DOCUMENT INFORMATION

As chief operating officer of the Premier health alliance, Susan DeVore leads Premier's three business units – Premier Purchasing Partners, LP; Healthcare Informatics; and Premier Insurance Management Services, Inc.  Prior to serving as COO for Premier Inc., DeVore was President of Premier Purchasing Partners, which provides group purchasing and supply chain services, technologies and solutions to Premier’s member hospitals and other providers.

DeVore spent more than 20 years with Cap Gemini Ernst & Young (CGEY) as a senior health care industry management practice leader and member of the executive committee for the North American consulting organization. She also led high tech, manufacturing and other business units of CGEY, giving her a broad understanding of supply chain solutions across multiple industries. Those experiences, coupled with her four years in hospital finance, bring proven skills in leading, managing and understanding hospital supply chain and support services to Premier and its members.  DeVore has been named to Modern Healthcare’s list of the 100 Most Powerful People in Healthcare and to the magazine’s list of the Top 25 Women in Healthcare.

Hospitals have always delivered quality care, so why the intense focus on quality we are seeing now?

Everyone deserves the highest quality health care, but we are finding that the delivery of that care, and the associated outcomes, are not consistent across our fragmented health care system. It has taken the prospect of economic pressures, such as the proposed value-based purchasing plan, to raise the quality agenda to what one might call a burning platform.

There is now an economic connection to quality that hasn't been made in the past. It's a great political platform: "Let's reduce spending by improving quality." So there are economic and quality related discussions occurring.

With CMS' proposal for value-based purchasing, the risk of losing payment has never been this real before. Hospitals are being told to improve their quality-and report it publicly-or face reduced reimbursement.

This increased transparency of quality is certainly another factor at play. Consumers, employers, government, payors, and individuals want to have more control in their health care decision making and are demanding more cost and quality information. Public web sites like Hospital Compare and HealthGrades are bringing quality information to the consumer as never before.

You cite a body of evidence that indicates evidence-based medicine isn't being practiced. A NEJM study published in 2003 found evidence-based care is only used about ½ the time. Why aren't more physicians, nurses and clinicians practicing medicine according to these guidelines more often? If this is the "best" way to deliver care, what can hospital leaders do to ensure that clinicians follow these guidelines?

Studies have shown that it can take up to 17 years to go from the reporting of an initial research finding to a point at which there is close to 100 percent physician adoption of what is known to be a proven, effective intervention. That rate of adoption is far too slow and means that we will only see incremental changes at best. But due to disagreements over evidence and the fact that it continually changes, there is general skepticism by physicians.

Change is painful, but several things need to change. First, we need to meet physicians where they are. Health care is a complex industry with multiple layers, and answers aren't usually cut and dried. Physicians are driven by data. If we have real-time measurement systems in place, we will have the data available to support physicians' utilization of evidence-based practices. Ultimately, real-time data will make doing the right thing easier.

And while physicians must be able to customize care to individual patients, it is often possible to standardize some important aspects of care. The best practice for initiating anti-coagulation therapy, for example, can be incorporated into a standard protocol which has been worked out in advance. An effective medical executive committee can make this easy to do by adopting and advocating the use of standardized order sets or standardized protocols. As a result, a physician might write "initiate standard anti-coagulation protocol," rather then reinventing the wheel each time.

Lastly, we have to align evidence-based best practices with proper economic incentives. Right now, we pay for throughput rather than outcomes or adherence to demonstrated best practices. Misaligned financial incentives really get in the way of our efforts to improve quality of care.

In a recent speech, you talk about the "road to value." What does this road look like? What steps can hospitals take to get there?

True value must include quality, customer satisfaction, access to care and reduced cost. There are many different models that are being tested. Pay-for-performance and Premier's QUEST: High Performing Hospitals programs are just two examples.

Many hospitals are building new models, implementing and testing them, and they are producing incremental changes. The problem is that the industry hasn't been able to put the pieces together in a comprehensive model yet. We are taking a wide-ranging view of the patient experience and using a collaborative methodology so everyone can learn from the best of the best.

What are the biggest barriers to improving care? What do hospital leaders need to do in order to overcome them?

One of the biggest barriers is that change is not systematic; rather, it is applied episodically and is hard to sustain. People need to be empowered to continuously make care better. Health care's current fragmented systems isolate the impact of process improvement, so while improvements can be made, it is difficult to sustain them.

Another barrier is the cultural. Process management with a teamwork culture will have the most impact on change. Give trained people incentives to improve care and you will be empowering teams.

A final barrier is "analysis paralysis." There is no shortage of data in health care - we could analyze until the end of time. You need an accelerated method of process management to accomplish your improvement goals. Premier has created a specific physical space reserved for brainstorming accelerated solutions with the idea that you don't need to analyze the problem for six months before implementing an improvement. Yes, the need for perfection gets sacrificed but if it takes too long, there will be too much frustration and no results. Success needs to come immediately.

Superior process management. What is it? How does it improve care? Where do hospital leaders start to improve processes?

Superior process management is a six-week cycle of activities, applicable to all businesses, not just health care. It is an application of knowledge, skills, tools and techniques to improve processes with the goal of improving care. To be successful, there must be consensus, from front-line employees to the board of trustees. Homework is still done on the front-end of the activities, but research, analysis and process change occurs quickly, and everyone's opinion is valued. This type of management is only successful with teamwork. A good example is the QUEST program. It has been designed to bring folks together who have diverse opinions and share their knowledge and experiences among the entire group of participants.