outcomes improvement governance the quest to achieve more ... · improvement. now, we think about...

OutcomesImprovementGovernance:TheQuesttoAchieveMorewithLess

November22,2016

OutcomesImprovementGovernance:TheQuesttoAchieveMorewithLess[00:01]

[TomBurton]Thanks,Tyler.GladtobewithallofyoutodayandIamexcitedtotalkaboutthisveryimportanttopic,theimprovementgovernance,andhowthatworks.

PollQuestion#1Which of the following symptoms of less-effective governance are present in yourorganization?(Checkallthatapply)[00:14]

So,Iactuallywanttostartoutwithapollquestion,andweseethesesymptomsalotasweworkwithhealthcaresystemsacrossthecountryandIwouldlikeyoutocheckallthatapply.Iwillreadthroughthemandthenwewillgiveyouachancetorespondtothispoll.Butletmeknowwhich of these symptoms apply to your organization. So, you might have pockets ofimprovementoccurbutveryfewinitiativesspreadtoeveryunitateveryhospitaloreveryclinic.Youhavesilosbetweendepartmentsandthatisprevalent.Thereisalengthyprocesstofundorapproveimprovementinitiatives.Youspendmoretimedebatingwhattoimproveratherthantheactualimproving.Therearelotsoftopprioritiesorconstantlychangingpriorities,orthereisa big battle for resources at budget time, or your organization has trouble saying "no". Inaddition,youmighthavealighteffortonawholebunchofareasratherthanadeepeffortonacriticalfew.

Sotheseareallsymptomswehaveseenbeforeandwewillnowopenthepolluptoseewhichofthoseapplytoyourorganization.

[TylerMorgan]Alright.Thepollisopenrightnowtogiveeveryonetheopportunitytorespond.Wehavegotabunch of folks come in. We do have a couple of questions. There are questions regardingwhetherornotwewillhavetheslidesavailable.Yes,wewillmaketheslidesavailableaswellastherecordingtothiswebinaraftertheevent.

PollResults[01:53]

[TomBurton]Alright.Takingalookatourresultshere.Itlookslikewehavealotofsilosbetweendepartmentsandalotoftimedebatingratherthanactuallyimproving.Andso,wewilltalkaboutalotofthesesymptoms today and what we feel are the resolution of those symptoms with some coreprinciplesaroundoutcomesimprovementgovernance.

LearningObjectives[02:18]

Okay.Sowehavefourmainlearningobjectivestoday.Thefirstistolearnhowtoengagetherightpeoplearoundgovernance.Second,understandhowimportantitisthatwehaveasharedunderstandingofthedifferentimprovementopportunitiesandwhatitisgoingtotakefromaresourceandanalyticsperspectivetoachievethoseimprovements.Wewilltalkabouthowwealign incentives andwewill also talk about balancing polarities. This is probably one of thehardestthingstodo. Andthefourthlearningobjectivewillbehowdoyouoptimallyallocatescarce resources to the most important, the highest priority, highest yield improvementinitiatives.

Welldesignedandexecutedgovernanceoptimallyallocatesscarceresources…[03:08]

So, at Health Catalyst®, we fundamentally believe that well designed and executedgovernance optimally allocates scarce resources, and when that is done, that significantlyaccelerates thebreadthandthedepthofoutcomesimprovement.Andso,wewilltalkaboutwhatisrequiredfor outcomes improvement and how, if we get governance right, it reallyimpacts outcomesimprovements.

WhyGovernance?[03:33]

SomeofyoumayhaveattendedotherwebinarsorcometoourHealthcareAnalyticsSummit™and we spent a lot of time talking about what are the key ingredients of outcomesimprovement.Now,wethinkaboutthose inthreemajorcategories–bestpractice,analytics,and adoption.Bestpracticeisreallywhatshouldwebedoing,shouldthispatientgetaspinefusion or should they just have a physical therapy. Then the question is how are theyactually doing – that iswheretheanalyticscome intoplay. Arewecompliantwiththebestpractice,arewefollowingthat,whatpercentageofthetimearewefollowingthat. Andthenfinally, there is typically a gap betweenwhatwe should be doing andwhatwe are actuallydoing–sohowdowechange,howdowe transform, and that is all about adoption. Whenthose three things work together, you get significant massive outcomes improvement.Now, that could be in one key clinical or operational area. For example, pregnancy orhearth failure or asthma. Now, how do you get it to spread to all areas, all clinical andoperationaldomainsofthecaredeliverysystem?

CapabilitiestoSCALEOutcomesImprovement[04:51]

Inordertodothat,youhavegottohavegreatleadershipcultureandgovernance,andthatwillbeourfocustoday,aswellasyouhavegottohavefinancialalignment.Sothesearethecoreprinciplesaroundscalingoutcomesimprovement.

AndIwanttoturnthetimeovernowtoagoodfriendofmine,DavidGrauerandalittlebitofbackgroundaboutDavid.DavidspentmanydecadesatIntermountainHealthcareandhismostrecent role before joining Health Catalyst® in our professional service team as one of ourkeyleaders,hewastheCEOof IntermountainMedicalCenter,which isthe largesthospital inthe State of Utah and he had the opportunity there to just spend a lot of time withimprovement work, governing that improvement work and seeing how all these pieces puttogether. So Iamveryexcitedtosharethiswebinartodaywithmygoodfriend,David,andIwillturnittohimnow.

[DavidGrauer]Thankyou,Tom,andthankyouallforjoiningustodayandgivingusthechancetotalkwithyouaboutourexperienceandsharesomebestpracticesthatwehavelearnedbothintheindustryandhereatHealthCatalyst®.

Andthewaythiswebinarwillbestructured,wehaveaseriesofprinciples,therearefourmainprinciplesthatTomhasintroduced,andeachoftheprincipleshasseveralstepsassociatedwiththem,andwewillwalkyouthrougheachoftheprinciplesandthestepsassociatedwiththem.

Principle#1:StakeholderEngagement[06:30]

Andletusstartjustwithprinciple#1,whichisaboutstakeholderengagementandtheconceptis really quite straightforward and it is starting at the top. Be sure that we engage all thestakeholdersaroundthecommonvision.

Principle#1:StakeholderEngagement[06:40]

Andthequestionstobethinkingabouthereasyoumakesuretherightpeopleareatthetableare on the slide here. Which stakeholders control key resources and funding? Whichstakeholders have specific domain knowledge? Who is themost qualified tomake tradeoffdecisions?Whocaninfluenceotherstoadoptchange?Whocanunderstandtherootcausesrelatedtopooroutcomes?Whoisbestabletoredesignmoreeffectiveprocesses?Andwhoultimatelywillbeimpactedbyprocesschanges?Thosearethequestionstothinkaboutasyoudesignyourteams,asyousetupexecutivegovernanceandasyouthinkaboutwhooughttobeincludedintheprocessandatvariouslevelsoftheprocess.

FourLevelsofStakeholderEngagement[07:28]

We think about and talk about four key levels of stakeholder engagement here at HealthCatalyst®.Those who control resources and make funding decisions at the executive level,those withdomain expertise or specific expertise, and that can be in any of a number ofareas – clinical,operational,financial,orothers.Thosewhohavetheabilityandtheexpertisetoinfluencetheadoption–soatanimplementationteamlevel,thosewhocanactuallysupportandencouragechange.Andthoseataworkgrouplevel,thosewhoareinnovativeandwhoareable to address root causes, identify and address root causes, and drive the process towardbetteroutcomes.

Soultimatelyaswethinkaboutthis,wearetalkingaboutthosewhohavetheabilitytodrivechange,tosupportchange,toresourcechange,andtofacilitatechange,rememberingthatthisisreallybothstrategicandtactical,andalotofthisrevolvesaroundtheorganizationalabilitytofacilitate cultural and adoptive change. And so, that requires, in our opinion, expertise andengagementatalloftheselevels.

Step1:CalltoAction[08:46]Sostep1underprinciple#1isacalltoactionandIliketothinkofthisasthebuglecallortheshootforthemoonstatementbyPresidentKennedyortheCEOoftheorganizationsayingthemostimportantthingthatwearegoingtofocusonissafetyasexamples.Andtheintentionhereisforaleadertocreatesomemomentum,tocreatesomeengagement,togivesomeauthorityandaccountabilitytotheteamandmakeitclearthatthiswillbeanorganizationalpriorityandthatwillberesourcedandthattherewillbecommitmentinordertomovethisprocessforward.It is critical for this to come really from thehighest level of theorganization that is possiblebecausethoseleadersaretheoneswhohavetheabilitytodriveanddirectthestrategicdirectionoftheorganization.Soitisthebuglecall.Itisthecalltoaction.

Step2:FormtheLeadershipTeam[09:48]

Step#2isaboutformingaleadershipandletmejusttakeyoubacktothosequestionsthatwereonacoupleofslidesago,whereyouthinkaboutwhohastheabilitytoinfluence,toresource,tosupport,todrivestrategy,andsoforth.Itiscriticalthatthisteamisrepresentative,inouropinionofmany,ifnotalloftheCsuitelevelexecutivesoftheorganizationbecauseoftheirabilitytodrivethethingsthatwearetalkingabout.Aprincipleheretothinkaboutthoughisbalancingagilitywithrepresentation.Itisimportanttobeagileenoughthattheteamcanmakedecisionsandbedynamicinitsworkbutwealsowanttomakesurethatitisrepresentativeenoughthatthosewhoareaffectedbytheworkandwhocanactuallydrivetheworkarethere.

AStoryofMissingStakeholders[10:47]

Justaquickstoryandaquickexamplethat isnotauniqueonetomeand it isprobablyverycommonwith all of you. Wehaveworkedwith a client. In fact,multiple clients,whohavemultiplehospitalsinmultiplestatesandtheoneIamthinkingofspecificallywasverypassionateaboutoutcomesimprovement.Theyidentifiedlotsofopportunity.Theyformedaleadershipandexecutivegovernancecommitteeandtheyfailedtoincludethechieffinancialofficer.Theydidatonofwork,theydidatonofgreatworkprioritizing,identifyingopportunities,planning,puttingteamstogether,andwhentheywerereadytopullthetriggerandstartdownthepath,theCFO,whoultimatelyhadafundingauthority,said,"Iamsorry.Whatareyoutalkingabout?"Andputablockonit.AndthepointIthinkhereisobvious.Youneedtomakesureyouhave,inthisexample,theCFOinvolvedearly,engaged,understandingtheprocessbecauseheorsheinthisexamplehastheabilitytostalltheprocess.Andreallythepointisitcouldapplytonursing,itcouldapplytothephysicians, itcouldapplytotheinformaticsgroup. Thepoint isthattheleadershiphastobeinvolved.Ifyouexpectthatyouroutcomesimprovementeffortwillaffectyourpositions,youhavegottomakesurethatyourchiefmedicalofficeristhere.Youexpectthatitwillaffectyournursingoryoushouldmakesurethechiefnursingofficeristhere.Inmyexperience, Ialwaysknewthat Ineededmyexecutiveteamwithmeifwearegoingtomoveanythingforwardsuccessfully.

PrincipleReview:StakeholderEngagement[12:29]

Okay.Justaquickreviewonthisprinciple.AndIshouldhavemakeaquerywhenwestarted.We believe these are guiding principles at Health Catalyst®. Some of the details, some oftheorganizational reality that youall experience isdifferent. This canbe flexible in termsoftheactualtacticalsteps.Forexample,youseehowinthisslideyoumayalreadyhaveateamthatislargelyconsistentwiththeprinciplethattheremayneedtobesometweaks,yourcalltoactionmay be slightly different. The key is following the core principle, adapting it to yourspecific environment and more specific reality. But remember, start at the top, engage allstakeholdersaroundthecommonvision.

Principle#2:SharedUnderstanding[13:16]

Principle#2isaboutsharedunderstandingandmakingsurethattheorganizationhasacommonunderstandingoforganizationalneeds,capabilities,andreadinesshere.

Step3:IdentifyHighLevelOpportunities[13:27]Oneofthemostimportantthingsthatanexecutivegovernancecommitteecandoinoutcomesimprovementisidentifypriorities.Andaswemovethroughthesesteps,wearemovingthroughanarrowingprocess.Andso,ifyouthinkaboutaverywidepanel,ultimatelywestarthighlevelandwenarrowtojustafewasthegovernancecommitteedoesthatwork.Andearlyonhere,thisisaboutidentifyingtheveryhighlevel,theParetoPrinciple,ifyouwill,andunderstandingsomeofthebasicopportunities,whetherit isthemostvariation,whetherit isthemostcost,whether it is themost opportunity, to improve outcomes at a high level and beginning thenarrowingprocessandunderstandingwheretheorganizationmightfocus.Rememberingthatthe data will tell you one thing, you have to apply the data and integrate it with yourorganizationalreality.

Step4:AssessOrganizationalCapabilities&Readiness[14:27]

Step#4againisnarrowingtheprocessandwearerecommendingafewstepsherethathelptoinform the governance committee about how to choose those priorities, and this is aboutunderstanding the capability, the capacity and the willingness of the organization to moveforward.Again,ifyoudonotunderstandthesethingsinadvance,youcannotplan,youcannotresource,youcannotpreparetobeginthisworkinearnest.

Thereareacoupleoftoolsthatwehavethatwehaveusedsuccessfully.Thediagramthatyouseeonthebottomrightisareadinessassessmentthatwecanhelpperform.Itisanonlinetoolthatlooksatthefivequestionsandthefivecapabilitiesthatyouseethere–leadership,culture,andgovernance,thesearethefivethatTomtalkedabout–Analytics,bestpractice,adoption,and financial alignment. Wecanhelpwith interviewsof keypeople, key team leaders. Andultimatelythegoalistolookathowreadyareyou,howcapableareyou,whatresourcesdoyouneed,wherearethegaps,andhowdoyoubegintheprocessofnarrowingthosegapstomoveforward.

KeyResourcesThatAreOftenScarce:[15:37]Thesearejustafewareasthatweareseeingrepeatedlywherethereareoftenscarcitiesinourexperience.Intheanalyticsanddataarea,dataexpertise,theabilitytocapture,provision,andactuallyinterpret.Alsointheprocessandqualityimprovementareasofexpertise,thosewhocanfacilitatechange,managementengineers,processengineers,andthesubjectmatterexperts,orSMEsaswecallthem,whoreallyunderstandthefundamentalsofeachoftheseprocesses.Communicationexperts,contentexperts,andthentheclinicalandoperationalleaders.Andwesee parenthetically adaptive leaders. Remembering here that much of this is aroundorganizationalandculturalchangeandtheabilitytoadapttothechange.Andso,itiscriticalthatthepeoplewhoareinleadershiprolesunderstandhowtochangeorganizationsandmoveforward.

PrincipleReview:SharedUnderstanding[16:38]Aquickreviewagain,the'How'canbedifferent,thekeyhereistomakesurethatyouhaveacommonunderstandingoftheorganizationalneeds,capabilities,andthereadiness,sothatyoucanplan,prioritize,andclosethegapsonresourcesinordertomoveforwardassuccessfullyaspossible.[TomBurton]Justacomment,David,onthatassessment.Thereisafreeversionofthatassessmentthatyoucouldjustgotoourwebsiteandtaketheassessmentasanindividual,andthatwillgiveyouagood senseof the types of capabilities that are really needed for broad anddeepoutcomesimprovement.Andso,anyoneiswelcometotakethat.Itisafreesurveyanditgivesyouaniceanalysisofkindofyourownpersonalassessmentofhowyourorganizationisdoingandthatcanbeagreatstartingpoint.

Principle#3:Alignment[17:30]Iamgoingtodivenowintothethirdprinciple,whichisalignment.Thisisoneofthemostdifficultprinciplestogetworkingwellinanorganization.Inoticedonourearlypollquestionthatsilostendedtobeabigchallengeandalignmentisallaboutbreakingdownthosesilos.Soaswethinkaboutalignment,thereareacoupleofcoreprinciples.Oneiscomingtogetheraroundhowyoudoimprovement;second,aligningincentives;andthirdandperhapsthemostchallengingisbalancingpolarities.

Step5:AdoptaConsistentImprovementMethodology[18:09]So letustalk firstaboutaconsistent improvementmethodology. Oftentimes,weseealmostreligiousbattlesoverwhatimprovementmethodologyshouldbeused,andweseetheSixSigmaCamp,thePDSACycleCamp,theToyotaProductionSystemCamp,theLeanCamp,allofthesedifferentmethodologies.WelltheyallkindofhavetheirrootsinDemingandtheyallhavethesameunderlyingcoreprinciples. And thecore importantconcepthere is tohaveacommonlanguagetotalkaboutimprovementworkandbeabletocommunicatetherootcauseproblems,be able to understand what are the deep challenges to getting to improving outcomes forpatientsintheareasweareworkingon.Itisnotreallyasimportantwhatthemethodologyis.Itisthatyouhaveastandardmethodologythatyoucancommunicatethroughandthatyouhaveasystematicwayofdoingit.Sothatisthecoreprinciple.Manyoftheteammayneedtobetrainedinanewmethodologyonceastandardisdeterminedandmakingsurethattheentireteamfromthetoplevelexecutivesdowntofrontlineworkersunderstandsthat improvementmethodologyisreallyimportant.

Step6:AlignIncentives[19:37]

The second key principle is aligning incentives, and this includes not just goals for clinical oroperationalimprovementbutalsofinancialbonusesandfinancialincentives,andhavingspecificgoalsaroundclinicalquality,financialobjectives,operationalorpatientexperienceobjectives,researchobjectives,andhavingthose(20:05) canhelptobreakdownthesilosthatoftenexists.

OneofthethingsbackinthedayswhenIwasatIntermountainthatwedidanditfeltlikethiswasahugechangewaswechangedalotoftheadministrators.AndDavid,maybeyourememberwhenthishappened,butwechangedtheadministrators'bonusplansfromstrictlybeingbasedontheirfinancialperformancetohavingclinicalandpatientexperiencegoals. Idonotknow.Maybeyoucouldjustcommentonwhatthatchangewaslikeandwhatimpacttheyhad.

[DavidGrauer]No,thatistrue.Andinfact,peoplewereoftenstunnedthattheadministrators'compensationwasbasedonmeasuresforwhichhehad,inmycase,noexpertise.SoIhavenoclinicalexpertiseyet.Iwasrewardedorpenalizedbasedontheclinicaloutcomesthatweprovidedatthehospital,thepatientexperience,andsoforthandithelpedtoalignallofusaroundthecommongoals,whichwereinthoseareasofsafetyandexperienceandclinicaloutcomes,aswellasfinancial.SothisisabigshiftandthisrequiresmaybemembersoftheCsuitetocomeintogethertodesignthoseobjectives and those compensationpackages thatwill actually promote alignment andpromoteworkingtogetheracrossdepartmentalorrowlines.Andso,thisisabigchange.But,itcanbeverypowerful.

Just a quick story. When we have started Health Catalyst® about eight years ago, SteveBarlowand I,we have been in the healthcare delivery system formanymany years andwehatedthe

waythatvendorsinteractedwithus.Wecouldsmellacommissionsalespersonamileawayanditbuggedus.Wehateditbecauseitwasallaboutthemhittingtheirquarterlynumber.Andso,whenwestartedHealthCatalyst®andafterthefirstthreeorfouryears,wefinallyhadtohireourfirstsalesperson,wewantedadifferentkindofcompensationstructure.Wedidnotwantcoin-operatedsalespeoplebecausewehadexperiencedhowbad inexperiencethatcouldbetryingtoworkwithsomeonewhojustfocusedonthenumberandwedidnotfeeltheyreallycareaboutusasadeliverysystem.

AStoryofAlignmentSuccess:[22:51]

SowecameupwithanalignedincentivepackageforeverybodyatHealthCatalyst®. Andso,thisis our – I will just share our bonus structure. It is based on three aligned incentives.Anddependingonyourrole,youmayhavelessormoreinfluenceonaparticular,oneoftheseareas,but everybody's bonus is exactly the same. So a third of everyone's bonus is basedon ourcustomers actually achieving outcomes improvement. Whether that's clinical orfinancialoutcomes, it ishelping themtoachieveameasurable improvement inoutcome. Sowe track that. We have a target number of outcomes improvement that we are going foreach quarterandathirdofthesalesteam,athirdofthefinancialteam.Everyone'sbonusisbased, a third on that metric. A third of everyone's bonus is based on staying within ouroperating budget and meeting the timelines that we commit to our customers. And thenfinallyathirdofourbonusisbasedonushittingouroverallglobalsalestargetsasacompany.Wellwhat this has done is it is amazinghow just this bonus structurehas changed a typicalbehavior.Sonow,asalespersonisextremelyinterestedinmakingsurethatthecontractthatiswritten is fair, that its timelines are realistic, and that we could actually achieve animprovementinoutcomes.

Inthesameway,adevelopingteammemberisreallymotivatedtogohelpthesalesteammaybewithademotoshowin-depthvisionoftheproductbecausetheirbonusisalsobasedonthewholecompanyhittingoursalestarget.Andithadthisreallypositiveeffectofcreatingbreakingdownboundariesandarereallycreatingateamkindoffeelingacrosstheentireorganization.So,wereallybelievethisprincipleisimportant.Wehaveusedthisstructureinternallyofhavingasinglebonusstructurebasedoncoreprinciplesthatwebelieveapplytoeverybodyandit ishowyoujumpback.

IndianaJonesandtheLastCrusade[25:05]

Alright.Now,Iwantedatthispointtoshowaclipofoneofmyfavoritemovies,IndianaJonesandtheLastCrusade,butIhavebeeninformedthatvideoclipsandwebinarstendtoalwayshavetechnicalproblems.SoIamjustgoingtodescribethistoyou.So,manyofyouhaveprobablyseenIndianaJonesandtheLastCrusade,andtowardstheendofthefilm,IndianaJoneshastogothroughthislabyrinthofdeadlytrapsinordertogettotheHolyGrailandhisfatherhasbeenshotandtheyareyellingtoIndianatohurry,youhavegottogettheHolyGrailsothatthehealingpowersofthismysticalcupandwatercanhealthedeadlywoundthathasbeeninflictedonhisfather.Andso,hecomestothispointanditisaleapoffaith.Thereisthishugecastleanditlookslikethereisnobridgeacrossthis.Andso,hehastotakeastepoutintowhatlookslikenothing.Hefeelslikeheisgoingtofalloffintothisdeepcavern.Andinreality,thereiskindofthis invisible bridge and he is able to then walk across this invisible bridge, which is justcamouflagedthatlooksjustlikethewallsofthedeepcavernandhemakesitacrosssafelyandthenhethrowssomepebblesanddirtbackoversoyoucanseetheinvisiblebridgeanditisnolongerinvisible.Well,thisisverymuchlikeapolarity.

ProblemorPolarity?[26:46]

Andletmedescribeapolarity.Alotofusconfuseproblemswithpolarities.Now,aproblemismuchmucheasierthanapolarity.Aproblemisnotongoing,ithasanendpoint,itissolvable,itiskindoflikewhatisthesolutionhere,figureoutwhatthesolutionisandapplyit.Apolarityisquitedifferent.Apolarityissomethingthatyouhavetomanageovertime.Itisongoing.Thereisnorightanswer.Anditisusuallyabalancebetweentwogoodthings.Andifyougettoofarextremeoneither(27:24)canbebad.Andso,whatyouaretryingtodoisdobothofthethingssimultaneouslyandkindofstayinthemiddle.

PolarityExample:DataProtectionANDDataSharing[27:33]

SotheanalogyIwanttodrawisitislikethisinvisiblebridgethatIndianaJoneshadtowalkacross.And ifhekindofgearedtotherightorthe left,hewouldfall intothecavern,but ifhestaysbalancedinthemiddleofthatbridge,thatwillbeagoodthingandhewouldmakeitacross.

So,letmegiveyouanexampleofapolarity.DataprotectionANDdatasharing.Soifyouthinkaboutdataprotection,somesymptomsoffallingoffacliffandgoingtotheextremewouldbeyourITcontrolsthefinalsign-offonalldataaccess.Andso,ittakessixmonthstogetsomeonewho has legitimate need for the access, the ability to actually log into an application withanalytical capabilities andgetaccessandbeable to see that information. Or someof thoserequestsjustgetdeniedanditisallaboutIhavegottoprotectthedata.Soifthatgoestoofarfromtheextreme,youarelimitingyourabilitytoimproveoutcomesbecausetherightpeoplearenotgettingaccesstothedata.

Now,however,ontheotherextreme,ifyouaresomuchaboutdatasharing,thatyoudonotputsafeguardsinplace,thatyoudonothaveaprocessforlegitimatelygrantingaccess,youcouldendupwithadatabreach.Hugeprivacyissuesthatcouldbringyourentirecompanydown.Oryoucouldhaveinappropriateuseofthedata.Andso,thatextremeisalsobad.Soifyouhaveeitherextremedataprotectionordatasharing,youcouldfalloff intothis(29:14),falloffthisbridgeintooneofeithersideofthecliff.

Now,whatistheevidenceofabalancedapproach?Whileyouhaveanappropriateandsecureprocessforgrantingaccessandauditingifthataccesswasappropriate,youwouldalsohavetheabilitytousedataforimprovementandyouwouldbeabletogettothatdataquicklysothatyoucouldmake improvementdecisions. So, streamlinedaccessprocess, consistent auditing, the

appropriateuseofdata,andbigdatastewards.So,cliniciansoroperationpersonnelwouldbetheonesgrantingtheaccess.So,thisisagreatexampleofapolarityandonethatweseepeoplestrugglewithquiteabit.So,letustalkabitabouttheprincipleofmanagingthesepolarities.

Step7:KeepPolaritiesinBalance[30:12]

Sothekeyistokeeppolaritiesinbalance.Now,therearealotofpolaritiesthatyouwillneedtomanage.Andso,youdonotwanttotackleallthepolaritiesatoncebutidentifyyourtopfivepolarities that your organization struggleswith and put some policies and processes aroundmanagingthosepolarities,sothatyoukeeptheminbalance.SimilartotheexampleIgavewithdataperfectionversusdatasharing,youcouldhavepoliciesaroundwhatisareasonableamountoftimefortheaccesstobegranted,whograntsthataccess,whohasthestewardshiptoremovethataccessonceaprojectisdone,oristhatcontinualaccessbecauseoftheirpermanentrole.Thoseareallthingsyoucandefinewithpolicies.Now,letmejustmentionherethatoftentimespeoplegetstartedondatagovernancewiththesetypesofpolaritiesattheproblemtheyaretryingtosolvebuttheydonotthinkaboutthemaspolarities.Theythinkaboutthemjustasonesideofthepolarity.Andwhathappensinthosecasesisyoucreatetheextremepolicythatservesoneofthegoodprinciplesbutignorestheother.Andso,datagovernance,outsideofthecontextoftheimprovementgovernance,canbecomeveryproblematicandfrustratetheimprovementefforts.So,wearenotgoingtotalkindetailaboutdatagovernancetodaybutmanyofthedatagovernanceprinciplesarepolaritiesthatneedtobemanaged,buttheyneedtobemanagedinthe context of overall improvement governance because any analytic system that you arecreating,thefocusofitistoimproveoutcomesforyourpatients.Andifyouapplyrigorouspolicyfordatagovernanceoutsidethecontextofimprovementgovernance,youwilloftenbefallingoffthecliffintothedeepcavernthatIndianaJonesdidnotfalloffofbecauseyouarenotdoingitin

context.So,findthosetopfivepolaritiesthatarechallengingforyourorganizationandmanagethosepolarities.SoIwanttogoandasktoshowyousomeexamplesofsomepolaritiesandthenwearegoingtohaveapollquestionheretoseewhichpolaritiesyourorganizationisstrugglingwiththemost.

PolaritiesExamples[32:43]So here are just a fewgovernancepolarities thatwe seeoften as people strugglewithbothimprovementgovernanceanddatagovernance,andthentherearealotofotherpolaritiesinhealthcare. So, you can see there is just a fewdataprotectionanddata sharing (that is theexample Igave), financialperformanceand improvedcaredelivery, information transparencyversusinformationprivacy,dataaccuracyversustimelydecisionmaking,dataforlearningversusdataforresearch,clinicianandpatientdecisionmaking.YoucouldseethereisawholelotofpolaritiesandIjustlistedhere.Iwillnotreadthroughallofthem.Whatwehavedoneisonthisnextpollquestion,wehaveputsomeofthemostcommonpolarities.

PollQuestion#2:Whatarethehardest3polaritiestomanageinyourorganization?(check3)[33:35]SowewillopenthispollquestionupandwhatIwouldlikeyoutodoisidentifywhichofthethreepolaritiesthatyourorganizationstruggleswiththemostofthese–andagain,thisisjustalistofpolarity challenges we see commonly. So, data protection and data sharing, financialperformanceandimprovedcaredelivery,dataaccuracyversustimelydecisionmaking,dataforlearningversusdataforresearch,spreadingandsustainingimprovementsversuspromotingnewimprovements,organizationalgoalsandpayer incentives, regulatorymetricsandmetrics thatmostcorrelateoutcomesimprovement.So,Tyler,letusopenupthepollandwewillseehowouraudienceratethesedifferentpolarities.Whichofthetopthreethatyouarestrugglingwithatyourorganization.[TylerMorgan]Wellthankyou,Tom.Wehavethepolluprightnow.Andwewouldliketoremindeveryone,asyou are filling this out, you can check up to three definitely. Also,wewould like to remindeveryone,youcantypeinyourquestionsandcommentsinthechatpaneofyourcontrolpanel.Alotoftheresponseiscomingin.letustakealookandseewhatwehavegot.

PollResults[34:51][TomBurton]Veryinteresting.So,alotaroundfinancialandclinicaloutcomes,aswellaslearningdataversusresearchdata.Okay.Interesting.Ithinkalotofthese,everyonestruggleswith.Andso,comingupwithpoliciesaroundkeepingtheminbalanceisarealkey.

PrincipleReview:Alignment[35:17][DavidGrauer]IfIcouldjustadd,Tom.Ithinktheconceptofbeingabletodobothhereiscritical.Andwhenyouthinkabout,oneofthehighestgoingonhereisthefinancialandclinicaloutcomes.Inthehealthcareindustry,whenwethinkabouthowdoyouimprovequalityforyears,thethinkingwasinordertoimprovequality,youhadtospendmoreandtherehadbeensomanystudiesnowthathaveshownreallybetterqualityisactuallylowercostsandwereallycandoboth.Youcangethigherqualityandreducecostandthatissomethingwearereallytryingtoworkwithclientsacrossthecountrytotrytofacilitate.Andoneofmyfavoriteexamplesactuallyisinnursing,andso, theclinical folksonthe line,andtheargumentwas fora longtime inorder togetbetterpatientsatisfactionandpatientengagement,youneededmorenursingresource.Andthatisnotalwaysthecase.Youcanactuallygetappropriateutilizationofresourcesbydrivingoutwastesandprocessesandimprovingthingsforthenurseswhoareprovidingcareandimprovepatientoutcomesandpatientexperienceandpatientsatisfaction.Soitisthisconceptofdoingbothonbothsidesofthepolarity.[TomBurton]Yes.Bothandinsteadofeitheror.Thanks,David.So,justtoreviewthisprincipleofalignment,youhavegottogetaligned.Thatincludesaligningaroundtheconsistent improvementmethodology, it includesaligningfinancial incentivesandother incentives, and it includes balancing polarities. So a core principle in outcomesimprovementgovernanceisalignment.

Principle#4:Focus[36:56]The final principle wewant to cover today is focus. Practice disciplined decision-making toprioritize,fund,organize,andsustainimprovements.Thisisperhapsthehardestthingtodo.Asweworkwithorganizations,wewilltypicallystartbyfocusingonjustoneortwo.Andinevitably,whenwehaveincrediblesuccessinthosefirstcoupleofareas,someoneontheClevelwouldsay,well,letusdo30ofthesenextquarter.Anditisjustnotpossible.Wecannotspreadourresources that thinly. It ismuchbetter todo somesignificant improvementsdeeply than tospreadeverybodyreallythinlyandwemakeminimalprogressineveryarea.

Step8:AnalyzeOpportunitiesandDeterminePriorities[37:49]So,howdoyoudothat?Howdoyoudecidewhichareastoputasignificantamountoffocus?Wellthefirstistoanalyzetheopportunitiesanddeterminewherecanwegetthebiggestbangforthebuck.Ittakesaboutthesameamountofefforttoimproveasmallprocessversusalargeprocess.Sooneofthethingsthatwerecommenddoingistokeepprocessanalysis.Lookatthevariationinallofyourprocessesclinically,operationallyandfindthelargeprocessesthathavealotofvariation.Thoseareprobablyyourbiggestopportunityareas.

Step9:AllocateResources[38:29]Next,youwanttoallocateresourcestothoselargeprocesseswithalotofvariationandmakeitreal.Resourcesmakeitreal.Whenyouassignpeopletogoandworkonthatandformdeepteamsthathaveanalyticsteammembers,clinicalandoperationalteammembers,financialteammembers,itbecomesafocusfortheorganization.Itdoesnotseemrealuntilyouhavetakenotherthingsoffofpeople'splaceandaskthemtofocusonaspecificimprovementarea.

Step10:EstablishPrioritizedTeams[39:01]

Thethirdisestablishingtheseteams.Now,theseteamsshouldbeinourdisciplinaryandtherearemultiple teamsatwhich improvement shouldbeestablished,and thesemapback to theteamsthatDavidcoveredinthestakeholdersection.So,youwillwantaleadershipteam,youwill want guidance teams, you will want innovation or workgroups that come up with theimprovements,andthenyouhavegotimplementationteamsthatwillspreadthemacrosstheorganization.Severalofthewaysthatwehaveseentooperationalizethatisfortheseteamsthataredeliberatelyorganizedandthencontinuous.Theyhavedailycuddlesorstandups.Theyhaveweeklyiterationplanningmeetingswheretheyarefocusedonhowwecanimprovecarethisweek.Theyhavemonthlyadoptionmeetingswheretheytalkaboutthenextinterventionthathasbeendesigned,howareyougoingtorollthatouttoalltheclinics,alltheunits.Andfinally,quarterlyguidanceteammeetings.

Sowhatyouaredoingisyouaresystematizingimprovementwork.Youaremakingitpartofyourcultureandyouhaveagovernancestructureinplacethatsupportsongoingimprovementwork.Wewanttoestablishcontinuousimprovementteamsthatdonoteverrunoutofthingstoimprove.SomeoftheteamsthatwereestablishedatIntermountainhavenowbeengoingfor20yearsandtheyhavenotrunoutofthingstoimprove.Andso,itisacommitmenttoinvestincontinuousimprovementandcontinuouslearning.

Step11:ExtendandSustainImprovement[40:48]And the final step is extending and sustaining the improvements. Oftentimes, we seeorganizationshaveaprojectmentalitywheretheygotwrittenupbyCMSonsomecoremeasure.Andso,theyformaSWATteamtogoinandworkonthatparticularbadscoretheygot.Andso,ateamforms,theygoworkonit,theyimproveit,andthenboom!theteamdissipatesandgoesandworksonthenextburningplatformissue.Well,thechallengewiththatisyoudonotsustainthegames.Youdonothavetheabilitytocontinuallymeasureandmonitorthenewimprovedprocessandyoudonothaveanautomatedwayofmeasuringthat.Andso,whathappensisastheteammovesonandfocusesonsomethingelse,youwillwritebacktotheoldhabitsandwehaveseenthattimeandtimeagainwhereitischallengingtosustainthegains.Sowhatyouwanttodoisestablishaconsistentteamthatwillownthatparticularimprovementarealongterm.Now, it is not a dedicated team. Itmay just be a portion ofmany people's time but it is aconsistent team over time. And so, you adopt and then sustain those gains, sustain thoseimprovements.So,IwillturnitnowtoDavidforastoryabouthowimportantthislastkeyareaandprincipleisonfocus.

AStoryofFocus[42:25][DavidGrauer]Thankyou.So,TomactuallycuedthisoneupperfectlyandIthinktheexampleorthestorythatIwanttoshareisacommonone.WehaveseenitmanytimesandIhaveactuallyexperiencedanditiswhereaclientgivesimprovedoutcomesonaverycriticalmeasure,andletussayCLABSI,CentralLineAssociatedBloodstreamInfections,orCAUTI.Therearelotsofthesewherewehaveseen it happened. But they lose the gamebecause they fail to focusor theyenduphavingcompetingpriorities.AndwhatwewanttoencourageyoutodoistothinklongtermandthisiswheretheextendingandsustainingstepthatTomjustdescribedcomesin.Itisimportanttobethinkingaboutthenextpriorityandtobelininguptheresourcesandcreatingtheskillswithinyourorganizationtocontinuethis.Imeanthisisnottheoneprojectandthendonementality,asTomsuggested.Youwanttobeplanningforthenextinitiativeinyourgovernancecommittee.So as you identify one and youwork on it and you begin tomake progress, you should bepreparingforthenext,trainingyourteams,creatingtheresources,andthegainsthatyougetfromimprovementproject#1canallowyoutoinvestinimprovementproject#2andsoonandsoon,andwhatyoudo isyoucreatenotonlyacultureofcontinuous improvementbutyoucreatearesourcingandaninvestmentapproachthatallowsyoutostayfocused.Butbeforeyouactuallymoveon,actuallyyoudonoteverreallymoveonbecausewhatyouwanttomakesureyouaredoingisbuildingintothegovernanceprocesstheabilitytomonitorandmeasuresothatyoudonotlosethatfocus,youdonotlosethatgamethatyouachievedasyoumovetothenexteffortbecausethesehavetobeadditive,notuniqueimprovementprocesses.

PollQuestion#1–Revisited[44:16]

So,Iwanttotakeyoubacknottoredothispollbutonlytothinkaboutthis.ThisslidehasthesamesymptomsthatTomopenswith.WesimplycategorizedthemherealongthelinesofthefourprinciplesthatwehavejustreviewedwithyouandIhopethatitisevidentthateachofthesesymptomsfallsprettycomfortablywithinoneoftheprinciplesthatwehavejustreviewedandthepurposeofthisistodrawthatconnectionandtobethinkingabout,okay,wherecanyouorwheredoyouneedtofocusasanorganizationgoingforward.

PollQuestion#3[44:52]Which leads us actually to our last poll question and it is, as you think about each of theseprinciplesandallofthestepsthatwehavereviewedwithyou,wheredoyouthinkyourgreatestopportunityis,andasyouleavethisandgobackandthinkaboutwhatdoyouwanttodonext,wheredoyouthinkthegreatestopportunityis?[TylerMorgan]Alright.Well,wehavegotthepollquestionup.Youcancheckallthatapply.Whichofthesefourprinciplesdoyoufeelyourorganizationneedstoimprove?Stakeholderengagement,sharedunderstanding,alignment,orfocus?Whileweleavethisuptogiveeveryoneachancetorespond,wehaveactuallyhadquiteafewrequestsforthelinktotheoutcomesreadinessassessmentthatwehaveonourwebsite,andwewillbesuretoaddthatlinktotheemailthatwesendout,alongwiththerecordingandtheslidesaswell.Sowewillmakesurethateveryonegetsthatlinktoday.

PollResults[45:44]Soaswelook,itlookslikealignmentandfocusinparticularseemtobeleadingback.Sothosearetoughtoughprinciplesthatweseealotoforganizationsstruggle,especiallywithalignmentbutyoucanachievealignmentasyoufollowtheprincipleswehaveoutlinedtoday.

LessonsLearned[46:09][DavidGrauer]SoIthinkactuallyalignmentisoneofthemostdifficult.Imeanaswehavetalkedtoclients,theyallunderstandconceptuallyandphilosophically the importanceofaligning incentives,asTomdescribed.Butactuallymovinganorganization,particularlyalargeorganization,toasinglesetofalignedincentivestakestimeandwerecognizethatandIthininmyexperience,justlookingattheresults,alignmentandfocus,Ithinkinmyexperience,focusisprobablytheareawhereIhad struggled themost, staying focusedand sustaining andholding the games thatwehaveachievedisprobablywhereIhavestruggledthemost.So we hope that these 4 principles and the 11 steps that we shared with you have beenenlighteningandhavestimulatedsomethinkingandperhapssomeactionforeachofyouinyourorganizations and our hope is that as you focus on these, you can improve and achieve thesuccessandoutcomesimprovementthatyouhope.Webelievethateverybodycannomatterhowdysfunctionaltheorganization.

GovernanceHandbook[47:17]

Andonetoolthatwehaveproducedandpublishedisahandbook,theGovernanceHandbook,thatoutlinesalloftheprinciplesandstepsthatgoesintomuchgreaterdetailthanwedidtodayonthiswebinarandthisisavailabletoanybodywhorequested.IwillletTylerexplainhowyoucangetonebutthisisaresourcethatwehaveproducedandwehavebeensharingthathasbeenindemandwithourclients.Sowearehappytomakeitavailable.

[TylerMorgan]Asamatteroffact,David,wedidcreateonelastpollquestionforeveryone.

PollQuestionWould you like to have someone from Health Catalyst® reach out to share with youthegovernancehandbook?[47:50]

Would you like to have someone from Health Catalyst® reach out to share with youtheGovernanceHandbook.Simplyyesorno.

Sowewillleavethisuptogiveeveryoneachancetorespond.Andwhiletheyareresponding,wecanactuallygoaheadandmoveitastimeforourquestionsandanswerstimesowecanmoverightintosomeofourquestions.

QUESTIONSANDANSWERS

The very first question thatwehave, I believewhenwewere talking about that, I think thequestionisareyousayingherethattheCsuiteistheteam?

[DavidGrauer]Youknow, it is a greatquestion. I donot think in all cases it shouldbe theC suite. I thinkdependingonthesizeoftheorganizationandthecomplexityoftheorganization.I thinkina

smallerlesscomplexorganization,thatmayinfactbetheexecutivegovernanceteam,butinalargeorganization,Ithinkyouneedtothinkalittlebitdeeperasyouthinkaboutthelevelsofengagementandthedifferentteamsandyouincorporatesomepeoplewithsomeveryspecificonthegrounddomain,expertiseaswell. So I thinkmyanswer is itdependsonthesizeandcomplexityoftheorganization.

[TomBurton]Yes, I would agree with that, David, and I think the key is to have the right stakeholdersrepresented as you are thinking about outcomes improvement. And so, there are clinicaloutcomeswearetryingtoimprove,therearefinancialoutcomesthatwearetryingtoimprove,thereareoperationaloutcomesandpatientexperienceoutcomeswearetryingtoimprove,andthenthereisthetechnicalinfrastructurethatsupportsallofthose.

So,havingrepresentativesinthosekeyareasiscritical.Now,notalwaysitisataClevelpersonthatisinchargeofoneofthoseareas.Andso,youmayhaveamemberofthatgovernanceteamthat is a vice president or a senior vice president, not a C suite person. So it is more arepresentationatthehighestlevelpossibleofthosecoreareas–clinical,operational,financial,experience,andtechnical.

[DavidGrauer]AndImightaddoneotherpoint.Weoftenseefacilitatorrolesonthatgovernancecommittee.Theymay not be a C suite person but theymay be a vice president of analytics or processimprovementorsystemimprovementandtheyhadtremendousexpertiseandfacilitationtothegovernancecommitteeaswell.Soyoumightthinkaboutaddingsomebodylikethat.

[TomBurton]So I seeanotherquestionhere,howdoyouapply theseprinciples inahealth systemthat isspreadacrossawidegeography,andthiscanbeachallenge.Whentravelandface-to-faceisdifficult,theseprinciplesmaybemorechallengingtoapply.Someoftheways,andwedohavesomeofourclientsthatareveryspreadoutasfarasthegeographygoes,theprinciplesstillapplybutsometimestheremaybesomeaddedlayers.Youmayhavearegionallayerwhereteamscometogether.Andyoumayimplementsomeoftheseatamid-layeroralocallayer,butthenstillhaveitrolluptotheoverarchinglayer.Now,thattypicallymaytakealittlelongertoestablishbutwehaveseenitsuccessfullyapplyacrossalargegeography.

[DavidGrauer]Agreed. Andthechallenge is ifweareworkingwithasystemthathasninedifferentregionsspreadacrossseveralstates,ifweonlyhadacentralizedbodythattrytogovernalltheprocesses,we would bemissing out on some of the unique organizational realities that occur at eachhospital.Imeanmultiplehospitals.Andso,asTomsaid,besttohavesomeregionalteamswithsomelocalrepresentativesaswellthatultimatelyfeedinandinformanexecutivelevel.

[TylerMorgan]Great.Nextquestionis,howcanasmallandmid-sizehealthsystemavoidbeingoverwhelmedbythis.Theylackhumanandfinancialresources,unabletodevoteenoughtimeduetootherpressingdemands.

[TomBurton]Sothisisagreatquestion.Thesmallandmid-sizesystemsmaynotbeabletodedicatespecificskilledresourcestogoafterthis.Ithinktheprincipleshavetobeadoptedinthosecases.Andso,youmayhavesomepeoplewearingmultiplehats.So,wehavesomeofourcustomersthatare a single small regional hospital in a rural location. However, they still have the samechallenges.Therearestillsiloseveninasmallhospital.Therearestillmisalignedincentives.Andso,youcanapplytheprinciplesthatadoptitandmaybeyoudonothaveeverysinglelayerofthatexecutivedomainadoptionandinnovation.Someofthoselayersmaybecombinedbuttheykindofswitchhatsorswitchrolesandplaydual roles. Sotheymaybedoingtherootcauseanalysisonwhatneedstobeimprovedandtheymayalsobetheoneimplementingitthroughoutthe(53:25) unit.Sowehaveseenthatitscaleddownaswellasup.

[DavidGrauer]Ithinkthequestionspeakstotheimportanceofprioritizationatthegovernancelevelbecauseinasmallerorganizationwithfewerresources,itisreallyimportanttogetanearlywinbecauseifyouget anearlywin, you can generate savings, you can generatemomentum, you can thencapitalizeonthatandusethisinvestmentphilosophythatItalkedaboutearlier.Ifyougetanearlywinbecauseyouhavechosenwell,youcanthenplanthenextoneandresourcethenextone.Andso,thatspeakstotheimportanceofpickingandchoosingwisely.

[TomBurton]Wehaveanotherquestionhere,howdoesHealthCatalyst®helpcustomersalignandexecuteontheseprinciples?Thatisagreatquestion.AnditkindofgoesbacktowhywestartedHealthCatalyst®inthefirstplace.BackwhenIwasatIntermountain,IhadtheprivilegeofgoingthroughBrentJames'courseonoutcomesimprovement,andIwouldhearfromallsortsofpeopleacrossthecountrycomingtohiscourse,wellyeah,youcandothisatIntermountain,youdonothaveasmuchcompetitionhere,youhavegreatleaderslikeBrentJamesthatpromotesthisdeeplyacrosstheorganization,andtheywouldmakeexcuses,like,wellwecouldneverdoitbackhome.AndIjustfundamentallydidnotbelievethat.

Andso,weactuallypitchedtheideatoIntermountainof,well,whatifweformthedepartmentthatgotinthetrencheswithorganizationsonthegroundandreallytrytohelpthemimplementwhattookusyearsandyearstodoitatIntermountain.Andultimately,Intermountaindeclinedbuildingthatinternally,aconsultingprofessionalservicesorganizationaswellasatechnologyorganization, but Steve and I got pretty excited about that and that iswhywehave formedHealth Catalyst®. And so, what we try to do is be in the trenches with our customers,helping themthroughthesereallychallenging,applyingthesereallychallengingprinciples.Andso,wehave a professional services team thatworkswith executives that actually sits down,walksyouthroughstepbystepaswetrytoimplementthesebestpracticeprinciples.

It looks likewehavetimeformaybeacouplemorequestions. Idonotknowifwehavetheelectronicversionbutwewillfindthatout.Thereisaquestiononisthegovernancehandbookelectronic.IthinkweprobablycanhaveaPDFversionofthatavailable.Wewillincludethatintheemail.

[DavidGrauer]In theemail thatwewill sendoutandmakesurewehaveall theavailable linkorsomethingthere,ifnecessary.

[TomBurton]Perfect.

[DavidGrauer]There isacommenthere. It isnotactuallyaquestion,and Iagreewith it. Thecomment is,"betteroutcomesshouldimprovefinancialperformances.Theyarenotpolarities."AndperhapsI misspoke. We do believe higher quality actually reduces the cost and improves financialperformance.Andso,thosearenotobviouspolaritiesbutthereistensionalwaysinahealthcareorganization between outcomes improvement and cost and efficiency. And so, I think thecommenthereisrightbutthereisatensionthatalwaysexistsifyouthinkabout,okay,wheredowe invest, howdowemost appropriately use our clinical resources, andwedobelieve thatimprovingqualitydoesreducecost.

[TylerMorgan]Okay. It looks likewehavetimeforonemorequestion. So itwasmentionedthatquarterlyhealth outcomes objectives can be set to incentivize success. Could you please provide anyexamplesofsuchquarterlyhealthoutcomesobjectives?

[TomBurton]Yeah.So,anditisnotalwaysquarterly.Sometimesitisannual.Sometimestheseimprovementstakelonger,but…Soforexample,atIntermountain,eachclinicalprogramsetanoutcomegoalofeitherreducingthecostofcareorimprovingthequalityofcareandtheneveryone'sbonusesweretiedtothoseimprovements.Andtheywouldtrackactuallydailyandweeklyprogressonthoseinitiatives,buteverysingleclinicalprogramhadaboardgoal.AndIntermountainhassetagreatexamplethereofactuallyhavingboardlevelgoalsthataretiedtoquality.

PriortoDr.JamesandDr.Burtonpromotingthose,mostofthemeasureswerefinancialattheboardlevel.Andso,wereallyrecommendestablishingsomegoalsannuallyataboardlevelandthenbreakingthosedownintomeaningfulchunksquarterly.Soforexample,youmayworkondifferent aspects, different processmetrics that tie into the outcomemetric. So if you areworkingonheartfailurereadmissions,youmayworkonmedicationreconciliationonequarterandthenextquarteryoumayworkonmakingsureofafollow-upvisitschedule.Thenthenextquarter, youmayworkonmaking sure that theyhavegotagood time to theirprimarycare

physician.Andso,thoseprocessmetricsthatyoulookatandfocusonquarterlycanthentieintoanoveralloutcomemetricatreducingreadmissionsorreducingthecostofcaresignificantly.

Ithinkweareoutoftime,Tyler.

[TylerMorgan]Ithinkweareoutoftime.Therewasaveryquickquestion.IstheGovernanceHandbookfree?

[TomBurton]Yes.Yes,itis.

[TylerMorgan]Okay.Iwanttomakesurewecoverbeforeweclose.Thanks,Tom.Thankyou,David.Shortlyafter thiswebinar, youwill receive an email with links to the recording of thewebinar, thepresentation slides, and the audio download, as well as a link to our outcomes readinessassessment.Also,pleaselookforwardtothetranscriptnotificationwewillsendyouonceitisready.

ThankYou[59:31]

OnbehalfofTomBurtonandDavidGrauer,aswellastherestofushereatHealthCatalyst®,thankyouforjoiningustoday.Thiswebinarisnowconcluded.

ENDOFTRANSCRIPT