How Utah Shares and Spreads Improvement Using the Value Summary

The Problem(s)

The Value Summary solves two thorny problems of system-wide improvement:

1. Improvement work isn't easy

Think about the all-too-common issues that plague project teams and health care in general: no clear goals, not understanding the root causes, etc. They’re real. In fact they’re so common, they’re not thought of as problems. It’s not enough to promise yourself to avoid these traps.

2. Engaging an organization isn't easy

Once our large, matrixed academic health center became attentive, sharing and spreading improvement proved challenging. Attendance and an ever-shrinking pool of available time limited the impact of a traditional power-point report out.

Could technology help? We needed a tool to enable the adoption of a standardized improvement method, provide real-time education and coaching, create a forum to share and spread improvement across a system AND give the leader easy, real-time view into hundreds of improvement efforts.

What does it do?

The Value Summary meets many organizational needs.

1. Guide improvers through standardized methodology

Organizations that know how to improve performance faster adopt a standard methodology. The most well-known of these is Toyota's A3. Using a standard methodology requires discipline, and we’re trying to achieve that discipline through the Value Summary.

U of U Health’s improvement methodology combines lean, Six Sigma, and PDSA approaches. We think we’ve improved upon the A3 with the Value Summary, a modified A3, which guides improvers to ask the right questions to solve the right problems. It is a tool to plan, guide and teach improvement using proven methods.

Project Phase	Definition	Problems Prevented
1. Project Definition	Define the project vision, scope, goals, and team	Effort has no clear goals or scope (i.e., “Just get better!”) Multiple false starts The right skills aren’t available to you Unintended consequences: Fixing this issue may cause more issues
2. Baseline Analysis	Define the current state qualitatively and quantitatively	The perceived problem isn’t really as bad as you thought or felt The problem’s impact isn’t quantified Stakeholders don’t understand each other’s work processes
3. Investigation	Use data to direct the project	Hacking at the effects of an issue without addressing the root causes Competing directions from team members Underlying problems seem too numerous, broad, or unfocused Team members are blamed for the outcomes instead of a broken process
4. Improvement Design & Implementation	Select interventions, test them, and develop a plan to implement	Solutions are selected before the problem is understood Too many solutions are implemented (overkill) A broken process isn’t fixed; merely reinforced with organizational duct tape A new process depends entirely on training (soon to be followed by blaming) The solution depends entirely on hiring more people The “solution” is nothing more than promises of vigilance No one asked a patient about the old or new process
5. Monitoring	Track adherence to and performance of your new process	No tracking of solution’s impact; seems to be working, but maybe it’s not After a while, no one pays attention and performance drifts back Tracking the impact of the solution is hours of manual work

2. Share and spread ideas

Individuals and teams face similar challenges throughout the organization, but the spread of best practices often stops at a group or service line. The organization is large enough and busy enough that people in diverse parts of the organization do not have the opportunity to share. When there have been opportunities to share ideas, people are hungry for it. They love to teach and to learn from each other. They build relationships with each other that end up producing solutions that meet patient needs.

Ideas are more easily spread because of the Value Summary’s centralized online portal. Once a paper form shared through email or shared drives, the Value Summary functioned as an individual planning and reporting tool. Today, the Value Summary portal allows users to search and track efforts in real time. Everyone across our system can now access what they want when they want it.

3. Align the organization

Leaders want to know about the work that is happening on the front lines of health care, and the front lines of health care want their leader's support of their work. But in a complex organization, this flow of information can be stymied. It is important that everyone (leaders, physicians, and employees) in the system can work in and see the same form.

The Value Summary portal provides senior-leader level reporting of aggregate financial impact, team engagement as well as the breadth of projects. Leader-level reports create visibility into front line improvements without the need for formal reporting meetings, which allows executives to support projects in real-time.

Because of the diverse institutional needs reflected in the design, the Value Summary also meets organizational requirements, such as CLER expectations (Resident QI participation), and hospital accreditation (DNV, audit tracking).

4. Incentivize physician engagement

U of U Health utilizes an additional lever to incentivize physician engagement. By using the Value Summary to document improvement work, physicians earn Maintenance of Certification (MOC) Part IV credit. The University of Utah MOC Part IV program utilizes the Value Summary to guide improvement effort through enrollment, tracking, and reporting. To facilitate publication of improvements, the Value Summary is structured to accommodate SQUIRE 2.0 guidelines (SQUIRE is a framework for reporting health care improvements).

University of Utah Health MOC Part IV Improvement Program 2-Year Results

The Reflection

Can one tool enable a learner to act their way into thinking? Throughout the organization, the Value Summary is the only way to plan, measure and communicate the successes (and failures) of value work.

But our organization is more than just the sum of hundreds of Value Summaries. While the Value Summary was created for institutional reasons, it has impact for individuals. The Value Summary has become a path for self-reflection and learning. The Value Summary creates a scholar in every improver by reflecting on the steps taken and what made the effort successful.

Chrissy Daniels

Former Director of Strategic Initiatives, University of Utah Health

Mari Ransco

Editor-in-Chief, Accelerate Learning Community; Senior Director, Patient Experience and Accelerate, University of Utah Health

Brittany Patterson

Senior Business Analyst, Patient Experience, University of Utah Health