THE 2023 INNOVATOR AWARDS PROGRAM


case management services, has been the establishment early on of clinical practice committees, or CPCs, in every area of the initiative’s work, with about 33 CPCs being active at any one time. The CPCs, Harbison says, have been absolutely instrumental in reducing unnecessary variation and waste. Harbison is board-certified in internal medicine and pediatrics, and practices hospitalist medicine. Meanwhile, Nnaemeka G. Okafor,


Nnaemeka G. Okafor, M.D.


M.D., chief analytics and informat- ics officer and an emergency physi- cian by training, notes that, from the beginning, “We understood this would be a team approach, something that neither


the phy- sicians, nurses,


respiratory therapists, or administrators, etc., could design by themselves. So in each area of activity, we would begin by creating a collaborative design among stakeholders,


identify the potential


options for implementation. Implement what worked. And measuring efficien- cies and return on investment.” What have been some of the biggest


challenges in the work so far? “As you can imagine, finding new opportuni- ties each year becomes trickier as you do the work and accomplish goals,” says Christine Lanza, the health system’s asso- ciate vice president of finance. We will have achieved $275 million of savings by the end of this year; and we’ve completed our tar- get process, iden- tifying targets in each area. So part of the challenge is finding those new opportunities. We


Christine Lanza


use benchmarking measures for length of stay, and cost measures for supply chain. There’s a lot of collaboration and partner- ship; that’s the key. Nor is this process at all finance-led; instead, I’m there help- ing the teams. And everybody has great ideas. And will they be cost-effective? It’s a balanced approach” to determine what is worth addressing. Harbison adds that, “We also under- stood that if we were going to tackle an


issue, we needed to determine what the KPIs [key performance indicators] were for that issue. For example, we developed about ten KPIs for fragility fracture, which is a measure of our clinical per- formance around caring for patients who have experienced bone fractures”—such as hip fractures. “For example, someone falls in their home and fractures their hip, and is then brought to us for sur- gery. We mapped out the entire process of care for that urgent condition in the CPCs, and identified key elements of the process as patients move through our care delivery system, measuring our success at each time point or measure. We honestly created a beautiful clini- cal performance dashboard for it, one of the best I’ve seen, involving a large number of elements, such as time to the orthopedic surgeon seeing the patient, time to imaging, time to OR [operating room], time to the administration of a nerve block—in the elderly population, you want to avoid administering nerve blocks whenever possible. Now, we’re looking at delirium prevention and are developing a delirium prevention bundle. And without Dr. Okafor and his and his team’s discipline around the analytics, we wouldn’t have been able to develop an effective clinical pathway in this area.” Okafor says that, “For us, I think the


biggest challenge has been prioritizing what we should go after, given limited resources. There certainly has been no shortage of ideas. We have to figure out what we can tackle first and project the value of something. Sometimes that would hurt people’s feelings, if they had pet projects to bring forward,” he adds. “So prioritizing projects has helped, as has being transparent, saying to a group, well, you’re number seven on the list, for example.” Further, Okafor opines, “You always


start with clarity on the problem you’re trying to solve, and then define it. Discharge, for example, means different things. Getting definitions is key, as that’s what’s required to translate to the purely technical people, to know what data to pull. And as Dr. Harbison has made clear, measure, measure, measure before you cut. How will we use the data? That has been what we’ve tried to be disciplined with. And we know that it’s not just enough to show people the data. We’ve needed to create regular touchpoints and have needed to be transparent with the


“For us, I think the biggest challenge has been prioritiz- ing what we should go after, given limited resources. There certainly has been no shortage of ideas. We have to figure out what we can tackle first and project the value of something.” — Nnaemeka G. Okafor, M.D.


information that we have, while asking participants to be transparent with us around the barriers they’ve faced.” “And,” Asprec adds, “not everything


works. So one of the lessons learned in all this has been that sometimes what you design doesn’t produce the intended result. But we’ve created a culture where we can produce the outcomes we’re producing.” All the leaders have heaped praise on


Asprec for her leadership in the ongoing initiative. “One of the critical elements has been Erin’s leadership; she has been very consistent around the goals of this mission; and this is a long-term strategy,” Harbison says. “She was really consistent particularly across the first three years, in being consistent with vision.” Asprec herself praises everyone


involved in the initiative, saying that “The whole team has exhibited focus, accountability, and willingness to lift barriers, as well as being open to change.” “And I think accountability is huge


here,” Lanza says. “Erin really holds people accountable. And that’s a huge, important key.” What should the leaders of patient


care organizations around the country think about, as they consider taking on something like Clinical Care Redesign? Okafor says that “You will need a com- bination of transparency and willing- ness to negotiate, to say, here’s what we would like to accomplish. And then the person says, no, I have twelve things on my plate. So a negotiation takes place. So having the ability to transparently negotiate for what you need to have hap- pen, is key. And this is a team sport. There is no one person who can get all this done.” HI


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