to stay where they were in the rankings. This early finding suggests that organizations that have the secret sauce discussed earlier (ie, the right processes, systems, and culture) not only succeed over time, but also during the most turbulent and challenging of times. Like all organizations, these top performers have had to make quick changes and pivots in response to the pandemic, but their culture and structure has helped them remain on top. This year's Q&A results also highlight the importance of "systemness" in achieving and sustaining top performance. The results show that several health systems have had multiple hospitals achieve top performance, a strong indication that success stems from being part of a larger organization. More information can be found in the article on p. S6 by David Levine, MD, FACEP, and Steve Meurer, PhD, MBA, MHS, entitled "Centralized Data and Analytics Support Locally Driven Change, Systemwide Improvement"). Acting like a system appears to pay dividends during a pandemic as well, enabling flexibility such as the shifting of resources and staff in response to demands. For example, some systems have designated 1 hospital to handle COVID patients, thus minimizing disruptions to other hospitals in the organization. Going forward, pandemic-related challenges will likely accelerate the need to act as a single system rather than a collection of individual silos. Looking ahead Over the past year, health systems have responded rapidly to unprecedented challenges, faster than most leaders of those organizations ever thought possible. The industry deserves tremendous credit for turning on a dime; for example, those who once felt that it would take years to pivot to virtual care orchestrated the transition in a matter of weeks. Similar successes have been achieved in ramping up intensive care unit capacity and staffing, securing scarce personal protective equipment, and countless other areas. Armed with these experiences, leaders should not underestimate what they can achieve going forward. They should commit to leveraging this momentum and not going back to old, familiar ways of doing things. The hurdles may seem insurmountable, but recent experience makes it clear that they are not. Incredible things can happen when people put their minds to it. 1.Keroack MA, Youngberg BJ, Cerese JL, et al. Organizational factors associated with high performance in quality and safety in academic medical centers. Acad Med. 2007;82:1178–1186. Real-Time Learning and Sharing During a Pandemic Cindy Abel, RN, MSN, CEN Vice President, Performance Improvement Collaboratives, Vizient Joan Moss, , RN, MSN Managing Principal, Sg2 Intelligence The COVID-19 pandemic has unleashed enormous energy, innovation, and agility among Vizient members. Faced with unprecedented challenges, including surges in patients, shortages of staffing and supplies, and the overnight loss of major revenue sources, these organizations sprung to action to revolutionize care. These changes have the potential to be a turning point in the industry, marking the dawn of a new era of health care in this country. The challenge is to keep the momentum going and not drift back to outdated practices. Real-time learning on the front lines of care Vizient members quickly learned about and adapted to a new disease. Countless examples exist of changes, big and small, ranging from the rapid acceleration of virtual health to creative ways to address personal protective equipment (PPE) shortages and peaks and valleys in COVID-19 patients. A great example of this learning and adaptation came from the summit, where Cleveland Clinic chronicled its journey in dealing with an early surge of COVID-19 patients in a video featuring member stories. As patient numbers grew, Cleveland Clinic began isolating infected patients on specific units, both to reduce the risk of spread and to preserve scarce PPE. Even with cohorted patients, PPE shortages quickly became an issue. Innovative frontline staff quickly decided that one way to reduce PPE was to for thus the equipment to be put in the As a result, staff not have to the room to change the and not need to and PPE. As innovative as this change to it created across the creating RN, a critical care came up with a of a to keep the off the by it to the or a was adapted from one to with patients with Cleveland Clinic is working to make of the as available to other organizations. 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