Predictable, transparent decision making a critical difference

March 23, 2020

Today the advancements in healthcare technologies and patient care delivery occur faster and faster. Unfortunately, most organizations struggle to keep pace. In order to adapt, successful health systems need to focus on quality and process improvements that ensure improving both patient care and their bottom line.

Rather than becoming bogged down with cumbersome internal politics, more transparent decision-making processes must be embraced. The benefit is that everyone involved in the care delivery system is part of the process, which will result in cultural and moral improvement as well as patient satisfaction that extends well beyond the balance sheet. For those who haven’t already done so, the logical place to begin is in the value analysis committee process. Advancing traditional value analysis beyond the historical supply chain focus is absolutely key to evidence-based performance improvement. 

Despite advances in medical science and technology, our healthcare system doesn’t always translate knowledge into practice; thus not all caregivers apply new technology safely and appropriately. All too often, this leaves healthcare providers questioning the key business decisions that impact patient care. We have all heard “who made that decision?” Often decisions are a result of inefficient and variable processes, not individuals. These shortcomings have financial ramifications that the advent of value-based medicine has emphasized. With reimbursement now closely tied to clinical outcomes, demonstrating measurable improvements in care is more critical than ever. Clinicians, specifically physicians, are an essential component of any solution. They will need to lead the reinvention of healthcare and its delivery, measurement and improvement.

Dr. Mark Kestner and Dr. Li Ern Chen have authored a white paper that points us towards attributes to consider as we formulate highly reliable organizations. These basic elements are key to future success and include:

  1. Sensitivity to operations; every voice matters. Frontline staff are in the best position to spot potential failures and identify areas for improvement. We need to focus on clinical processes that guide decision-making and operational improvements.
  2. Deference to expertise; expertise trumps authority. We depend upon experts. Clinical experts, more than executives, should be relied upon for decision making in high-risk situations.
  3. Preoccupation with failure; find trouble before it finds you. Recognize that any deviation from expected results can escalate into disaster. All staff need to have a role in the identification of process breakdowns.
  4. Reluctance to simplify; don’t keep it simple. We need to reject simple diagnosis of problems. We should challenge long-standing beliefs about why a problem occurred. We examine data and conduct root cause analyses.
  5. Commitment to resilience; rapid operational response. Healthcare organizations need to continually anticipate trouble spots, prepare for emergencies, identify errors and develop innovative solutions.

Select organizations have begun the journey to become much more transparent and predictable in their decision-making process. As we begin to see clinical effectiveness become the foundation upon which healthcare decisions are based, the expanded membership in these activities are including non-traditional members of the healthcare team, such as Supply Chain. Some key attributes that high-reliability organizations have embraced include standardization of process, a team focus and flexibility in a willingness to modify process with a focus on continuous improvement. When organizations realize that everyone has a role in achieving high reliability, those organizations begin to achieve much greater value not only for their own viability but for the highest outcomes for the people they serve.

As Kestner and Chen conclude, “There is no one-size-fits-all approach to quality improvement. What is true is that to promote movement toward zero patient harm, quality initiatives should focus on meeting patient needs. This requires measurement, transparency and accountability. Quality improvement metrics and KPIs must be identified, tracked, acted upon, and, when appropriate, made publicly available. This is more than just best practices for a highly reliable organization, as quality measurement and reporting are increasingly required for reimbursement.”

To obtain the referenced white paper visit 

About the Author

Dee Donatelli

Dee Donatelli, R.N., CMRP, CVAHP, has more than 40 years of experience in the healthcare industry as a registered nurse, supply chain executive and consultant. Donatelli has held leadership positions in hospitals, consulting firms, distributors and GPOs. Donatelli is a past president of the Association of Healthcare Value Analysis Professionals (AHVAP) and is Chair-elect of the Association for Healthcare Resource and Materials Management (AHRMM). An Bellwether Class of 2015 inductee, she also serves on Bellwether League’s Board of Directors. Donatelli currently serves as Vice President, Professional Services, at TractManager and as Principal, Dee Donatelli Consulting, LLC. She is a member of Healthcare Purchasing News’ Editorial Advisory Board and can be reached at [email protected].