Standardizing administrative and clinical processes has historically been a challenge in the health and human service field. A great illustration of the effects of this lack of standardization is the just-released study from BMJ, a medical journal. The study found that 6% of consumers experience in harm in a medical setting and that 50% of that harm is preventable – much of this due to a lack of standardization (see Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis). And this lack of standardization is responsible, in part, for the slow adoption of new technologies and treatments.
But the big question for most executives running provider organizations is how to standardize services. Most of those executives know what the ‘end’ looks like. But it is going from where they are now, to that future state where every service unit is operating in a standardized, effective, and efficient way. To do this, I think that management teams need an understanding of four key concepts – evidence-based practice, practice-based evidence, standardization of care, and measurement-based care.
First, while all these terms have different meaning and nuances, they are all interconnected. Without the use of EBPs and practice-based evidence (we’ll get into the nuances later), it’s difficult to develop standardized care and without measurement-based care, it’s difficult to determine whether that standardized care is working.
Evidence-Based Practices (EBPs)
EBPs are considered the best treatment and clinical practices based on available research combined with the clinical professional’s expertise and the consumer’s preferences and unique characteristics (see Policy Statement on Evidence-Based Practice in Psychology and Evidence Based Health Care). The best research for EBPs is empirically based and utilizes a multitude of different types of studies and randomized trials. The Substance Abuse and Mental Health Administration (SAMHSA) maintains a database of EBPs for the behavioral health field (see Evidence-Based Practice Resource Center).
The concept of EBPs has been met with a fair amount of criticism, specifically that delivering treatment in the “real-world” is not the same as delivering treatment in a laboratory or in a carefully controlled randomized trial. As a result, the concept of practice-based evidence grew from the idea that communities know what treatments are best for them, which are culturally relevant, address emergent issues, and/or focus on populations typically excluded from EBPs. These are bottom-up, grassroot treatment efforts which may eventually become evidence-based practices. It’s important to note that practice-based evidence cannot really exist without measurement-based care. If care is delivered because it is thought to be effective, but there are no outcomes or measures, it’s just delivering care under the status quo (see Issue Brief: Using Practice-Based Evidence To Complement Evidence-Based Practice In Children’s Mental Health and Uniting Practice-Based Evidence With Evidence-Based Practice).
Standardized care builds on the use of EBPs by incorporating them into everyday use. Standardized care also recognizes the sheer difficulty in keeping up with and evaluating the growing body of medical research. Standardized care evaluates the evidence and creates clinical pathways or “a plan of care for a well-defined group of patients, which translates guidelines, evidence, and expert consensus opinion into local care and is a result of multidisciplinary work“ (see Standardizing Care Processes and Improving Quality Using Pathways and Continuous Quality Improvement). The idea of standardized care is not to prescribe the same care for every consumer or to develop cookie cutter methods of care. The idea is to simplify care for less complex consumers so that more time can be spent with complex consumers, reduce errors, and allow clinical professionals to focus on the visit (see Standardized Care vs. Personalization: Can They Coexist?).
Measurement-based care, sometimes known as patient-reported outcomes (PROs), continuous assessment, and feed-back informed care, is the process of monitoring consumer outcomes and using those results to inform treatment. Typically assessments for measurement-based care take the form of the PHQ-9, GAD or are idiographic in nature (ie. goal setting and tracking). The results of these assessments are used by the clinical professional to tailor and change treatment as needed to improve consumer functioning, highlight treatment progress, and reduce symptom deterioration (see Using Measurement-Based Care to Enhance Any Treatment and Implementing Measurement-Based Care in Behavioral Health: A Review).
Why are incorporating the use of these practices into your organization important? Health plans are looking for provider organizations that can show reliable outcomes. Payers want to direct their members to treatment with proven results. Additionally, with the uptake in value-based reimbursement, provider organizations are not only going to have to take a look at cost and quality, but they are going to have to be able to replicate those results. The integration of standardized care combined with EBPs and measurement-based care makes replication easier. Stay-tuned over the next couple of weeks as we discuss case studies, payer preference, and tips for integrating these practices into your organization.
For more on best practice management, join us next month at The 2019 OPEN MINDS Management Best Practices Institute, where OPEN MINDS chief executive officer, Monica E. Oss will discuss the role of best practices and innovation in building a sustainable business model in her keynote address, “The ‘Melting’ Value Chain: Defining Best Practice Management Models In An Era Of Change.”