Like many of you, I am a sucker for personal and professional development. Stacks of books adorn the office, the bedroom night stand, and anywhere else I can find space. One of my pandemic reads was the massive best seller, Atomic Habits, by James Clear.
I had initially held off reading it, confidently assuming I knew everything I needed to know about habits. However, after Clear relentlessly showed up on every podcast I listened to (and made a lot of sense), I finally broke down and bought it.
Random music side note:
Did any of you ever do that with albums/CDs? I remember when The Police’s album Synchronicity came out, I was thinking, “If I hear just one more hit from that album on the radio, I’m buying that album.” Of course I bought it. Wow!
Back to James Clear and Atomic Habits. One of his assertions in the book is this:
“Forget about goals, focus on systems instead.”
When you think about it, and if you read the book, you will find it makes a lot of sense.
And yet, many of us in healthcare consistently focus on goals like reducing length of stay, reducing costs, reducing readmissions, and so on.
What would happen, though, if instead of focusing on these goals, we focused on the processes (and for physicians the practice patterns) that lead to those outcomes? What would be the result? Could that change in mindset compete in a world focused on the bottom line?
It turns out that it could and can.
What if we focused on supporting the habits of high-value care?
At Agathos, we think it is wrong that patients presenting at a healthcare facility with similar symptoms often receive notably different care, pay drastically different costs for treatment, and often have inconsistent experiences and outcomes. That is why we show physicians how they compare to their peers in various clinical practice patterns. They can see where they are practicing differently than their peers. Whether they might — unknowingly — be delivering low-value care, unwarranted care, or even risky or harmful care. Every empathetic, growth-oriented, competitive physician is willing to take a hard, honest look at themselves when they see Agathos data. Agathos data produces change.
But I am not here to explain what we do as much as I wanted to share how focusing on the practice patterns (and not the outcomes) creates multiple types of value.
Building systems of high-value care creates four types of value
When physicians reflect upon practice, collaborate, and both learn and share knowledge, they make self-directed changes that improve healthcare. And when they do that, many of the outcomes healthcare executives seek fall into place:
- Reduction in unnecessary care and, thus, direct costs underlying DRG-based payments
- Decrease in length of stay (through adherence to best practices)
- Improvements in quality of care
- Support for a culture of continual learning, growth, and peer mentorship
Some leaders seek point solutions toward each one of those outcomes, and, yet, by simply helping physicians zoom in on their practice patterns, you will find value in all of these four unique and intertwined ways. The following sections explain more about each type of value and offer examples. This video gives a nice overview as well and shows you some of the talented voices behind the Agathos organization.
Reduction in direct costs
When it comes to reducing direct costs of care, decreasing unnecessary testing is one great place to start. Agathos tracks the following types of utilization in hospital and emergency medicine:
Hospital Medicine
- Common lab utilization
- Comprehensive (vs. basic) metabolic panels
- CT utilization
- Daily common labs
- Echo utilization
- MRI utilization
- Telemetry utilization
- Transfusions, hemoglobin over 7 g/dL
Emergency Medicine
- CT utilization
- MRI utilization
- Lab utilization
- Chest x-ray utilization
- CTA chest utilization
Request a complete list of all metrics tracked for hospital medicine, emergency departments, and critical care here.
Above is an example of one client’s recent reduction in comprehensive (vs. basic) metabolic panels after using Agathos.
Some might wonder why anyone would focus on areas that have relatively low individual cost. As one of my former financial executives said, “Crumbs make the cake.” Multiply those small individual costs per day, across a physician team, and then over the course of a year, and you have significant savings. Moreover, unnecessary testing can produce false positives, flow disruptions waiting for results, and avoidable complications and escalations of care. James Clear calls this the “aggregation of marginal gains, a philosophy of searching for a tiny margin of improvement in everything you do.” Besides all of that, these changes also improve the patient experience.
Decrease in length of stay
Research suggests that a number of practice patterns can have a direct impact on length of stay. When we make improvements to those patterns, those improvements can cause a notable reduction in length of stay. You already know that translates to better patient experience and cost savings. With our customers, we have found meaningful reductions by focusing on these practice patterns:
- Consult utilization (overall)
- Discharge efficiency
- Disposition insights
- Handoff efficiency
- Multi-provider weighted LOS
- Observation LOS
- Imaging orders that prolong LOS
- Palliative care consult utilization
- PT/OT consult timing
- Weekend discharge rate
Request a complete list of all metrics tracked for hospital medicine, emergency departments, and critical care here.
It makes sense. If you operate more efficiently you contain costs. But you cannot simply tell a physician to “be more efficient.” They need to understand their individual role. These above metrics are at least in the direction of practice patterns over which physicians have direct control. Showing them how they compare to their peers in these areas results in self-directed change that reduces length of stay.
Improvements in quality of care
Not all improvements are directly tied to financial gains. Some improvements are toward providing the best care possible. (The reason we are all in healthcare!) This is the third type of value Agathos offers. A number of our focus practice patterns focus specifically on improving the quality of care in both hospital and emergency medicine:
- Benzodiazepines, patients 65+
- Glucose management
- Opioid discharge prescription rate
- Opioid discharge dosage
- Opioids, long prescriptions
- ED bouncebacks
- Same-cause readmissions
- 7-day readmissions
Request a complete list of all metrics tracked for hospital medicine, emergency departments, and critical care here.
Support for a culture of learning, growth, mentorship
Many forward-looking organizations are seeking to build “learning organizations.” These organizations will not settle for status quo, but rather seek to build a culture of continuous improvement, much in line with the Atomic Habits mindset. The data Agathos delivers — and the approach Agathos uses — both aid in building this culture of growth and mentorship.
First, by showing physicians how their practice compares with that of their peers, Agathos sparks curiosity in the physician: “How is it that Dr. Bushman is able to get her discharge orders in regularly before 11 a.m.?” This leads to conversations, collaboration, and sharing of ideas. All without administrative load.
Furthermore, Agathos data sometimes helps drive larger organizational conversations that can lead teams to discuss how to, for example, handle transitions of care better or reduce telemetry utilization.
A side benefit, especially coming out of COVID, is that these discussions and collaborations can have an impact on one of the hardest struggles of being a physician — loneliness. When physicians start to engage more with one another with the context of convincing data and common goals, bonds grow, friendships are built, and work becomes more of what they had hoped for when they chose medicine as a career. It is a beautiful way to provide mentorship and peer support without specifically creating a program. It happens organically.
One of our CMO partners put it like this:
“This program helps move us into a mentorship modality, where senior physicians can use that data to engage, share leadership lessons and best practices. This can help us develop stronger leaders, resiliency, and create a culture of innovation.”
The pay off
As healthcare leaders, you are constantly prioritizing and evaluating the best way to deliver on your own promises to the community — the best care at the lowest possible cost. Solutions like Agathos cover multiple categories of practice-level improvement to deliver value at the financial level (i.e., utilization, costs, operational efficiencies), but also at the levels of quality care and improved culture. With so much value in such a simple concept, what would stop you from exploring how you can build better practice habits at your organization?
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