How can a Portfolio Management Office (PMO) support the advancement of your innovation strategy?

I am sure you may be asking, “What is a Portfolio Management Office (PMO)?” In order to better understand a PMO, we can begin with some high-level definitions.

A portfolio is a collection of projects and/or programs that are coordinated (timed and sequenced) to support the efficient execution of strategic initiatives. Portfolio management is an approach that incorporates tools, processes and methodologies to support achievement of strategic goals through transparent reporting and outcomes tracking. The Portfolio Management Office serves as a center of excellence to ensure project prioritization, resource allocation, goal alignment and outcomes achievement are occurring in an efficient and effective manner. Portfolio management ensures that the collection of projects/programs selected are supporting the achievement of the strategic goals of the organization.

Shortly after the OSF HealthCare Performance Improvement division (supporting the execution of strategic initiatives) was formed in 2009, the need to establish a PMO was quickly identified. Absent a PMO, speed to value and achievement of outcomes were stifled. The challenges included:

  • No central tracking for project work
  • Lack of visibility into resources and timelines
  • No shared reporting to executive leadership
  • Inability to spread internal best practice when outcomes where achieved
  • No consistent tracking of outcomes achievement
  • Lack of project transparency resulting in duplication

A small team began working to build a customizable, centralized database that would allow consolidation of information across the organization and mitigate the challenges encountered. Building the shared database was complex. We had to understand and agree upon what information was needed within the database to support an efficient and effective PMO. Our ability to build a robust tool linking our strategic goals, prioritized initiatives, ongoing progress monitoring, detailed reporting and outcomes tracking provided significant value across OSF for executives, PI practitioners and other Mission Partners.

Developing a PMO for OSF Innovation

In 2016, Performance Improvement moved into the OSF Innovation space along with several other disciplines including Jump Simulation, OSF Ventures, OSF Partnerships, Healthcare Analytics and Telehealth. These disciplines were brought together to work collaboratively to solve the most complex problems facing health care. As our teams began working together we quickly identified the need for a shared portfolio. We had all been working on various strategic initiatives but were doing so within our own silos. We recognized that in order to collaborate, create speed to value and solve the most complex problems facing health care we needed a PMO for Innovation.

OSF defines innovation as the process of translating ideas that align with our vision of transforming health care into value for the benefit of the patients and communities we serve. Our ability to translate ideas into value requires efficient portfolio management and transparent sharing of information both of which are achieved through the PMO.

PMOManaging an Innovation portfolio introduces additional complexities such as the mix or balance of projects within core, adjacent and breakthrough. Core initiatives involve optimization of existing products, processes or assets for existing patients and employees. Adjacent projects are those that expand from an existing model to a new model. Breakthrough projects include developing concepts and inventions for areas and/or markets that don’t yet exist. Many studies have been conducted over the past several years linking effective portfolio balance to improved outcomes.

The “gold standard” when determining balance is 70% core initiatives, 20% to adjacent and 10% to breakthrough. Focusing efforts in the core allows you to build a solid, stable, reliable foundation that can support the introduction of new adjacent models as well as new inventions. Organizations will always have a need to advance their strategy which requires 70% focus on the core initiatives, but if you don’t balance that with the other 30%, you will likely only achieve incremental improvement and miss the opportunity to introduce innovative solutions. You must also consider how to manage adjacent and breakthrough work as an integrated component of your portfolio to achieve your desired outcomes.

The PMO at OSF supports our ability to make decisions that will advance our innovation portfolio and extend our Mission to serve with the greatest care and love.

Healthcare Analytics: Leveraging data to transform health care

healthcare analyticsIn today’s reform environment, the importance of turning data into timely and informed decision-making is a fundamental requirement for health care provider organizations. Analytics are vital to support health care transformation by providing the key information for the management of populations to achieve value. Data on patients, their medical status and the progression of their conditions will be available from new sources, in new formats, in much greater volumes and at more regular intervals. This avalanche of data including the kind related to new practices, devices, treatments and outcomes will need to be organized and structured in a logical framework to enable informed decision-making.

As we continue to transform Healthcare Analytics at OSF HealthCare, we must make critical decisions about future partnerships to support big data analytics, predictive modeling, population health analytics, as well as, implement systems and processes that support the ability to truly understand the cost of care.

OSF Healthcare Analytics Vision & Guiding Principles

The vision for the Healthcare Analytics Division, a part of OSF Innovation, is to enable and enhance an analytics capability that supports a growing culture of data-driven and contextual decision-making. Continued development will enable OSF to leverage analytics and process improvement techniques to serve high-performing care delivery teams and our patients, in a manner where OSF is seen as one of the innovative pioneers of the new health care model.

We have a variety of roles within OSF including to support the One OSF strategy, clinical agenda and the execution of strategic initiatives. Our group establishes an enterprise view of revenue, cost and quality information for every patient and clinician and encourages a single source of truth for the tactical and strategic analytics information needs for the organization.

We’ve developed a common analytics model to easily track ministry priorities. Healthcare Analytics continually explores and tests new data sources, techniques, and tools, seeking to optimize and enhance our clinical and strategic analytics.

It’s also our role to grow a robust, thriving team with a depth of technical knowledge, clinical expertise and business acumen.

Healthcare Analytics Scope

As OSF HealthCare continues to expand geographically, enhance patient care to provide excellence in clinical outcomes and move to value-based population health care, there is increased need to integrate and transform more data from our source of electronic health records and many other external data sources. The integration and development of data provide the capability to turn the data into information driving knowledge, insight and ultimately outcome optimization and foresight for OSF leaders, clinicians and Mission Partners. As we advance down the analytics journey to having more capability to provide prospective analyses, we will be able to reveal systemic issues and accelerate diffusion of best practices which represents the next phase of advanced analytics.

The health care industry has an imperative to do more with less which means growing systems like OSF have ever-growing demands for analytics capabilities to support their decision-making needs. OSF Healthcare Analytics continues to support the strategic goals and initiatives of OSF through the ongoing development and expansion of its scope of services.

To keep pace with the needs and demand, OSF must continue to invest in the resources (Mission Partners and Technology). That includes developing ways to recruit and retain the best candidates. In addition, the need for new sources of data, predictive algorithms and modeling will require expansion and new technology infrastructure considerations such as evolving from a data warehouse to a data ecosystem which includes both on-premise hardware and cloud-based infrastructure.

Products – Clinical, Population Health, Market/Consumer, Financial & Operational Analytics

Over the past four years, Healthcare Analytics has developed and maintains numerous Dashboards to assist in monitoring progress toward OSF goals as the dashboards have established targets and are used to drive performance improvement. In addition, several self-service Explorers which are information exploration tools, assist our Mission Partners in using available information to uncover valuable insights and opportunities.

Over the years as Healthcare Analytics has matured and extended the access to key strategic information across the Ministry, there continues to be a growing need for analysis and insight development in partnership with many business/clinical leaders driving change and improvement. Healthcare Analytics provides expanded analytic information, services and analytic insight to improve patient care, outcomes, population health, operational and financial performance.

Advanced Analytics

The Advanced Analytics team was established as part of the Analytics Transformation at OSF, with the vision to create a focused functional team that specializes in utilizing advanced analytics techniques including Descriptive, Predictive and Prescriptive Modeling, Decision Trees, Machine Learning, Natural Language Processing, Image Processing, Simulation & Optimization and robust statistical analysis to serve high-performing care delivery teams and their patients.

The Advanced Analytics team is composed of Data Scientists and Statisticians. At its core, the team focuses on matching the best tools to the project needs and audience. There is a tremendous opportunity at OSF to leverage advanced analytics resources to innovatively enhance the way we care for our patients. To create value for OSF, Advanced Analytics team members closely collaborate with business and clinical leaders to understand the problem, define focus questions, prepare appropriate data, build effective models and implement solutions to enable business and clinical actions guided by model results. Business value is often maximized when the deployment of the model is integrated with clinical workflow to provide prompt or near-real-time opportunity for intervention.

 

Mission Partner hopes to inspire women to get screened

Sometimes when it rains it pours. Ida Lassandro understands this perhaps better than anyone. It was 2015 when she, still reeling from the sudden death of her husband David in 2014, received her diagnosis of breast cancer.

“It was difficult,” she says. “I was still grieving my husband and now I had cancer. There were lots of struggles along the way, but I had to keep on going.”

The next couple of years were equally rough on Ida. With radiation treatments and multiple surgeries, it was not only a physically draining time, but an emotionally draining one.

Thankfully, Ida had the love and support of her family to help her endure and keep on fighting Plus, as a patient accounts supervisor who’s been with OSF HealthCare Saint Anthony Medical Center for 36 years, she had a strong crew of co-workers to lean on for strength. A visit from Pink Heals volunteers didn’t hurt either.

“My co-workers have been amazing,” she says, “And I can’t say enough good things about our cancer center here at OSF. They’re like a family to me.”

Thanks to the great work of her care team at the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony, Ida has pulled through and is now cancer-free.

It’s been a harrowing few years, but she’s looking forward to a healthy future and has some simple advice for other women – advice she hopes resonates during Breast Cancer Awareness Month in October.

“Get your mammograms regularly, and report any changes to your physician as soon as you notice them. Early detection is crucial. It can save your life.”

Mammograms are the single most effective tool in the early detection of breast cancer and are proven to save lives. When detected early, doctors can begin treatment before symptoms begin, resulting in a better outcome. Learn more at our women’s health page.

According to the American Cancer Society, death rates from breast cancer have been declining since 1989, which is believed to be due to a combination of increased awareness resulting in more women getting screened regularly, advancements in screening technology and advancements in treatment. However, there’s room for improvement. More than 40,000 women in the United States are still expected to die from breast cancer in 2017.

Interns accelerate OSF Innovation projects

We’ve talked a lot about the importance of collaboration within OSF Innovation. It’s our belief it takes multidisciplinary teams working together to generate ideas that will transform health care for the benefit of the communities we serve. These teams can consist of anyone from Performance Improvement, Healthcare Analytics, Telehealth, Simulation & Education, Innovation Partnerships, OSF Ventures as well as those outside of OSF Innovation. They work together to transform care through the Complex Solution Innovation (CSI) division of OSF Innovation which developed a standard for how multidisciplinary teams will approach, collaborate and innovate around the toughest problems in health care.

Over the summer, we integrated college interns from various universities onto our teams. Many were shared from the Jump Simulation Engineering Internship program and one group was from the University of Illinois at Urbana-Champaign. We didn’t know what to expect from these young people considering they would only be with us for about a month and a half. However, the results they have achieved have been extraordinary with at least a couple of projects identified for further development.

What we found in working with our interns is that we can engage them much like our professionals and challenge them with difficult tasks with the help of subject matter experts. Here are a few of the projects our interns brought fresh ideas to over the summer.

Improving Our Predictive Models (Led by Chris Franciskovich, Manager of Advanced Analytics)

The Healthcare Analytics team developed and continues to advance a readmission model that helps OSF HealthCare predict which patients are at most-risk for hospital readmissions. Patients identified as high risk are assigned a case manager who does a thorough clinical review and looks at their social needs to line up interventions when they leave. The idea is to help the organization reduce the hospital readmissions rate Ministry-wide. We hope to build the ability into our model to target specific diseases.

The analytics team got the opportunity to bring on board three U of I interns to work on this project. One is a computer science major, one is working on a Master’s degree as a statistician and one is a Ph.D. engineering student. Their charge was to find a way for the model to be applied specifically to the heart failure population.

The intern team developed a model that matches the results of the OSF program. This challenge showed that we need to have additional iterations to meet the solution we envision. But it’s something the analytics team will continue to work on. We found the interns to be valuable to our work and welcome the opportunity to bring other students onto our teams. The U of I has one of the top five Computer Science Graduate programs in the United States.

Access to Care (Led by Roopa Foulger, Vice President of Data Delivery)

Access t Care internsPerformance Improvement (Ministry and Saint Francis), Healthcare Analytics, Finance, OSF HealthCare Saint Francis Medical Center Logistics and others collaborated with summer interns to focus on capacity management issues at acute care sites throughout OSF. The goal is to ensure all of our patients can access emergency care where and when they need it.

The three interns came from Arizona State University (Justin Bloomer, biomedical engineering), Bradley University (Steven Gallagher, computer science) and the University of Illinois College of Medicine (Matthew Schaeffer, M2). Using system data, the three interns helped the overall team find three different business opportunities in the span of about one-and-a-half months.

One set of data around different types of surgeries found that procedures were starting about 14 minutes after the scheduled time, impacting operations for the rest of day. The team also looked at how many procedures were canceled on the day they were supposed to occur. They found that certain specialists had higher rates of cancellations than others. Both of these issues need to be explored further to determine why this is happening and how it impacts our patients’ experience.

Another deep dive into system-wide data found that nearly 300 patients who were transferred to OSF HealthCare Saint Francis Medical Center from other smaller OSF facilities didn’t need to be. This resulted in 388 other patients being denied access to the Peoria site. 60% of those denied were then transferred outside of OSF for treatment. This particular project also led to the development of a database for the improved collection of transfer and denial data. Saint Francis was initially using spreadsheets to gather this information. Purchasing a similar type commercial product had the potential cost of $250,000 to the hospital.

Much of the data collected by our interns will be used to build business cases around what the future design looks like for capacity management. Being able to lay out the complexity of this data helps paint a picture of why certain solutions will need to take place.

More for Those with Less (Led by Sarah de Ramirez, MD, Vice President of Transformation Innovation)

Social innovation internsAn ongoing issue for health care systems around the nation is hospital readmissions. A major contributor to patients having to revisit the hospital soon after discharge is their living circumstances. Maybe they can’t pay for medication; maybe they don’t have access to transportation for follow-up doctor’s visits, or maybe they just don’t have the ability to take care of themselves.

The Mobile Integrated Health program launched in March at Saint Francis Medical Center, in partnership with Advanced Medical Transport and the East Peoria Fire Department, aims to address some of these unmet needs through in-home visits over the course of a month and connection to social service agencies. It specifically targets patients who are at greatest risk for hospital readmission but don’t qualify for in-home services. Our intern project through OSF Innovation found a way to expand it even further to serve more patients.

The MIH program is currently offered to inpatients at Saint Francis, but the program hasn’t picked up much steam with only 35 patients being referred since March. That’s out of 443 who were eligible. The interns two of whom are in medical school (Sean Patel and Michelle Williams, U of I College of Medicine) and the third applying for entry (Ryan Nierstedt, University of Pittsburgh) worked with leaders of the program to develop a process map for the referral process and found multiple areas for improvement.

The group then investigated other MIH programs across the country to determine their strategies and operations and found that many were successful by not only reducing inpatient readmissions but also decreasing inappropriate Emergency Department utilization. Many patients who frequent the ED are Medicare/Medicaid/self-pay patients and usually have conditions that can be better handled outside of the hospital, but factors such as socioeconomic status, education and access impact whether these patients can get the help they need.

Knowing Saint Francis did not incorporate frequent ED utilizers in their program, the intern group went back to the leadership of the current program, ED physicians and ED case managers for approval to determine whether adding these patients to the model was feasible. Further research identified 438 high-risk patients who used the emergency department at Saint Francis at least five times or more in a year for non-emergent reasons and could have benefitted from the MIH program.

The interns then worked with Performance Improvement to develop a process map for ED referrals in order to avoid the problems noted on the inpatient side. Working with ED case managers, the team identified 57 frequent ED utilizers, considered high-risk, who would be ideal candidates for the MIH program.

By using data from the interns’ investigation into other MIH programs, they determined that these ventures have the potential to reduce ED visits by roughly 50%. Assuming 70% of the 57 Saint Francis patients accepted MIH services, the hospital would likely be able to open more space to individuals who need emergency care and save money.

The success of the interns’ findings led them to explore the feasibility of expanding the MIH program across the OSF organization. They found multiple locations where it could be implemented with potential success.

The next step is to finalize a business case and determine how the program fits into the larger OSF strategy. In the meantime, this intern project demonstrated the way OSF Innovation wants to continue to work in the future. We will continue to enable multidisciplinary teams where they focus on a specific problem for a sprint discovery. The work completed by the interns is a prime example of how much we can accomplish when we provide focused effort.

Learn more about other projects OSF Innovation is working on by visiting our website at osfinnovation.org.

Surgery saves Galesburg woman’s life – and family

For Christa Van Unnik, of Galesburg, the fall of 2009 was an exciting time. Her husband had returned from his deployment to Iraq, and they had moved back from North Carolina where he had been stationed. On top of that, they found out they were pregnant with their first child.

But their elation was tempered when Christa had to visit the emergency room.

“Two days after finding out I was pregnant, I went to the ER with severe pain,” Christa said. “The next four to five weeks were pretty rough. I was sick all of the time and very weak.”

A turn for the worse

On the night of November 18, after feeling the best she had felt during her pregnancy, she started to experience extreme pain.

“I spent the evening in the bathroom thinking I was constipated. I also had severe pain in my right shoulder, but I didn’t attribute any of this to my pregnancy,” Christa said. “On the morning of November 19, my husband woke me up to go to my doctor’s appointment. He had to pull me out of the bed because I could not get out on my own.”

Christa made it to the end of her bed before sitting back down.

“I remember sitting on the bed and then I woke up, my husband was on top of me about to perform CPR and my sister was on the phone with 911,” Christa said. “I had passed out and started shaking like I was having a seizure.”

When first responders arrived, they had a difficult time finding Christa’s pulse and placed her on oxygen. The ambulance took Christa to OSF HealthCare St. Mary Medical Center Emergency Department in Galesburg.

“I remember the ER doctor asking me questions and performing the various checks. I remember being wheeled to the ultrasound department to check on the baby, and that’s when they discovered my left fallopian tube had burst and I was bleeding internally,” Christa said. “I was immediately rushed to surgery.”

‘My surgeon did everything to save my life’

Christa was in a crisis situation. Surgical Services at OSF HealthCare St. Mary put all other blood transfusions and surgeries on hold and rushed her into surgery.

“I remember seeing the OB doctor running down the hallway,” Christa said. “I appreciate her hustle, and I am so thankful she did everything she could to save my life.”

Christa had to have five units of blood transfused because of all of my blood loss, and went into shock on the operating table.

“I have spoken with the surgical nurse that was with me that day, and she has told me that they were so afraid they were going to lose me due to all of the blood loss and the coding. The nurses were squeezing the bags of blood as hard and as fast as they could to get the blood into me quicker,” Christa said. “I am ever so grateful for all of the staff that were there that day that saved my life.”

Christa attributes the surgical team at OSF HealthCare St. Mary with saving her life.

“Before I went to the hospital, my husband and I thought I was just constipated. After we made it through a deployment to Iraq, and then to think that this was possibly the last time I was going to see him,” Christa said. “The look on his face when he found out I had to have surgery, and then to see him after waking up was a blessing.

“After my surgery I was very afraid that I wouldn’t be able to have kids. Thankfully, I was blessed with two beautiful girls that mean the absolute world to me. I thank God for them every day.”