Hey everybody, thanks for joining. I see some of you are actively entering the waiting room here and into the webinar. So we're going to wait just a couple of minutes before we get started as we're going to wait for others to come in. I see them trickling in slowly, so we'll start in about one or two minutes. I see a couple more folks have joined the webinar. We're going to wait just about another minute and then we'll actually kick off and begin. Thank you. Okay, well, I think we will kick off and get started. My name is Joe Sasson, I'm the Executive Vice President of MedAxiom Ventures and thrilled to bring you this webinar today. It's enabling performance excellence, empowering clinical teams with insights for transformational improvement. And so we all understand the notion of using data to improve performance in an organization. However, there's a lot of nuance in that. There's a lot of silos that are created in organizations, there's a lot of politics and cultural issues, and balancing who the decision makers are, and how do we put together administrators and clinicians to achieve that change together. And so you all are in these situations inside of your environments. And it just requires a little bit of extra effort and attention between doing it good and doing it really, really well and doing it great. And so today, we have two speakers who are going to help us talk through that and share their expertise. The first is Dr. Javier Valle. And Dr. Valle is an interventional cardiologist. And he also has a health services and outcomes research background from a fellowship at the University of Colorado in Denver. And so he'll be sharing the clinician perspective today during this talk. We also have Amber Pawlikowski, and she is the Vice President of Performance Improvement at Biome Analytics. And Amber is a certified healthcare quality professional, and she has a background in critical care nursing as well, and years of experience as a quality leader inside of many different healthcare organizations. She also holds degrees from the University of Virginia and Radford University as well, and currently completing her PhD in health outcomes research. So we have the clinical side and clinical and programmatic side put together here for you today. Before we get started, I do want to walk you through how you can interact best with us throughout this presentation. In the chat, and you'll see it's already been placed in the chat, is a link to the slide so you can download those for today's presentation. Also as we work through this, you may have questions about certain concepts for the presenters. There is a Q&A button on the right hand side of your screen there, just center right, and you can put your questions in there and we will get to them most likely at the end of today's presentation. If there is something that we feel we should answer as we're going through because it would just change the course of the presentation or you need that extra clarity, we will ask during the presentation, but 99% of the time we're going to hold those questions until the end. So just be aware of that. And then if you have any other issues or connectivity issues, feel free to ask them there as well. So thanks again for being with us today. We're thrilled to share this education with you. And I will turn it over to Dr. Javier Valle. Dr. Valle? Thanks Joe. So as Joe said, I'm an interventional cardiologist by clinical training, and then he also outed me as a data nerd with my health services research background and healthcare delivery. So a lot of the questions that come up are basically going to be how we discuss this kind of moving forward and what really kind of gives me any kind of authority to speak about this. You know, I've done health services research, I've done data analytics, I've done these kinds of things in the past. But the first thing really, first and foremost, is on a clinician. I deal with patients on a day-to-day basis. I deal with the rigors of being in a hospital and a healthcare institution in the health system. I am hospital employed, so dealing with basically some of the interactions that we have there about how I deal with a day-to-day interaction with my patients, with my patient panel globally, how things go. Those are some of the headaches and issues that I deal with on a daily basis. I think it's something that we need to address kind of moving forward and how best to really manage the healthcare crises that are coming on. So we're going to talk about things moving forward with basically this outline in mind. Number one is really understanding what this crisis is. There's really a conflict, many conflicts in healthcare that we experience. The first thing is how to define the one that we're really going to deal with today. Second thing is using basically performance strategies, how to navigate this coming storm that we're going to see. And finally, really the key to it is aligning priorities. So trying to figure out how people like myself and Amber, you know, can work with basically other sides of the aisle, so to speak, to try and basically find a way to work together. So aligning priorities and really kind of bringing together multidisciplinary teams. Healthcare is not a one-on-one individual relationship anymore. It never really has been, to be fair, but it was treated as such in the past. More and more today, teams are really what are necessary. There's so many pieces aside from just the clinician and the patient that go into delivering quality care, and we need to recognize that. And then also recognizing the role of that one patient, you know, physician relationship within the context of the healthcare system. There's a role of data and insights, transitional, transformational improvement. How do we approach that? What are the best ways to kind of evaluate that, initiate it, implement it, and evaluate it moving forward? And then what challenges do we overcome? What challenges, there are challenges in everything. What are we going to need to face, realize, and try and figure out strategies to tackle it before we face them? Those are tools and technologies that we'll offer towards the end of the talk, and then basically talking about basically the future of performance excellence. What does that look like in the future? What do we have now? What's coming on the horizon? And what are things that we can anticipate as far as things we may want to start familiarizing ourselves with or start utilizing to really get ahead of the curve? The first thing really is just talking about waste. The estimated cost of waste in the U.S. healthcare system ranges from $760 billion, billion with a B, to $935 billion, and it accounts for about 25% of total healthcare spending. This is from a study published in JAMA in 2019, relatively recent data. Recent analysis is basically gray literature, which is the white paper from the government, observational data, also some randomized clinical trials that have demonstrated basically waste in areas in medical spending. Potential savings from interventions that reduce waste, so the things that we can do, and that excludes basically savings from administrative complexity, range from the $200 billion to $286 billion range, and that represents a potential 25% reduction in the total cost of waste. It is a big, big, big number. This really leads to the unprecedented challenges that we're facing in U.S. healthcare, so there's really kind of three pieces that we're dealing with, and really kind of all these pieces are fighting each other. First, we're reaching a breaking point in healthcare. There are more patients to care for, there are fewer resources, and there are higher costs. When we talk about basically the more patients to care for, there's a high demand. There's a high demand for cardiovascular services, and it's expected to only increase by as much as about a third in the next decade. Total annual costs are going to soon top $1 trillion. We've gone from talking about billions to trillions now as far as healthcare in the United States. And then the demand for cardiologists, myself, is soon going to be exceeded, excuse me, will soon exceed the availability by a significant margin. Resource limitations, jumping off of that spring point, healthcare leaders believe that an economic downturn is coming on the horizon. Payers not adjusting for increasing inflation, and by 2025, we could see a deficit of up to 450,000 registered nurses. So not just cardiologists, but people helping to make the healthcare team possible are going to be at a significant deficit. And then finally, cost. Equipment, drugs, supply costs remain at an all-time high. We're still recovering from COVID. We're dealing with supply chain issues that drive the cost, trying to find basically how do you get the supplies you need to take care of your patients in time, and the costs are continuing to climb. Emerging technologies, resource scarcity continue to drive demand and cost. All these things are in conflict with one another. If you look at them, they're basically just pulling at each other all the way around. There's a huge Gordian knot of these complex scenarios that we need to try and figure out how to navigate. And so for a healthcare system to remain engaged, to remain basically ahead of the curve, they've got to really prepare by embracing innovative performance strategies designed to navigate these complex issues. So what does that mean? Really, it means kind of quality improvement. And as I said, I'm a little bit of a quality nerd, so really talking about what that means, it means becoming a high-reliability organization. So quality improvement, to start off with, it's a collaborative and ongoing dedication of a collective that includes multiple pieces. Again, multidisciplinary. It's the healthcare professionals, the patients, their families, researchers, payers, planners, educators, they all work together to bring about improvements in patient well-being, the effectiveness of the healthcare system, and the growth of professional expertise. So keep in mind, it's not just one patient with one another, it's the growth of the healthcare system in general and advancing the field. These come down to high-reliability principles, which are seen on the right. These are well-defined. In general, basically we talk about sensitivity to operations. Don't forget the frontline workers, the boots on the ground. That's the piece there that really kind of, when you think on a high level, you don't think about necessarily the people who are on the ground doing the day-to-day work. Preoccupation with failure. To paraphrase, never let a crisis go to waste. Each failure in a healthcare organization needs to be seen as an opportunity to improve and refine. Fair or not, the goldflippers are always moving. We've got to be able to move with them. That's a high-reliability organization. Resistance to simplify. Healthcare systems are not simple. There's multiple relationships, multiple strategies, multiple avenues by which basically there's ins and outs, addition, subtraction, et cetera. You can't just reduce things down to one off because each decision you make will have significant downstream impacts on other pieces of the organization that you have to encounter and you have to account for when you make these decisions. A commitment to resilience. That's basically committing to weathering the storm that's coming. And then finally, a deference to expertise. Just as in clinical care, I'm a cardiologist. I'm not going to pretend that I know anything about how to set a bone, how to replace a hip, how to do anything like that. Rely on the other experts that are trained to do these things, that have expertise in these things to help make decisions. So high-reliability, innovative solutions involving multidisciplinarity teams are really the key to navigating these challenges that are ahead. And again, these challenges are complex. You look at this word cloud here, all the things that come up here, when we think about quality and value, these sort of keywords, value really being quality, excellent healthcare with cost baked into it, what does that look like? All these things interplay and they can be conflicting, which makes it really challenging. So, sounds simple, right? Just follow the HR principles, commit to quality, the rest will take care of itself? Not necessarily. Again, these strategies are complex, and again, the strategies to deal with them can sometimes be conflicting, and there are many, many viewpoints that can be conflicting as well. So what do we talk about here as far as how healthcare systems are organized? The big thing that you hear about from both clinicians and administrators, basically this is the divide. There's two silos. There's us versus them. I'm a clinician, the administrators are out to get me, the administrators are there, the clinicians don't understand how to run a hospital. All these things are in conflict because it comes down to basically there's my viewpoint and there's their viewpoint, and they're completely separate and often in conflict. So again, one of these most common barriers hinges on silos. Silos or organizational disconnects often viewed again as an us versus them mentality. These barriers often exist between these silos arising from different backgrounds, priorities, even verbiage or communication strategies. Those same words that I might use to explain cost or risk or hazard are completely different than those administrators may use. And so we may be delivering the same message, but completely missing each other just because we don't understand each other's language. The reality is though is that we present this as kind of a problem. It's a big conflict, but in reality, they are helpful. They are actually really important things to have in a healthcare system that's going to be healthy. The main reason for this is because why do these silos exist? Number one, there are distinct roles and responsibilities. Administrators and clinicians have different primary roles. Administrators focus on resource management, budgeting, regulatory compliance, the health of the healthcare system as a whole. They have an idea of the hospital, of the healthcare system, the growth in general. They have the idea of the entire picture. Clinicians are primarily focused on patient care. When I'm looking at the patient ahead of me, it's hard for me to say, okay, I'm thinking about you and the drug I'm going to prescribe to you and the procedure I'm going to do for you and have to think about basically what that influences on the Hemant clinic or the infusion clinic on the other side of the hospital. That is the far that it doesn't even enter my brain. But that's what administrators have to balance. And that's something that we really kind of need to understand. Both pieces are important. Communication gaps. So healthcare facilities have separate communication channels and reporting structures, not just the language, but basically how information comes in is critically important. Okay? Hierarchical structures, differing objectives, limited cross-functional teams. Okay? All these things basically are contributing to why silos exist, but at the same time, they're very, very important. So how do we navigate this? What's the best way to deal with it? And in all honesty, it's really kind of realizing that there is an advantage to having these things. And the key thing is really kind of organizing the two in a way that they can communicate and the way that they can find basically aligned incentives. So this Venn diagram here that you see are the clinical teams and the admin working together to find that small little overlap and saying, okay, I need this from you. What can you give me to make this happen? How can we grow together to kind of make that you're not going to get everything you want on your side. Yeah. I'm not gonna get everything I want on my side. How can we accomplish this together to move forward? What we have to realize on both sides is that healthcare is a zero sum game. It really is. There are dollars at stake and they can't keep growing because of some of the limitations that we talked about in the crisis coming. So what that means is that basically resources used on one patient are not available for the next. So diving deep into a rabbit hole for specific procedures, disease processes comes at the expense of another line. But at the same time, too much administrative or financial priorities can leave patients teams feeling unsupported, at which point you start producing burnout, you start producing unhappy positions, unhappy teams, people leaving, and then draining the resources that are already limited to begin with. So what do we need to do? And really what we need to do is develop these aligned goals and priorities. So aligned goals for both clinicians and administrators, and this is the really hard part, but I think it comes down to basically chasing this goal of value. Value is quality care. We all kind of have an idea of what quality is. You know, it's good, excellent care, all right? But value becomes more challenging. It becomes a little bit of a dirtier word because then you're talking about cost. And cost is something clinicians never want to talk about because then you monetize medicine. But thinking about it and presenting it in a way of saying, look, if I don't limit this here on this end over here, I take away from over here for your other patients, that matters. And so when we talk about value there, that's what I kind of try and hammer into my colleagues and say, look, we can spend a ton of money on this program that will influence one patient, but then the other 500 patients that are going to be needing treatment for X aren't going to get that. And so really kind of understanding where that comes from helps with dealing with administration and having that cross communication. But ultimately, again, number one, the priorities that we have as clinicians and as administrators are maintaining excellent quality care, affording patients, clinical teams, the best opportunities to preserve outcome. What you want to do is deliver the best care you can, not influence outcomes. Once you're doing something well, don't take away from it. Priority number two, and there's two pieces here. So we can agree on one. One is very easy, right? It's hard to achieve, but it's very easy to agree about. Number two, 2A is deliver quality care in as lean of a fashion as possible. Try to limit your variation, try and limit basically things that are going to be wild, you know, outliers as far as what you're doing there, because that can lead to waste and higher costs. That's the challenge for clinicians. We want to do it our way. We have our way of doing things, but we try and understand if we limit it to a certain number of ways, we can offer it to more patients. That's an argument that can be made and can be understood from the administrative side. That's the give from the clinical side. Priority 2B, and I'm not saying A and B, they are equal, is that expensive things can be okay. When we talk about new and emerging technologies, even though they may cost X amount of money on the onset, they may have significant benefits and downstream growth potential for the healthcare institution as a whole. And sometimes that investment is critically important for the healthcare system because that's where the field is going. And clinicians can lead us in that direction as long as they speak the language and can really kind of say, this is the thing that I really need. We really need to grow this program to make that next leap forward, to really kind of access and provide opportunities to patients that don't have it otherwise. And the give from the administrative standpoint is understanding that, seeing the long-term picture, understanding the global view of the healthcare pathway to kind of make sure that that's an opportunity that's afforded to the clinical team that they're asking for. Thanks, Dr. Vais. So you said this really nicely for me. So basically we've talked about some of the challenges that exist. We've talked about sort of the upcoming challenges that are going to continue to be facing the healthcare landscape. So how do we navigate this complex landscape and also align those multidisciplinary teams to achieve that value proposition? So you're going to see on the screen here, some of the tactics and strategies that we've outlined that we'll dive into deep detail around throughout the rest of the presentation. And by focusing on these key concepts, teams can really enhance their ability to engage in performance improvement initiatives and again, deliver that high value care to patients. So I'll touch on a few of these and we'll go through some examples, but I want to highlight a few of them for your consideration. First is this concept of creating a common fact base. So it's really important to create a shared understanding of current performance and metrics and challenges in your organization, always promoting that data-driven decision-making. It's very important to make sure that this fact base doesn't just include context from financial data or clinical data, but to actually marry that financial, operational, and clinical data together and make sure that these are coming from trusted sources. Again, everyone should be at the table for these discussions and be able to evaluate a project from these various lenses and to vet that the data that is trusted and coming from a trusted source. Next is stakeholder engagement. So there's a quote that has existed much before this presentation, but it's nothing about you without you. And I think it's a really nice way to kind of outline this concept of stakeholder engagement, which is if we're having a conversation about something that impacts you, either for the area of patient care that you might be delivering, it's really important that you're at the table for these types of conversations. So again, nothing about you without you. Let's involve all key stakeholders for a project prior to embarking on the performance improvement journey. Next is setting strategic agendas and prioritizing as a team. Again, we talked about this concept that healthcare is sort of a zero sum game. So we have to ensure that when we're thinking about resource limitations, and when we're thinking about the fact that we might have few people to take on various projects, we really need to make sure that we're setting those strategic agendas and that when we're defining performance improvement initiatives, that we have buy-in from those key stakeholders. We're not gonna be successful in improving a measure, whether it's clinical, financial, or otherwise, if we don't have those key stakeholders aligned upfront and making sure that they also feel this is a worthwhile initiative to take on. Finally, data transparency and sharing. So it's also extremely important to make sure that we're promoting a culture of data by using technology and using that data access across teams and holding regular meeting to review that performance data. You know, one of the things that we've seen recently, and it's really taking off is sort of this generation of quality committees where various key stakeholders across the service line meet and report out on the top KPIs or performance measures for their individual area of service. Again, extremely important to, that this encourages both accountability, and then again, also really increases that sort of culture of data transparency and sharing. So the role of data and insights cannot be understated. We know that over the last several decades, the understanding and the way that we consume data has completely changed. It's undergone a profound shift. We used to rely heavily on books for information, and then we moved to the internet age where Google and things like that provide access to vast amounts of data. And now with the advent of AI, the relationship with data has once again evolved further. So we've moved from actively seeking information to really having it delivered to us in a personalized and context aware way. And this is fundamentally changing the way that we interact with and also consume data. So in turn, in healthcare, we have to be harnessing that power of advanced data analytics to not only access information, but also provide that personalized and again, context specific insights for the folks that makes decisions, you know, both at the bedside, and then again, globally within the healthcare system. And this shift is crucial for us to optimize patient care, treatment plans, and healthcare operations. And ultimately it's going to lead to, again, really optimizing that value proposition. So to start off, it's really important to kind of highlight what is the difference between data and actual insights? Again, as someone who sort of is in this world all the time, I often hear these phrases about actual insights, but what does that really mean? So data is the raw information. These are numbers and text, and actual insights are meaningful interpretations, again, context specific that are drawn from that data. Data will provide the what, for example, let's think about something like readmission percentages. Data is going to tell me how many patients are coming back to my organization, but insights give you the why and the how, and they reveal trends and guide decisions within the healthcare system. Again, data is sort of that foundation and actual insights are the intelligence that drive effective decision-making. Drawing back to this readmission example, you know, we might understand those patients that are coming back. We have raw data that tells us about those patients that are coming back, but actual insights will tell us the how and the why. Why are patients coming back to our organization? How often are those patients coming back to our organization? And really, when we think about data through this actionable insight lens, we can go from just looking at raw numbers and figures to understanding and having data explained in context with a story that we can use to drive decision-making. So it's really important when we think about data and insight and the role that data plays within our organization to also think about quality as a business plan. So what exactly does that mean? So we have all this data, we have actionable insights. How can we use performance improvement to drive our healthcare organization to the next level and to achieve optimal patient outcomes? In healthcare, it's really common for us to emphasize, you know, things like market capture and growth because they directly impact revenue and expansion, but it's equally balanced. You know, we need to make sure it's equally balanced with a strong operational focus and also a really strong focus on quality outcomes. And performance improvement initiatives can be thought of as a strategic business plan. So they can help to manage things like direct costs and again, allow operations and operational margins to excel. And they also can play a crucial role in understanding resource capacity. So again, let's just not think about a performance improvement project as something that we should be doing, but it's really an operational imperative to making sure that we're reaching that value proposition within our organization. And again, by incorporating quality improvement into the business plan, into the service line of operational plan, healthcare organizations can strike a balance between growth and efficiency. And this will benefit, again, both the bottom line of the organization as well as the patients, of course, served in the community. So when we think about transformational improvement and we're embarking on that PI journey, it's important to remember that there should be a focus on both hard and soft impacts. So what exactly does this mean? So we know that actionable insights derived from the data can really change clinical practice and patient care and has far reaching benefits. And when we think about what those benefits are, it's extremely important that we're just not focusing on one of those lenses. So when we think about the three lenses through which we evaluate performance improvement, we can think about the clinical lens, of course, operational as well as financial. But when we're evaluating a performance improvement project, it's really important that we're thinking about what are all the far reaching benefits that this particular initiative could have? So this could be things like cost savings, enhanced quality of care, improved patient outcomes, patient satisfaction, reduced cost, operational efficiencies. All of these things are extremely important to consider. You're going to see on the right, and of course we'll circulate all of the references that we utilize so you can have full access to this publication as well. But this is a really nice outline of some of the things that we want to think about when we're measuring the impact of a performance improvement initiative. And this is sort of broken out into these hard and soft impact areas. And we'll show you a case example of what this can look like within your organization in the next slide. But when we think about things like hard impact, we might be looking at improved patient outcomes or absolute cost reduction, utilization of efficient resource allocation. Soft impact, excuse me, soft impact can be things like enhanced patient experience. And then also not to be understated here is the fostering of a culture of innovation. So what this means is that as individuals from the organization engage in quality improvement, they're more likely to want to participate in that quality improvement. And then they also become more engaged in finding better ways to deliver care, resulting in increased enhancements in quality and efficiency. So again, these benefits can span from concrete all the way to increased market capture. So there's a lot to think about when we think about these performance improvement initiatives and making sure that we're measuring this in a way that we can really showcase the improvements that have been made across the organization. So what might this look like if we want to look at a case example here? So this is an example for same day discharge for outpatient PCI. Again, this is real data from a large community hospital that focused on increasing the outpatient discharge, or excuse me, same day discharge for outpatient PCI in their population. Not only were they able to realize improved clinical outcomes, and you can see here that annualized that increase in out same day discharge for outpatient PCI grew by 20%, but they were also able to outline direct cost savings and bed day saved. And again, that's really what we want to think about when we're focused on ensuring that these performance improvement initiatives are showcasing the far reaching impact of the improvement. So you can see here for an annualized savings for this particular organization, 192 bed days saved and $280,000 in direct cost savings. So we know that it's extremely important when we engage in these performance improvement initiatives that we're quantifying that hard impact. Also though, and very important to note here is that this had a soft impact in terms of enhanced patient experience. So patients are reporting that they appreciated the convenience and comfort of returning home on the same day. And this led to increased patient satisfaction. Also, again, that culture of innovation. There were some individuals from this particular organization that were able to engage in performance improvement initiatives for the first time. And it really transformed the way that they thought about care delivery. They felt that they had ownership over the care delivery at their organization and were more likely to participate in the future performance improvement initiatives. So I think this case study really serves as a compelling example of how data-driven decision-making can lead to both concrete financial benefits and also valuable improvements in patient care in the organizational culture. So if only it was that easy, right? If only we could break down the silos, implement some of those strategies, but we know that it's not. Of course, as Dr. Bai mentioned, healthcare is a very complex environment and there are going to be lots of barriers. So one thing that's really important is to understand what those barriers are and address them early in the process. So you can see here, we've outlined some of those very common barriers to overcoming challenges for performance improvement and breaking down those silos. And again, we know, as those of us that have worked in the healthcare systems recognize that resistance to change and competing priorities, burnout, these are all things that we're very well aware of. So as we talk about some of those strategies that you can use to engage staff, it's also really important to engage the key stakeholders early and often and address any of these perceived ownership challenges upfront and early within the project. Also, we recognize that leveraging professional norms, whether this is through benchmarking or networks, can really help to decrease some of these barriers. So again, understanding what other folks within the community are doing or what other healthcare systems are doing to help decrease some of that skepticism about impact or even competing priorities and resistance to change. Really, the key here is to introduce a balanced approach and don't have a one-sided approach. Again, we have to think about performance improvement initiatives through the lens of clinical, operational, and financial performance, and that will really help to decrease any of these upfront barriers. Ensuring that those key stakeholders are engaged early in the process is going to significantly help to mitigate any of these issues that might come up later in the performance improvement lifecycle. And then finally, of course, tools and technologies. So we know that there's a lot of tactics out there that can help to really navigate some of these barriers and performance improvement excellence, but we also recognize that there's lots of tools and technologies at our fingertips, especially in today's healthcare landscape. So we know that there's lots of complex data coming in from various sources. We have EMR data, we have wearable technology, we have medical imaging. I mean, the amount of data that we get is just significant. And we also often hear this phrase of data-rich, information-poor, and I think that that's one of the challenges that we're facing in healthcare is that we have lots of data sources that are coming in, but it might not be in a unified platform. And again, it's sort of that difference between data and actionable insights that we're really looking to kind of navigate that challenge. So when these kinds of conversations come up, there's lots of discussion about leveraging technology and what sort of tools exist to assist in this performance excellence journey. So one thing that often comes up, especially if you're thinking about engaging a partner or a vendor, or really trying to understand what the best solution is from a technology standpoint is this sort of build versus buy conversation. And really what this is, is do we have the tools that we need in-house to transform from looking at data to actionable insights, or should we partner with a outside facility or vendor to really help us get the data that we need? So a couple of things to consider, again, this is a conversation that comes up quite often, really to consider is customization versus speed of implementation. So again, with those multi-stakeholder groups, considering the trade-off between building for customization and buying for speed and ensuring that we're shortening that life cycle, the performance improvement initiatives, and that we have a solution that's up and running that can help us today to navigate the challenges of the healthcare landscape moving forward. Also total cost of ownership and long-term sustainability, very important to recognize, really evaluating the total cost of ownership for both options and including what this will look like in terms of maintenance and scalability, and also ensuring that the approach aligns with the long-term sustainability of the organization and evolving healthcare goals of your organization. And finally, benchmarking. Again, when we think about operationalizing performance improvement initiatives and really embarking on that improvement journey, it's very important that you can set goals for your organization, again, based off of benchmarking from like organizations in other areas. Finally, the power of AI and machine learning and healthcare analytics, of course, cannot be overlooked. I think if you've been to any conference or webinars, podcasts over the last year in healthcare, we just have heard so much about artificial intelligence and machine learning. There are lots of examples of how this is being utilized in the market. And of course, when we think about performance improvement, there's lots of tools and technologies out there that are currently utilizing artificial intelligence and machine learning to help provide those actionable insights to the organization. So something really important to consider as you're thinking about your long-term data strategy. Finally, what does the future of interprofessional performance excellence look like? So a benefit for me on the biome side is that I have the ability to look at how leading cardiovascular service lines are operationalizing interprofessional performance improvement across their healthcare systems. And some things that we see very commonly, first is this data-driven decision-making. Again, these healthcare teams are using data-driven insights, not just data, to guide decisions for improved quality and efficiency. Value-based care integration, again, something we've heard a lot about over the last decade, very difficult, I think, to implement some of this, but we've seen lots of focus on interprofessional teams integrating with value-based care models and prioritizing patient outcomes and cost-effective care, moving and shifting to models like co-management to help ensure that we are aligning those financial incentives with quality outcomes. High reliability culture, again, another thing that lots of healthcare systems have been focused in this journey to high reliability. And again, I think this is going to become more and more of an area of focus over the next years, promoting that quality and culture of safety and reducing errors through interprofessional teamwork. Improved data exchange, also very important. We recognize that this will enable comprehensive patient record access, increased access to data, and this will facilitate coordinated care among interprofessional teams. So, extremely important that, number one, it's a data-led strategy for cardiovascular service line, but also that that improved data exchange is happening. And finally, we already mentioned this a little bit, but those AI insights. Again, we see every single day hospitals leveraging AI and machine learning to help deliver the insights that the administrative and clinical teams need to drive decisions and propel the service line forward. So finally, before we jump into some Q&A, some key takeaways. So, we recognize that performance excellence is an imperative in healthcare. So, it's not, you know, no longer is quality improvement or quality improvement team or performance improvement team something that's a nice to have. It's really becoming an imperative, especially as we look to achieve that value-based care. Second is to achieve optimal patient outcomes, there has to be collaboration between administrative and clinical teams. I think we've talked a lot about that in this webinar, but it's really imperative to ensure we're looking at every single project through that multifactorial lens and understanding both clinical, operational, and financial impact. It's important to prioritize that has a structure in place that supports this model. So again, what does this look like? We know over the past decade or so, there's been a movement to this admin and physician dyad service line leadership. And really that is the best practice in sort of how we operationalize this multidisciplinary lens for performance improvement. A great way to sort of begin is to create this dialogue at your organization. Again, we recognize that a lot of healthcare systems may be more mature in this journey and some are still trying to get these types of, this culture off the ground. So really having that dialogue, understanding what some of the barriers might be, understanding where you are on the journey is a great way to begin that sort of conversation at your organization. Focusing on quality as a business plan. We talked a lot about this, but focusing not only on the hard impact of these performance improvement initiatives, but also on some of the soft impact and then really thinking about for every performance improvement initiatives, how do we quantify this? How do we quantify both direct cost savings, bed day savings, so that we can continue to foster the discussion about reinvestment and performance improvement within the service line. And then finally ensuring that there's clear operational clinical and financial objectives for all key products and goals. This will really help to not only ensure that you're creating that story around the hard and soft impacts of the performance improvement initiatives, but also it will help to ensure that by identifying these goals, you're engaging these key stakeholders from the administrative team and clinical teams right off the bat at the beginning of the performance improvement journey. So again, we really thank you for your time today and we hope that you found this informative and we would like to hold some time here for question and answers. Amber, thank you so much. And Dr. Bai, I may be the only one who got drenched by that fire hose I was drinking from right there, but holy moly, that's a lot. So thank you guys, just very well put together and really hinting at some of the nuances that I kind of referred to at the beginning. So I've got a zillion questions, but what I wanna remind everybody of is down at the bottom of your screen off just to the center right, there is a Q&A button. And if you want to type in any questions from the presentation from Dr. Bai or from Amber, feel free to do that and I'll continue to kind of monitor those as they come in. The first one is really from me, to be honest with you. And I'm taking a look at how this evolves in the workplace and not just from an academic and modeling perspective, but where the rubber hits the road, right? And we come into some challenges. So I'm curious from both of your perspectives, what are like the common challenges that you see when people start to initiate these performance improvement efforts, especially as it relates to like breaking down between the clinical side of the house with its potential goals and the executive or administrative side of the house with their goals. When you say we're all trying to get to the same place for the patient, we all are kind of measured a little bit differently sometimes. I'm sure there's some friction. How do you break down those barriers or how do you resolve any of those clinical and administrative issues? Yeah, I can take a swing at this first and then I'd love to hear Dr. Bai as well, especially from the clinician standpoint. But one of the things that I find most frequently happens is a failure to engage or do a key stakeholder assessment early in that performance improvement journey. So there's all different ways. There's lots of tools that you can utilize out there to perform a really good key stakeholder assessment at the beginning of a project. I personally think one of the easiest ways to do that is to kind of ask, if you have a performance improvement project, we'll just focus on that same day discharge initiative. We might have the clinical team involved upfront, but really if we think about this, if we were to say, well, if we have additional capacity within the hospital or if we need funding for a project like this, who would we go to secure that funding? And really what that allows you to do, asking those key questions upfront allows you to ensure that you have the right stakeholders there, whether it's from a clinical standpoint or operational standpoint or financial standpoint, upfront in that performance improvement journey. What I find very commonly is that we'll engage, or a system will engage in a healthcare performance improvement project. And then later on down the road, you know, we figure out that, oh, well, we may need to bring in the finance team, or, you know, we overlooked involving a director for the echo department if we're engaging in a, that's a very common issue and of course the CV world. And so what then happens is you kind of have to take 10 steps back. You have to go back to evaluating, you want to get buy-in again. So really I would say the most important thing you can do upfront is identify those key stakeholders that you'll need to engage early and that will help to navigate some of the barriers down the road. Yeah. Amber, I couldn't agree more. I think identifying exactly who the performance improvement plan is going to impact is critically important and then really kind of understanding it from both sides. So again, thinking about it for the administrator hat and then from a clinician side. When you're coming to it with whichever side is coming forward with the plan, from the clinical side, I always try and come up with what is the return on investment? What's the opportunity here? What are the profit and loss thing? Understanding that's not my language. That's not what I usually speak, but how I need to explain this so that it's going to be understood in a way that's going to be manageable and applicable and appealing to the other side that's going to actually finally fund it. And really understanding not just necessarily that with this administrator, but also my colleagues. If we're implementing a same day discharge PCI program, which we did a few years ago and setting a COVID, what's the benefit to my colleagues that kind of work to get these patients out of the hospital? It's nice to be able to check labs the following day. You feel comfortable. You don't have to incorporate your nurse and checking in on them afterwards. What's the benefit of that to us? And then really thinking about, okay, the extra work that we're going to do to get these patients home. Number one, patient impact. Number two, less rounding days, less congestion in the hospital, more ability to kind of actually offer more care to patients on the clinical side. That's a benefit that you can make in an argument upfront. The idea of a performance improvement strategy is not just influencing that one thing, but seeing how it's going to impact the other things down the road. If you don't try and identify the barriers you're going to face early on, you're going to get blindsided. And basically, as they were saying, you take 10 steps back every time something new comes up that you could have anticipated earlier. So I think that's probably the strategy is once you start coming up with an idea, it's not just the idea itself, it's what the downstream effects are going to be. And if you have a good thought process about that and systematically approach those, have a solution in place already, or at least an idea of a solution, that'll grease the wheels much better than just kind of coming in and saying, we're going to try this and see how it goes. Yeah, that doesn't always work well. I do have a question that's come in, and I think it would probably be for both of you, but it's about leadership. And the question is more specifically, what role does leadership play in creating these cultures of collaboration and performance improvement? And are there any leadership approaches that you found to be effective? So I think I've captured that, if not, please correct me on the question. But I think I've captured that accurately there. So Dr. Vai, I'll start with you on that in terms of leadership approaches and the importance of it. Yeah, I think leadership is incredibly important, lead by example, and then transparency. I think transparency is incredibly important to kind of say, this is where we are, this is where we're trying to move, this is what's going to happen, and these are the risks that we're taking. If you don't acknowledge that, and something goes wrong, or you don't acknowledge it, and it even becomes the light that it could have happened, that really creates a problem with trust in your institution. I think that's critically important. So having some sense of just basically saying, this is where we are, laying it out on a table, and then basically a culture of acceptance and innovation, where you're encouraging your entire team, it can come from anywhere, to try and basically provide innovative strategies and improvement. Also, developing these dyads. I think that's very, very, very important. We talked about the silos that exist. Each role has a very important role, sorry, I didn't really use the word, but basically each side has a very important role in the healthcare system, forcing that interaction early on, so that basically ideas and solutions come from the joint partnership of these dyads, is incredibly helpful. So I think promoting those things, and then finally supporting the actual work. I mean, I think quality engagement, developing value-based care, developing innovative strategies takes time. It's not something that happens basically in the weekends, after you get home, when you're watching TV, trying to unwind from the day. It takes time. And so recognizing the importance of that, the clinical impact of that, the financial impact of that, should be something that, if leadership truly values it, to try and basically provide some protected time so that people can work on this. It's not time for people to write papers, or sit in the ivory tower and pontificate about things. It's really trying to design concrete methods by which you can improve the healthcare in your system, and from a financial standpoint, return on investment from improving quality and ultimately value. So I think those are the three things that I think really are key from a leadership standpoint to promote this kind of environment and change. Excellent. Thank you so much for that. Amber, any thoughts you want to add? Yeah, I was going to say, I think that's spot on. I think the other thing I would add is just that this can't be a top-down approach. I think with performance improvement, I know that there's likely some other folks on the line who are really engaged in performance improvement, and there's this sort of concept within Lean Six Sigma that's called going to the Gemba. And what that basically means is that it's just critically important that from a performance improvement standpoint, and when we're engaging in a performance improvement initiative, that we're understanding what's happening, again, boots on the ground. And involving the clinicians and engaging clinicians is extremely important to ensure that we're doing that, especially if we're taking on an operational or an administrative-focused performance improvement initiative, but really ensuring that we're engaging those folks on the ground that do this work every day, making sure that we're involving the support staff and the nurses and the echo techs, depending on what type of project we're engaging on. It's just critically important. This cannot be a top-down approach, but you have to involve the people that are doing the work. One, because it helps to identify what's actually happening. Again, a lot of times, we might think we know what's happening within a process or a procedure, but until you get in there and you really observe and you get that sort of feedback from the people that do the work every day, it's going to help to understand a lot of those nuances and the care processes. Awesome. Yeah. Those are the people that are performing. So if we're going to try and improve their performance, you want to understand what they're doing. Their input is incredibly important. Awesome. Thank you for that. I'm going to do another reminder, because I saw a question just come in from somebody on our team, which I love, but I want to do another reminder to everybody down in the center right is the Q&A box. Please feel free to enter questions there, and we will get to them. One that also has just come through is about emerging trends, and so the question is, what emerging trends or innovations do you see that have the potential to further improve performance and collaboration within clinical teams? So what's coming down the pike that's going to help this process improvement journey and performance improvement journey get even better? Amber, I'll start with you on that one. Yeah. I mean, I think the biggest thing that really comes to mind is sort of this advent of artificial intelligence and what we're sort of seeing here. I think that we all know, and again, this has been just such a hot topic, I think, over the last year, that there are going to be limitations, and this is something likely that will augment care. Of course, I don't think this is something that's going to take over the way that we deliver healthcare and anyone's sort of roles or jobs, but I do think it will significantly impact the way that we think about clinical care and the way that we think about performance improvement. And I've seen some really just, I would say, revolutionary tools that are out there that are helping to create meaningful insights from data. A great example of this, again, we know that we leverage or we invest a lot in collecting data, whether it's from the registry or the EMR or these other platforms, but I think some of these machine learning and artificial intelligence tools and platforms that are coming out now are completely changing the way that we utilize that data and leverage that data, and they're transforming sort of the value that you get from collecting that data. So I think that that's something that I've seen lots of healthcare systems investing in, and I think it's really going to change. I think when we look back 10 years from now at the way that we deliver care and the way that we understand our healthcare systems data, it's going to change significantly over the next decade. Yeah, I would agree. I mean, I think the big issue with big data collection and big data in general is contextualizing the data. We can get a whole, as Amber was saying, I mean, there's a, or even Joey, I mean, there's a fire hose of data coming at you at all points in time. The question is really, what does it really mean? And interpreting that data and putting it into a context that is manageable and actually interpretable is important, both from an interpretation standpoint and actually trusting what the data tells you. The days of looking at a spreadsheet and saying, this is what's going on because the raw numbers tell me this are gone. That's not the way we practice care. That's not the way we should be practicing care. If that's what you're doing in your institution, I would advise to do otherwise. But essentially the models that are developing, the AI that's being used, machine learning to try and contextualize and add other pieces of clinical information that are going to come in and refine your conclusions are critically important to understand what the variance is that you're seeing, where are the gaps that are truly there and what's controllable and what's happening outside of your institution that may be influencing what you're seeing on the P&L sheets. I mean, this is just the reality of where we live. There's so many interacting pieces that it's hard to just look at raw numbers and say, well, our admissions went up this month. The docs aren't doing the right job as far as managing heart failure. There's a lot of different things that can be contributing and we need to understand those things so that you're not just demonizing based on one number. Yeah. Yeah. And the other thing I'll add to that too is we focus, of course, in this sort of presentation about those silos that exist between sort of members of the interprofessional team. But the other thing that we see very commonly is sort of silos that exist when you think about clinical, financial and operational data, right? I mean, those things traditionally have existed either in completely different platforms or in a way that, again, there's no context there. So one thing that I've seen and I think will continue to happen is this transformation of we don't have a source for our clinical data and a different source for our financial data and a different source for our operational data, but are these tools and platforms that are coming out that marry that data together to ensure that it's providing that context. And that could be a significant burden, I think, or a hurdle to overcome is getting that data together. But I think it helps in several ways, again, being able to evaluate the context, but also ensuring that we can create those tangible outcomes for performance improvement. Because to Dr. Baez's point, we want to look at if we're reducing those heart failure readmissions, what does that look like in terms of direct cost savings or what does that look like in terms of bed day saved opportunity costs? So I think that's another thing that we're seeing more and more happening is marrying that data together as well. Yeah, I like that. And, you know, I don't know if we ever can have a conversation that doesn't include generative AI now. So you guys found a way to put that right in. So thank you for that. But we talked about and you just mentioned, Amber, that we talked about silos, right? And so how do you break down silos to achieve performance improvement and cohesion inside of a clinical setting? But let's think about another kind of silo, which would be the way that you spend your time. And I think, Dr. Baez, you've got to balance clinical delivery with performance improvement, with the financial and the operational and the clinical. And that's a lot to put together. And of course, we want it all to be seamless. Sometimes that must feel a little bit segmented in certain instances. Can you tell me about how you are spending your time or meeting the demands of clinical, operational and financial improvement when your core training was clinical and you've now expanded beyond that with additional training? But you know, this is a real shift for clinicians to have to handle all of these components. And how do you how do you manage that? Yeah, I mean, I think, you know, I took on the role of the quality chair for the cardiovascular service line at my institution. And that provides me some time. Is it enough? No, it will probably never be enough time to actually manage this. But at the same time, it's something that, you know, has been afforded to me because the institution views it as important. You know, I think it comes down to, again, to aligning priorities, finding that partnership with the administrative staff to say, you know, this is our goal for the health care system is a goal for our patients. And coming down to those three sort of, you know, agreements that we made. How do we get to that point and really kind of understanding of how do I get a little bit more from, you know, my, you know, clinically segmented time to my quality time to do that to try and promote these changes? It's hard. It's hard to kind of wear each hat and try and do that. But the key thing, I think, from a clinical standpoint is to find the relationship and the bridge, because if you don't identify that for the goals, you're not really reaching that priority where you're marrying the alliance incentives, right? You want to find that thing that really you're passionate about, you know, same day discharge for PCI. That's my wheelhouse. I'm an interventional cardiologist. This matters for me. It matters for my patients. Yes, the financial, you know, benefit for the institution is huge, but it's really important for me as a practitioner. So being able to do that and have that sort of investment is important because it's going to mean I want the project, I'm going to work hard to make the project happen, and I'm going to work hard to kind of overcome these barriers. goals that really kind of tie back to the practitioner and the administrator, I mean, that's the whole idea there. And so, you know, that's what promotes not just in my, you know, sort of quality time, but has my wheels spinning at other times when I'm in the cath lab. How can I make this a little bit better? Because there's these things that are happening, and then you get this kind of, you know, these gaps that occur to me when I'm in the middle of a procedure. Not all the time, thankfully, but you know, where you see that and you say, okay, it's time to really think about how we can make this better for the rest of the practice. And like you said, you know, doing good is sometimes doing well also. So you have the interest in same day discharge and getting your patient out because it's better for the patient. And it also benefits the institution from a cost perspective. So there's certainly... That's an aligned incentive. There's certainly aligned incentives from time to time. We won't get into examples where that may not be the case. Focus on the ones for right now, because we only have a few minutes left where that is the case. Actually, because we only have a few minutes left, and I'm going to move just right into a closeout that I always like to do, and it's kind of final words of advice, if you will. And so what words of advice would you each have for organizations that are looking to improve performance and implement change management strategies, and really to do that in a way that fosters engagement with their clinical team? So how do we do this? Everything we've talked about, how do we do that well? What are your top bits of advice? Amber, I'll maybe start with you and then close out with Dr. Valle and we'll put a wrap on this webinar. Absolutely. I think sort of the easiest way to start to think about this is if you identify, I'm sure every single one of us that works in a healthcare organization right now, or if we have in the You can think of some top opportunities at your facility. You sort of know what things you need to be working on. So take one of those projects and pick a project that you might've been working on for a long time and start to think about what are the operational, what are the financial, and what are the clinical goals of this project? And really by starting to do that and starting to think about each sort of performance improvement initiative in that way, you can start to really create the dialogue around tangible impact of improvement. And it kind of all ties back because one thing we want to ensure is that when we engage in this performance improvement initiatives and the quality improvement journey is that we're able to quantify those tangible benefits, not only because of course we want to be able to engage the key stakeholders to say, look at what we accomplished and we've made a significant difference, but it also can help sort of foster a conversation about reinvestment and performance improvement initiatives. So again, if we're looking at, let's say a co-management organization where we may have saved the service line and direct cost savings, $4 to $5 million, that's a lot easier conversation to have about investing in protected time for your clinicians or investing in training for performance improvement training for the folks within your service line than it is if you don't have those tangible benefits. So again, really pick a project that you're working on now and ensuring that you have KPIs or focused goals for financial, operational, and clinical measures for that individual project. Thank you. Yeah. I mean, I can't agree with Amber more. And I think, you know, the other thing that I would say is that these opportunities for aligned incentives, I don't think are that rare. I think we're just not looking hard enough across the aisle to figure out where the incentives might be. And I think being creative about that, understanding what the input, what the influence downstream of your performance improvement strategy might be, or your expansion might be, whatever might be, thinking about that outside the box to say, this is outside your cost center, this is outside your clinical service line, even within service line across disciplines. What that means is going to be efficacious for you and helpful. And I think as you start thinking about that and really involving the other disciplines, the other services, the other members of the healthcare team, there might be a lot of actual benefits of the things that you want to improve for other people. As you band together, that's going to be a more of an influence and influential impact. The classic example I think of is Tavern. We always talk about Tavern. It's a huge cost sink for basically cardiology, right? I mean, the valve is expensive, the procedure is expensive, but everything that comes from that, the heart catheterization, the consult, the cardiothoracic surgery, the people that don't go for Tavern, go for surgical ADR, the ECHOs, the CT scans, everything else that comes from those patients multiplies and you reach a larger quantity of patients. You provide excellent clinical care, you provide an opportunity for patients to improve, and you grow the system as a whole. Is there a huge investment up front? But if you don't think about the rest of the stuff that's happening, you lose out on all the potential benefits that you may have, and that's been demonstrated over and over again with this halo effect. I think those things are really littered through the healthcare system. We just need to find them. Thank you. Well, thanks for those final thoughts. That was perfect. I'm thrilled that you both joined us today. With that, we will conclude today's webinar, and of course, if anybody wants to ask additional questions, please reach out to us and we will make sure to pass them on to Dr. Valle and Amber. With that, we will end today's webinar, and I want to thank you both again for taking the time to educate us all and share your expertise with us. All right. Thanks, everybody.

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