Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance

By Mark Crockett, M.D., CEO, Verge Health

In 2007, the Marine Corps deployed to Iraq and Afghanistan had a problem: how to identify an enemy that blended in with the population. They developed a behavioral approach to helping teams sharpen their tactical awareness skills to remain “left of bang,” or to fend off hostile actions before they culminate in the “bang” of conflict. In 2017, healthcare needs to deploy the same approach to managing risk and improving outcomes.

Almost all of healthcare is focused on the “right of bang,” or the future correction of adverse events. Everything is oriented to logistically and financially react to a problem that has already happened. Healthcare systems across the nation are realizing the importance of adopting solutions that can collect data to analyze and pinpoint at-risk processes. This movement towards “left of bang” approaches is essential, especially as the industry pushes towards value-based care.

The goal of value-based care is to standardize healthcare processes by mining data to determine which processes are successful and which are not. This is the kind of data integration that saves money, but most importantly, re-shapes the organization into a safety first culture. The ideal result is fewer readmissions, less frequent hospitalizations or trips to the ER, and quicker, more efficient remedies to adverse events on a long-term basis.

At one Northern California-based hospital system, this issue became a matter of life and death.  Their timeline-oriented thinking – and solutions – needed to become ‘left of bang’.  The hospitals had previously implemented a Six Sigma plan to reduce central line infections in for severely ill patients who need them. Six Sigma is a popular methodology that takes a data-driven approach to eliminate defects in any process. The approach aims for six (or less) standard deviations between the mean and the nearest specification limit.

Using Six Sigma, the hospital system found a catheter that was septic superior, then worked through purchasing problems, stocking the catheter, sterilization procedures, and finally, implemented a process that ensures no one receives the catheter until the surgeon is ready.  The improvement eradicated central sepsis in five years, an amazing feat compared to industry standard.

It’s a great thing when you can eliminate sepsis in central lines. But five years later, the 44-hospital system has no means of assessing compliance with the process design developed using Six Sigma. Nor does it have the ability to transition what was learned to other facilities.

“We know how to prevent central line infections,” said one team member. “But without strong leadership, and the technology to implement the safety procedures system-wide, inertia takes over. We have an adverse event, or worse, a death, and ask ourselves ‘Where is that folder on catheter infections?’  It’s just not good enough.”

So, what’s missing?

Getting hospitals to look for patterns in identifying adverse events, and working to identify them before they occur, keeps clinicians and staff in perpetual ‘left of bang’ mode. But process improvement through Six Sigma isn’t going to enable this essential shift to a safety-first culture. Neither will the latest software, or the best management training. It’s going to take all of these approaches – and more – for healthcare to truly see the results and outcomes that payers demand from providers.

That’s why we create the Converge Platform and a process to achieve governance, risk and compliance for healthcare.