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David Cook, Director of Operations, HealthInsight Utah has not set their biography yet

Finding New Vistas in Health Care

waterfall

A couple of weeks ago, I was talking with a neighbor who had just completed a 100-mile race across the Bonneville Salt Flats in Utah. He is an adventurer who loves river running, skiing and most any outdoor activity. I enjoy hiking, so we often talk about different trails in Utah. I've lived in Salt Lake City most of my life and feel I'm pretty knowledgeable about local treks, until he told me about the Heughs Canyon waterfall. I had never heard of this waterfall and was intrigued since the trailhead was less than 10 minutes away from my neighborhood.

My wife and I hiked to this beautiful waterfall last weekend and were surprised to find a cave, lean-to and fun bridges on the trail. As I was returning from the hike, I was reminded of the knowledge (and adventures) right under our noses that we often overlook because we don't know where to find them. I was grateful for a friend who pushes beyond the status quo and finds new adventures in the outdoors.

In health care, we are constantly pushing beyond the limits and looking for transformation and innovation to propel our health care system to heights never seen before. Currently, payment reform is big focus. Medicare is taking a leading role with bipartisan support behind the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation and is beginning to roll out the Quality Payment Program (QPP). There is a lot of information and resources about payment reform and QPP that clinicians may not know are available.

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Fall Chili and Physical Activity

Couple walking in forest

Recently, my family and I attended a chili cook-off in our neighborhood. Although we did not win the cook-off, I'm still confident our beef-cubed chili, with just the right amount of spices, is a winner. Nevertheless, between the aromatic spells of chili, fall, pumpkins and cider, I enjoyed talking to and getting to know folks in my neighbor's backyard, many of whom I had never met.

While visiting with our neighbors, I had a conversation with a man who is a researcher at the University of Utah. He told me about a clinical trial he is working on where he is tracking the effects increased physical activity on aging. If I understood my neighbor, his main hypothesis is that increasing physical activity at any age or in any circumstance has positive health outcomes and can contribute to living longer. He mentioned various studies which are showing a link between lower hospital readmission rates and physical activity.

After my conversation, and after having indulged in several varieties of chili, I left the evening thinking of my personal need to increase physical activity and the simplicity of this health care intervention. I wondered what other information was available correlating with my neighbor's hypothesis.

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Measurement has its Place, but Doesn't Always Tell the Whole Story

Basketball Backboard

I love the game of basketball. There are all sorts of statistics collected – 2-point shots scored, 3-point shots scored, free throw percentage, field goal percentage, assists, rebounds, blocks, fouls, steals, turnovers, etc. The statistics often tell a lot of the story. Steph Curry, point guard for the Golden State Warriors, scored 402 3-point shots this season, setting a new all-time record. Most would view this statistic as success and he was voted the most valuable player in the professional leagues this year. Nevertheless, statistics don't tell the whole story in basketball. Rarely do we quantify hustle, such as getting up the court quickly; team work like sharing the ball with others; or sacrifice when a player dives for a loose ball. These efforts, which few track, are often as important as points scored. Statistics can be focused on, to some degree, successfully (e.g. tonight I'm going to try and get more rebounds in this game). But in my opinion, too much focus on the numbers can be debilitating. There comes a point where you have to go play the game, have fun, do the best you can and not worry about the numbers.

Just as the statistics in basketball don't tell the whole story, such is also the case in health care. I was intrigued by a quote I read recently in the New York Times by the scientific health care quality pioneer Avedis Donabedien whose main focus was on measurement. He said during the last days of his life, "the secret to quality is love."1 This was a man who was dedicated to health care statistics. There are areas in health care we don't quantify but are extremely important, such as time spent with a patient discussing end of life care, treating co-workers respectfully and timely follow up with results. Although hard to quantify, few argue against the direct health benefits of the health care professional who spends extra time listening to a patient who has just had a difficult life event.

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HealthInsight Embarking with Lean to Propel the Boat Forward

Crew Rowing

Recently, I've been enjoying a book called "The Boys in the Boat," which is the story of nine Americans who beat the odds and found hope in desperate times in their quest for gold at the 1936 Berlin Olympics. The crewman in this story worked hard to improve their technique and effort to be successful. Speaking of the magnitude of the effort, the book mentions "Physiologists, in fact, have calculated that rowing a two-thousand-meter race—the Olympic standard—takes the same physiological toll as playing two basketball games back-to-back. And it exacts that toll in about six minutes." The rowing techniques of "catch," "leg drive," "layback," "release" and "feather," if not performed precisely, can cause the rower to "crab out" which, embarrassingly, might throw him from the boat. In addition to their individual efforts, a crew needs to find a rhythm as a team – the "swing" as they call it. They seek to combine efforts into one smoothly working machine.

As with rowing, so it is in our work process, there is no substitute for hard work in the office. We also are continuously seeking to fine-tune both our individual processes and our team processes. HealthInsight has expertise in human factors, causal analysis, and the Model for Improvement, and these are the basis of much of our improvement, training and work. Recently, HealthInsight has begun looking at lean as a model of efficiency for both team processes and individual processes – we are just beginning our lean journey. We have been focused on seeking value by reducing waste in our company processes. For example, our communications department is looking to streamline multiple newsletters to increase value for our external and internal customers, and to enhance processes and delivery methods in order to become more efficient and leaner in our work. They are implementing lean principles such as just in time production and elimination of waste.

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W. Edwards Deming - Let's Not Miss the Quality Boat Twice

W Edwards Deming

I have a couple quotes from W. Edwards Deming, an American engineer, statistician, professor, author, lecturer, and management consultant, on the white board in my office that read "drive out fear" and "encourage effective two-way communication and other means so everyone in the company can be effective." I was intrigued by how many of my health care quality improvement co-workers commented on the quotes and in return, shared one of their own favorite Deming quotes. One co-worker shared "Inspection is waste"; another co-worker shared "A bad process will beat a good person every time." Another shared "In God we trust; all others must bring data" and "If you can't describe what you are doing as a process, you don't know what you are doing."

We take Deming seriously at HealthInsight. Deming has been given the title of "philosopher of quality" and championed the cause of "statistical process control." Deming was largely ignored by the production-focused United States during the 1960s and1970s. Deming took his quality message to the Japanese industrial leadership and the results produced placed him on a path to stardom in Japan. The Japanese automotive and electronic industries skyrocketed in sales due to higher quality products which were reliable over time. Most experts feel the United States missed the quality boat during this time frame as Unites States sales were down and their products did not last as long. Many industries in the United States have warmed to his quality message over time. In health care, the Institute for Healthcare Improvement (IHI), among others have championed many of Deming's ideas.

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Sepsis: A Quiet Killer

patient in hospital bed

Several months ago, I attended a conference where a mother and father spoke about their son's tragic battle with sepsis. Their experience left an impression with me that I will never forget. In 2012, their 12-year-old son, Rory Staunton, received a scrape on his arm during a basketball game. The scrape became infected and Rory received a slow diagnosis of sepsis, which eventually led to his death. The Rory Staunton Foundation was created in his honor as a way to help the fight against sepsis.

In addition to hearing about Staunton's experience, I also have two close friends who have battled sepsis. I visited both in the intensive care unit during their battle with this devastating infection. At one point, they were hardly recognizable because of inflammation.

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Let’s Measure It and See!

Graph showing rising data

Measurement is an integral part of our personal lives – we frequently want to know how far, how fast, how long, and so on. As my daughters grow, they are interested in their height and want to know when they exceed certain milestones: 3 feet, taller than Dad's waist, 4 feet, 5 feet, etc. Often, one of my girls will ask, "Dad, how tall am I?" and I will respond, "Let's measure it and see!" The wonder and hope on their faces is contagious as they wait to see if the milestone envisioned was achieved.

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Four Keys to Successful Health Care Project Leadership

Project Collaboration

During college, I worked at Primary Children's Hospital in several different positions, mostly the operating room. Etched in stone at the side of the front doors of that operating room are the words “The Child First and Always.” These words captivated me; I memorized them and it gave meaning to my work. The origin of the phrase is from the first children's hospital in England, the Great Ormond Street Hospital, founded in 1852 as the Hospital for Sick Children. Both hospitals now use it as their motto. Although I no longer work directly with children, this simple idea applies to all people. Putting the person or patient first is at the root of our efforts. It is also the first of four key steps to promoting effective change in health care. #1 - Put the patient first

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