Author, Nicola Hawkinson with SpineSearch

Our recent article "WHAT MAKES A CENTER OF EXCELLENCE..., EXCELLENT?" certainly caught the attention of many readers, and your questions have been well…, “excellent.”

Here's Part 2 of Creating a Center of Excellence (COE). After nearly 15 years working with top Healthcare facilities across the country, we've observed some wonderful successes (and some failures) in the creation of COE’s. What have we learned?

First. There are no shortcuts on the path to creating a COE. We assume that you have gone through the steps we described in the first article. Clearly, you've got an appropriate physical location and you've acquired the necessary equipment to provide state-of-art care.

You have also successfully moved through the first major step..., People. You've staffed your medical group with expert, team-oriented practitioners and support staff. Your corporate culture is one of continuous training and improvement, but how exactly will you go about that?

One way of looking at a COE is that is not just a health care thing. It’s a quality indicator used in many industries and institutions. COEs are usually defined simply as a team, facility or organization that provides leadership, best practices, research, and training within their focus area. That means companies that qualify as COEs, don’t just deliver quality goods or services; they are continually seeking new and improved methods to truly excel when measured against others in their industry. This may take the form of efficiencies, better outcomes, great patient satisfaction, or any other metric of performance.

In effect, a COE is as a “competency center” or “capability center.” In both cases, the COE can be seen as a focus for “knowledge management.” There’s a common misapprehension that a COE is intended to be better than other departments in the same organization. That’s not the point.

A COE is a team or organizational environment established to provide outstanding healthcare, research,  education and training, regulatory compliance, policy, information technology, combined with particularly effective performance.

A COE experiments with, implements, and measures best practices at every step of the way, and shares those practices with all parts of the organization. In the end, it’s all about the expertise and experience of your people, and the way in which they share knowledge.

It's BIG DATA baby!

In addition to the people needed to render care, a COE will also need skilled study designers, data collectors and analysts. In some cases, there may be an overlap with your healthcare teams but not always. Most MD's take at least introductory statistics at a university level, but it may be valuable to your organization to seek leadership that not only includes MDs, but also individuals with either an MPH or MHA. There are similarities between the degrees, but what you are seeking almost certainly includes individuals who have qualifications as epidemiologists or biostatisticians.

In other words, we’re back to people. A Center of Excellence is staffed by outstanding medical practitioners, medical support, and specialized staff dedicated to efficiency, analysis, and effectiveness measurement and process development. A true COE includes this new group of specialties and job descriptions that are integral to making excellence happen.

Effective study design is part science, and part art. The art part kicks in when we must assure that our studies don’t play to preconceptions or “common wisdom.”  Careless study design tends to “favor” retention of old systems simply because everyone is familiar with them. A COE is dedicated to finding truth in their analysis of the strengths and weaknesses of different systems.

Non-Medical Center of Excellence Staffing

Job Title and Descriptions that you may not have considered that are customarily found in a COE include:

Scribes: An in-office or virtual Medical Scribe normally has specific training in EHR Data Entry. This can improve accuracy, while also reducing administrative burden on practitioners.

Social Workers: Where a Center of Excellence specializes in high-mortality conditions, or illnesses that have greater than normal effects on Activities of Daily Living, the COE may establish support systems not usually found within a typical hospital or treatment center. This is compatible with the idea of a COE as an organization prepared to research and develop novel treatment ideas.

Health Information Managers usually have an MHA. They may or may not have specific medical training. Medical qualifications that can be of use to a Health Information Manager range from RN to fellowship trained MD.

As the quantity and quality of medical records grows and improves, it’s fair to say that many of our future medical advances will come from the collection of data and the application of AI (Artificial Intelligence) to examining and collating those records in search of relationships between diseases, treatments, and raw data, to suggest future medical advancements and research strategy.

Data Analysts often come from a pure math background. They may have special training in study design, statistics, and machine learning. They will also be skilled in the use of data visualization tools that enable your management team to understand and parse the results of data collection. The larger your COE, the more likely it is that you will have dedicated Data Analysts working for you.

Financial Considerations

Measurable and demonstrable improvements in outcomes can be expected to have increasing impacts on the bottom line in the future. As we move more to bundled payments and capitation, and away from episodic care, we can expect insurers to be looking for outcomes data. Results matter and statistics are your friend.

The patient differentiation inherent in a COE allows for optimization and specialization of equipment and the entire servicescape. Your servicescape is defined as the total environment in which service is delivered, and is made up of ambient conditions, spatial layout and functionality, as well as signs, symbols, and artifacts. A COE could for example physically lay out their facility so that the physical location of distinctive features optimized transit time between most commonly accessed areas as proven by their own treatment data and philosophy. This would theoretically improve efficiency.

Differentiation and efficiency can help assure steady patient volume which positively impacts bottom line performance. A properly marketed and authentic Center of Excellence may attract patients seeking the best care possible, with a willingness to pay for superior care. It can also increase patient satisfaction and reduce the potential for malpractice lawsuits. The creation of highly specialized centers may lead to economies of scale, which generate savings and improve overall financial performance.

Accreditation

We also recommend that you seek out accreditation by JCAHO (Joint Commission on Accreditation of Healthcare Organizations). Referred to simply as The Joint Commission, its mission is “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”

Although the phrase “Center of Excellence” is sometimes used as a marketing tagline with little basis in fact, JCAHO Accreditation provides a genuine,  and evidence-based criteria for declaring that your facility has met recognized standards of care.

The Joint Commission sets clear and objective standards which can help your organization measure, assess, and improve its performance in the delivery of healthcare. Members can directly assess their performance compared to leading healthcare institutions. A COE will aspire to be in the top percentile of performance.

Conclusions

Becoming a COE informs patients seeking treatment that they will have access to world-class doctors, nurses, and other professionals across many specialties — all working together to create a system and environment that fosters the highest-quality, most comprehensive and specialized care possible.

Negotiating re-imbursements while able to show objective proof of superior outcomes and increased patient satisfaction can be expected to improve the likelihood of negotiating attractive re-imbursement. It is also a powerful tool in setting a “framework” for your organization in disputes over denied claims. 

Nicola Hawkinson, DNP, RN, RNFA is the founder and CEO of SpineSearch, LLC, a premier recruitment and education source for healthcare professionals that serves individuals, practices, and hospitals.

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