Our next segment is dedicated to delivering high-quality care. What we choose to measure says a lot about us, as Sian mentioned just two seconds ago, and the goals we want to achieve. So much of this talk echoes what's been talked about so far. And I'm going to jump into the definitions of benchmarking. So we have a benchmark about what benchmarking means. Say that 10 times fast. So you can see from this slide what most people agree represent benchmarking. And benchmarking's goal really is to improve performance. So benchmarking includes all of these things, right? All of you are engaged in these activities whether you realize it or not. You may be unwilling participants, so to speak. It's a strategic and business imperative, particularly because health care is moving to a value-based payment system. All of these play a role in how health care is delivered. And the cost and value of those services you provide will impact on your success of your unit. So we're going to go to our first polling question for this talk. What challenges does your endoscopy unit face the most? A, cost containment and reimbursement. B, staffing. C, clinical integration. Or D, patient-related issues such as preps, no-shows, satisfaction scores. Okay. So I may have worded this a little bit wrong in terms of answer C in terms of clinical integration. Maybe I didn't. Maybe people didn't understand what that meant, so they didn't choose that. But obviously, you can see that staffing concerns is one of the most significant challenges for endoscopy units, followed by patient-related issues. So endoscopy units everywhere are facing challenges, and I've listed many of them here. Many of you are acutely aware of some of these challenges. And additional challenges are listed here. As you can see, sometimes these demands can seem counterintuitive, right? So for example, you want to have some significant outlays for technological advances. You want to put in the latest, greatest endoscopy equipment, and they can have some significant upfront costs which can impact your bottom line. So how do you decide from a business plan perspective if a particular technology such as artificial intelligence will have enough return on investment to justify its upfront and or ongoing costs? Fortunately, healthcare costs, although rising, seem to be decelerating in their percent rise year to year. If you recall the triple aim from my first talk, one of the aims is to reduce healthcare costs. In this figure, you can see that 2021 had a slight dip in costs, although as you know, this was because a significant number of patients in our population avoided their usual healthcare during the pandemic. Many people stopped coming in or did not even undergo their screening colonoscopies. But you can see that with Medicare alone, a projected $1.8 trillion in healthcare costs is expected by 2031. So what does we mean by value? It was really in the eye of the beholder. The healthcare team basically looks at value as equaling quality plus service over cost. However, employees or employers actually look at value as equaling to employee productivity plus employee satisfaction over cost. And for patients, the value equation looks like the healthcare team, but quality from a patient perspective may not necessarily be the same thing from the nurse or physician perspective. For example, a patient may look at more time spent with them as a quality metric, whereas the nurse may look at efficient throughput with less pre-op time waste as a quality metric. And whereas physicians and nurses look at quality and safety as being of the utmost importance, patients may look at cost as being a greater factor. So physicians, employers, and physicians and nurses look at weight of each of these factors differently. Patients have a different perspective of what quality means and what cost means versus what employers and physicians look at. So many of you are aware of the Centers for Medicare and Medicaid Services moving from a traditional merit-based incentive payment system to merit-based incentive payment value pathway, which was started last year. These are based on benchmark measures and activities that CMS will require to be reported for payment. The MVP pillars are familiar to those who have been involved with meeting MIPS, with the population health pillar added. There is a GI care MVP version, which was posted in December of 2023. And as some of you know, all of the GI societies, including the ASGE, have expressed significant concerns regarding these measures proposed for the GI care MVP, and a letter to CMS can be found in your course materials. You will need to pay attention to those measures as you establish your own benchmarking and quality metrics in your unit. Many of us think about quality as meeting a benchmark for procedures, such as adenoma detection rate, but there are multiple definitions of quality as it pertains to the operations for endoscopy units. These are shown here. So measurable quality can apply to ADRs, but also to turnover times and disinfection protocols. Appreciative quality can apply to competency in procedures and procedure skills, and perceptive quality can apply to patient and employee satisfaction. So here are quality indicators for colonoscopy screening. I chose colonoscopy because it's the most common endoscopic procedure being done in the United States. You will see several goals listed here, but you will note that there are not any goals for perceptive quality. And so, for example, from a patient perspective, their satisfaction with their PrEP or their procedure is not yet a goal. This figure shows several ways to improve colonoscopy quality based on those goals. You can see that every team member can assist in meeting the benchmarks and quality metrics for colonoscopy, from pre-procedure calls from schedulers and nurses to go over PrEP instructions, to techs and nurses assisting in polyp detection and adequate removal, to biomedical engineers and ensuring equipment and video monitors are working properly for high-definition endoscopy, to the IT people developing code and the electronic health record for pathology specimens and appropriate screening and surveillance intervals. Data from meta-analysis of randomized controlled trials show that the impact of these interventions on adenoma detection rates and advanced adenoma detection rates, audit and feedback are important. Gathering data from every endoscopist performing screening colonoscopy and providing that information back to the endoscopist is an important first step. There are several procedural techniques that can improve ADR. One example is a dual observer. How many of you encourage techs and nurses to assist the endoscopist in identifying a polyp? We discussed team psychological safety in my first talk. If a nurse or a tech points out a possible polyp, will the endoscopist get angry or will he or she encourage it? There are several assistive devices. I don't know how many units actually use these. Then there's AI, which has increasingly entered the realm. It's the laces kid on the block. It soon will move to Barrett's esophagus screening and surveillance and capsule endoscopy interpretation. But it's not just adenoma detection rate, right? I'm sure many of you out there have asked yourself, do I want this doctor to be doing their colonoscopy or my colonoscopy or my loved one's colonoscopy? These are intangible and factors in perceptive quality that matter as well and are not measured. How does your team meet that challenge? How are you and your team achieving your unit's benchmarks and quality metrics? What if you have an endoscopist? You're the endoscopist who has an ADR of 38%, but your colleagues are a lot lower. What about a 10% cancellation or no-show rate? Can you say that you're delivering high-quality care to your population? Remember, population health is the other pillar in the GI care MVP. What about 15% of preps are inadequate? Patient experience scores are declining. Employee engagement's declining. There's a high nurse tech turnover. Specimen errors are increasing. Infection control issues are becoming a problem. And supply chain costs are up because we have endoscopists who are using lots of different accessories, maybe unnecessarily. We have a physician who's using five hemoclips to close a five-millimeter polyp defect. Those are all issues that come up. So, you saw this slide from my first talk. Endoscopy teams that are patient-centered and emphasis on team-centered achieve better benchmarks and quality metrics. It really takes a robust and thriving team culture to be high-performance. And you've seen this slide as well. These are the principles of high-performing teams that build that robust and thriving team culture, which then leads to success in meeting benchmarks and quality metrics and beyond. This is one of the take-home slides I recommended you bring to your team. Here's another take-home slide I recommend, showing you the strategies that need to be adopted and the core competencies that need to be developed for a high-performing endoscopy unit. Having a vibrant team culture enables sound strategic execution of your team mission and goals. Every team is unique and different in many ways. I'm going to give you five strategies to consider in getting the most from your team to achieve success in getting benchmarking and quality metrics done right. Utilize recommendations from my first talk on team-based care. It really takes time, patience, and hard work to establish a vibrant team culture. And it requires constant nurturing. Know and share your benchmarks. Utilize the ASGE in reviewing them. The ASGE has a lot of resources to help you. Understand how you compare with other similarly situated endoscopy units is a good way to identify areas of improvement. So, we're going to go to our polling question here. Which of the following benchmarks are you aware of and share? So, number one is adenoma detection rates. Number two, turnover times. Number three, patient satisfaction scores. And number four, labor costs as a percentage of overall expense. So, if you don't share any, your answer is going to be zero. If you share one of these, your answer is going to be B. If you share two of these, your answer is going to be C. And if you share three or more, your answer is going to be D. Wow. This is impressive. So, it means that 78 percent of endoscopy units are sharing two or more of these benchmarks. That is really impressive. So, here's an example of a practice in New York City in which they're comparing their hospital and ASC endoscopy units. Looking at a variety of measures listed here, you can perhaps see that there's a variability in pre-procedure history and physical documentation, handoff documentation from the nurse in the room to the nurse in the recovery area, and handwashing. So, knowing the data allows you to make plans to improve. Here is an example of benchmarks and quality metrics for physicians that not only include sequel intubation rates and other typical colonoscopy metrics, but also patient satisfaction scores. Another example of a New York practice showing adverse events and cancellations compared to local, regional, and national averages. Here, you can see that the benchmarks included cancellations both within 24 hours and after they were in the pre-procedure area, and you find out, for example, maybe they didn't prep correctly or they didn't have a ride. So, you can see these metrics. Here's an example of benchmarking time efficiency with on-start times, procedure times, and visit duration. You can see that there are outliers in some physicians with regards to colonoscopy and endoscopic ultrasound. You can use these data to identify processes to improve efficiency. And you can even dive down into labor costs and scope repair expenses to compare your unit with other similarly situated endoscopy units to identify areas that need improvement. Here's an example of practice operations benchmarking. And as you can see, benchmarking really is unlimited in its scope. No pun intended. So, the third strategy is to target those benchmarks and quality metrics that are crucial for your team's strategic plan and mission. And look at those that don't just focus on the clinical ones, but also financial, operational, and satisfaction benchmarks, which I've listed here. Develop a process improvement plan. I'm not going to spend too much time on this other than to say using a PDSA framework or a SMARTI framework. SMARTI, some of you may know, stands for Specific, Achievable, Measurable, Time-bound, Inclusive, and Equitable. Those are templates for process improvement. And you'll hear more about this in the quality improvement projects. And then the fifth strategy is to repeat your process for continued improvement and success. You may find out that in your re-evaluation, there are issues with team culture and behaviors that affect your benchmarking and meeting your quality metrics. So, remember the acronym for team. Having a vibrant team culture leads to success in achieving benchmarking and quality metrics. Thank you for listening.

benchmarking

healthcare

performance improvement

endoscopy units

team culture