One of health care’s big challenges is getting scientific evidence adopted quickly in our nation’s vast health care system.
Studies show it takes an average of 17 years for research evidence to reach clinical practice. That’s too long, especially in this digital age. Seventeen years ago, Bill Clinton was running for re-election, Newt Gingrich was Speaker of the House and E.R. was the top-rated TV show. Do we want E.R. doctors treating strokes and heart attacks today with knowledge and technology from 1996? Of course not.
For this reason, the Cardinal Health Foundation has for the past several years been providing financial support to the innovative concept of health care “networks.”
In the language of business, a network continuously collects and analyzes data at the system level (upstream), so it can create procedures and protocols that let doctors, nurses and pharmacists easily make good decisions at the clinical level (downstream). In essence, networks try to hardwire the system so best practices become automatic and mistakes rare. They’re a cost-effective way to help evidence-based practices flow quickly from research to clinical practice.
High Reliability Organizations (HRO) in the airline and nuclear industries have taken a similar approach to implementing best practices for decades. Health care networks are an effort to import HRO strategies from other industries into health care. A simple example: airline pilots use checklists before taking off because the practice is known to reduce human error. Pilots accept and appreciate the checklist as an example of “hardwiring” the system to prevent human error. Everyone knows it’s not OK to crash a plane - even once.
Thinking like an HRO changes the way health care providers think about how to measure, share and respond to patient data - especially when it comes to errors. Airlines share safety data with competitors -- to the benefit of all. Networks let health care providers do the same: Share data across many institutions – to the benefit of all.
Networks are crucial because scale matters. Sharing information (a) improves data quantity and quality, (b) increases the number of experts analyzing information and (c) speeds the widespread implementation of best practices.
The results of the networks we’ve funded have been exciting. We’ve seen health care networks accelerate change, improve patient outcomes and save money. The federal government is now helping expand our first network investment - reducing preventable complications at eight Ohio children’s hospitals - into a nationwide children’s hospital network.
A Quick Look: Three Successful Networks
The current health care reimbursement system doesn’t naturally support multi-institution networking. To fill this gap, the Cardinal Health Foundation has donated nearly $4 million to fostering health care networks and is committed to further support.
We provide financial help, but it’s our institutional partners who do the heavy lifting - building networks, gathering data and treating patients. Three successful examples:
- Ohio Children’s Hospital Solutions for Patient Safety. Our foundation has invested $3.5 million since 2009 in an amazingly successful effort to reduce complications at Ohio children’s hospitals. (Read more at solutionsforpatientsafety.org.)
- Healthcare Value Network. This Wisconsin-based effort promotes knowledge sharing and information transparency using lean operational concepts pioneered by Toyota. We donated $250,000. (Read more at createvalue.org.)
- Alliance for Integrated Medication Management (AIMM). This Minnesota-based clinical pharmacy network forms teams (doctors, nurses, pharmacists, hospital administrators, etc. -- sometimes from different institutions) to coordinate best practice treatment of complex, high-risk patients suffering from chronic conditions. We’ve contributed $50,000 to AIMM.
The Cardinal Health Foundation is in the fifth year of its multi-million dollar effort to promote knowledge-sharing networks. Why are we so excited? Our partners are generating hard data that confirms the enormous potential of networks.
For example, the eight Ohio children’s hospitals referenced above reduced adverse drug reactions by 40% by sharing data, creating protocols and rigorously adhering to best practices. Surgical infections fell more than 60% in cardiac, neurosurgery and orthopedic surgeries.
Pause for a moment. Imagine the healthier children. Real kids on the playground, not just statistics in medical journals.
This is cost-effective medicine at its best. In two years, 7,700 children avoided harm and $11.8 million was saved by preventing these complications before they occurred.
In recognition of this success, the Centers for Medicare and Medicaid Services awarded the Ohio hospitals noted above an innovation grant to take the program nationwide. Today, 79 children’s hospitals across the country have joined the network.
What makes networks work
Let me share some things that the foundation and its partners have found to be valuable when building a successful health care network:
- Leadership support. Chief executives and boards of directors must be committed. Weekly C-suite meetings are a good start.
- Measure smartly. Focus on patient outcomes, not just financials.
- Let data drive. Best-practice protocols must be shaped by up-to-date medical evidence and data.
- Insist on transparency. Openness and honesty about practices and outcomes is essential to discovering what works and what doesn’t.
- Sharing is caring. Data must be shared broadly - both internally and across networks – for the continuous evaluation of best practices.
- Train, train, train. Embed new thinking about protocols and best practices through robust training.
- Start small. Begin with a pilot project; then spread the best practice more broadly.
- Use numbers, not just rates. Medical errors hurt actual humans, one at a time. Don’t let this reality get lost in a rate or percentage.
- Hear all voices. Listen to patients, to families and to employees at all levels. Their insights are indispensable to best practices that work in the real world.
Remember, “networks” are real things - like water pipes or power lines. Once built, they open a pipeline between patients, doctors, researchers, administrators and others. Networks are infrastructure that can create lasting change.