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Data governance: it’s not what you may think it is

In today’s healthcare environment, the subject of data governance is at the top of the list for hospital executives. Within the framework of strategic planning, quality, big data and regulation, your data reflects everything you do: patient care, cost practices and outcomes. In fact, the very sustainability of your organization relies on quality data. Dr. Elliot King, Department of Communication Chair, Loyola University, MD, makes the powerful point that “Data is an organization’s most valuable asset.

Data governance is a proactive process that provides the necessary framework to ensure data can be trusted and that there is clear accountability in place should an adverse event occur as an outcome of poor data quality. This structure is vital in managing the use, monitoring, maintenance and protection of an organization’s data. Without it, you may be missing crucial information needed to align clinical and business goals while reducing risk.

Data governance is not the routine maintenance of your data with oversight by the Information Services/Technology department. Data governance is a commitment organizationally to a process that manages the integrity of data. In turn, there is increased consistency and confidence in clinical and business decision making. There is better organizational planning, data transparency and optimized staff effectiveness through less re-work and decreased risk of regulatory fines.

In 2001, Congress passed The Data Quality Act (also referred to as the Information Quality Act). Embedded within a two-sentence rider was the requirement that the information you provide to any Federal agency must be consistent, of high quality and have data integrity. In other words, you are required by law to provide quality data.

Consider these notable comments:   

  • When asked about the biggest challenges and opportunities associated with the significant influx of data in healthcare, Anil Jain, MD, Vice President with (IBM) Watson Health responded: “The biggest challenges relate to the interoperability of data and then standardizing and cleansing the data.” “Just because you can get the data, that does not mean you can make sense of it.”
  • “Accurately measuring costs and outcomes is the single most powerful lever we have today for transforming the economics of health care” Dr. Robert Kaplan, Emeritus Professor of Leadership Development, Harvard Business School

The American Health Information Management Association (AHIMA) has been a leading authority on health information management since 1928 and was one of four parties responsible for ICD-10 Coding Guidelines as well as a contributor to the AMA’s CPT terminology. Some important AHIMA tenets are that Information Governance (IG) should ensure information is trustworthy, actionable, and aligned with organizational strategy. It is needed for all information, whether it is in electronic or paper form. EHRs are assets. Like other critical assets—people, capital, inventory, etc.—information is a strategic asset that requires high-level oversight in order to effectively use it for organizational decision-making, performance improvement, cost management, and risk mitigation. Information Governance requires a system-wide, multidisciplinary team (clinical, finance, decision support, materials management, risk management, pharmacy & IT) with executive-level sponsorship.  

How “Bad Data” Can Increase Risk

The Controlled Risk Insurance Company (CRICO) is the patient safety and medical malpractice insurer for the Harvard medical community. The Massachusetts-based company has expanded its proprietary coding system to capture EHR-related problems that have contributed to patient harm, and to guide the hospitals, physicians, and other providers it serves toward addressing vulnerabilities in their systems.

Results from a 2013 analysis of 147 medical malpractice cases were found to have an EHR-related contributing factor:

Top Issues in Claims w/EHR factors % Cases
Incorrect Information in the EHR 20%
Hybrid health records/EHR Conversion issues 16%
System failure – electronic routing of data 12%
System failure – unable to access data 10%
Pre-populating/copy & paste 10%
Failure of system design to meet the need 9%
EHR user training/education 7%
Lack of integration/incompatible systems 7%
EHR user error (other than data entry) 7%

These errors can range from faulty data entry (inches vs. centimeters can distort BMI calculation), unexpected automatic data conversions (2.5 becomes 25 impacting medication error), accessing wrong patient file or field, and repeated errors (mistakes that persist in patient records for years). Which EHR vulnerabilities are most troubling? CRICO’s early analysis reveals that incorrect information in the EHR was a factor in 20% of the 147 medical error cases reviewed. Half of the cases resulted in severe injury with $61 million in direct payments and legal expenses. This risk can and should be eliminated.

How Good Data Goes Bad

EHR system conversions are one of the most prevalent sources of data issues. Whenever data from different sources (multiple hospitals, physician office, and outpatient clinics) is merged, the result can be inconsistency, duplication and questionable validity. Data may not be compatible when different systems are linked/interfaced together. Additionally, formal data standards can be old or not consistently applied over time.  Without standards, you may end up with data that can’t be used for accurate comparisons or other analytics.

Deferring ownership of clinical data to IT is all too common; everybody uses data but nobody really knows who “owns” it. Your IT department needs to know how to resolve technical issues with data; don’t assume they know what the content should be. Data content issues fall into the overview of clinical and informatics staff, working hand in hand.

What is Good Data?

Your data must be available and easily accessible. This requires integration to enable all caregivers to see patient data in the right location at the right time while supporting patient care decisions and optimum utilization of resources.

You must have standardization as a bedrock of your data tables/files.

  • Any information that is recorded using free text is not reportable.  
  • Non-standardized procedures, for example, can result in duplicates or incorrect selection while documenting a patient’s surgical procedure. Procedures that cannot be tied to industry standards may introduce insufficient specificity.
  • A recent study published in the Journal of the American Medical Informatics Association found that a lack of standardization of observable markers of diabetes being collected in the EHR resulted in a significant variation from the standards created by the American Diabetes Association to diagnose the disease. The findings point to the need for standardization to avoid confusion among symptoms related to other conditions the patient may have.

Data must be complete. You must be able to show improved outcomes, regardless of the acuity mix of your patients. Data must be consistent. Necessary information is collected for all patients, all the time and data must be accurate.  A single source of truth ensures that each time a data element is used, it means the same thing everywhere it appears.

Introducing Data Governance

The most important point of data governance is to recognize that senior leadership and stakeholders must be engaged to ensure that your data meets the requirements of “good data;” not only within your EHR but also with every other system with which it interacts. Governance means putting a strategy and process in place for the proper proactive management of good data practices.

Some example considerations in the development of a successful strategy for the management of data are:

  • Put audit and validity checkpoints in place to keep your data accurate. Any interaction with humans will generate data errors – your aim is to identify and remediate as part of everyday activities across your hospital/health system.
  • Institute a schedule of routine audits of information that crosses from one system to another to find items that impact accuracy of cost and charge for supplies used during patient care.  Missing supply, implant or pharmacy charge coding and inaccurate mapping to codes can have a significant impact on revenue and case costing analytics.
  • Challenge the content of your reports. “Apples-to-apples” comparisons aren’t always what they seem to be. Do you collect data that does not result in action? If so, why are you collecting it? Can you see your data in real time to allow proactive action to mitigate unplanned barriers to efficiency?
  • Find any free text that can be converted to a standardized list of selections.
  • Review all of the lists of options selected by staff during the documentation process to search for duplicates, missing options and “home grown” areas that need to be updated to today’s clinical and regulatory standards.
  • Ensure that you are meeting all regulatory requirements by examining the data used to report to outside entities.

Introducing and establishing data governance is a challenging endeavor that takes discipline and time. Check out The American Health Management Association for more information.

Energy Leadership – A Fresh Perspective to Sustain Performance

As the CEO of a specialized Perioperative Services consulting company, I am frequently thinking about the subject of leadership within my company as well as how we embody leadership during a client engagement. The challenges currently occurring within the healthcare industry requires different thinking when evaluating talent along with engaging and developing people at every level. Tried and true “leadership training” may no longer be sufficient nor interesting enough to meet today’s unique demands. At the very least, I was interested in finding a new perspective.

I became aware of the concept of “Energy Leadership” through a colleague, Belda Villalon, from Progressive Synergy Coaching & Consulting Group. What stood out for me as a fresh perspective in our initial discussions was a focus on managing energy and values rather than strategies and tactics. I found this a useful jumping off place when considering the need to find sustainable solutions for our clients. For good reason, there is a desire to implement “best practices” developed through trial and error and backed up by research. The part of this I find most challenging, however, is how to ensure that your client can sustain those practices over time. My goal is to coach my staff or a client to their best performance.

As I am writing this, the 2016 Olympics have just ended. We have all watched remarkable and record-breaking performances in many sports from around the world. The swimming events are always the ones I enjoy the most. How can we not be amazed at the performances of Michael Phelps, Katie Ledecky, and the US relay teams as examples? Most amazing is the question of how Michael Phelps could sustain his level of performance over the course of 5 Olympics? While cheering them on through my television, I began thinking about this issue of energy leadership. High performing athletes always speak of the importance of their relationship with their coaches to their performance success. Together, they know the technical skills of swimming, they know their competition; they know the current statistics and world records; they adjust their diets and routines, and they know the conditions of the pool. That can be said of all the athletes as well as all teams within an organization. Something additional moves them to the top. Along with their coaches, they learn to identify what they personally value, which can differ among athletes, (competition, personal best, redemption, team results, mentoring a new swimmer, legacy, etc.) and then focus their energy in alignment with what they value. In this way, energy works for, rather than against them, and they increase their ability to shift and adapt their energy and the energy of those around them in response (especially when being part of a relay team).

We need this same recognition within healthcare. We can provide inservice training, take courses, set new departmental goals, acquire new tools, respond to new regulations and adjust our practices based on research. But……..how do we sustain those practices and how do we become flexible enough to adapt in real time to the changing environment? Teamwork & performance resulting from alignment of values and energy is a key. We often receive requests to document our process for the work completed. We can always develop and document a process but in order for changes to be sustainable, it requires leadership and management skills to ensure an environment in which all staff choose to contribute to improved results. People may know what to do but they need to choose to do it. Environment/culture, process, and accountability are necessary components for sustainability. It has been our experience that a focus on process is the highest priority within organizations including the development of Process Improvement departments and increased Lean Management skill levels. We are very supportive of this focus, however, adapting the culture and means of accountability get a secondary focus, and yet one could argue these are the components that directly impact sustainability of a new process.

For this reason, I participated in a personal Energy Leadership Index Assessment as a first step to see what I could learn about myself and the value it may provide for others. This is a process of becoming aware of how I respond to different situations and identifying strategies for utilizing the type of energy that will best serve me and those around me. It is a process of awareness of who I am and what I value as a framework for energy management to help others take sustainable action. While the results of the assessment remain personal, I offer these concepts that I am learning as a springboard for what might interest you.

Leadership

Leadership is simply interaction where influence occurs. The influence can be positive or negative, focused consciously or unintentionally, and the impact can be minimal or maximal. A leader is the individual in the interaction who knowingly or unknowingly creates the greater influence in the other person.

Our world tends to define leaders, and therefore leadership, within the context of formally defined roles found within corporations, small businesses, non-profit organizations, and political and community concerns. True leaders, however, are not confined to office walls and are not limited to specific positions within those walls. They are found in families, groups, sports, education, health fields, and within all levels and roles in small and large organizations. (“Organization” for purposes of understanding energy leadership means two or more people, in any walk of life, who are working or communicating together for a similar goal or purpose.)

Equally important to the above, is to remember that leadership includes self-leadership, which is the ability to motivate yourself to do what you desire to do.

Energy Leadership

Energy Leadership is based on the work of Bruce D. Schneider, founder of The Institute for Professional Excellence in Coaching. It is the process that develops a personally effective style of leadership that positively influences and changes not only yourself, but also those with whom you work and interact, as well as your organization. By learning and applying the principles and concepts of Energy Leadership, you can increase your ability to shift your own energy and the energy of those around you. When you do that, you will help to inspire yourself. 0thers feel a greater sense of purpose, get more done with much less effort and stress, and attract positive people and success to you. Everyone is a leader either by choice or default. Every interaction presents the opportunity to lead and have a positive impact on others. A system focused on energy leadership teaches individuals to consciously choose to use their ability to influence and impact others to bring about results that are positive for themselves, others, their organization and its stakeholders.

Anabolic and Catabolic Energy

For all practical purposes, there are two kinds of energy: anabolic and catabolic.

Anabolic describes energy that is constructive, expanding, fueling, healing and growth-oriented. Anabolic energy helps move you forward and achieve positive, long-term, successful results and is useful in leading others in the same direction. Using anabolic energy allows you to have a more complete and conscious view of what is going on around you, and to more easily come up with solutions and innovations.

Catabolic energy, on the other hand, is draining, resisting, and contracting energy. While catabolic energy provides you with a boost to combat what you perceive to be a stressful situation, it also is distracting and acts like a blinder through which you only see a limited view of the situation, thus reducing your choices. Though it may offer short term benefit, when used on a long-term basis, it imparts mental, emotional, and physical tolls that are potentially destructive to you, your organization, and those around you.

Research shows that the most successful leaders in life are those with high levels of anabolic energy. Those who lead using catabolic energy get results in the short term, however, they cannot sustain success. No matter who you are or what you do in life, increasing your anabolic energy level will help you better perform whatever you do.

I recently came across a quote from Sir Richard Branson, “Train people so they can leave, treat them well enough so they do not want to”. In the world of healthcare with changing demands and evolving roles, our approach to others is critical. Managing relationships and teamwork is more important than managing hierarchy if you want to survive the change. Great leaders are not only able to motivate, inspire and bring out greatness in others, but also in themselves. The question isn’t whether or not you are a leader; the question is….how will you lead?