What Is GNOSIS? Th 6 Annual Avera Women’S • How Do Adults Learn? Conference for Pcps • How Does GNOSIS Work? Lora Sparkman, VP Clinical Effectiveness

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Agenda

Using Data to Drive Improvement • What is GNOSIS? th 6 Annual Avera Women’s • How do Adults learn? Conference for PCPs • How does GNOSIS work? Lora Sparkman, VP Clinical Effectiveness

• How is GNOSIS different? October 2, 2015

• What is the evidence?

What is GNOSIS? Do we need a coach?

GNOSIS is a patented assessment-driven education and analytics solution that uses data to transform how doctors and nurses learn. THE NEW YORKER Oct 3, 2011 It embeds Adult learning principles to ensure learning is effective and efficient. Personal Best: Top athletes and singers have coaches. Should you?

by Atul Gawande

“No matter how well trained people are, few can sustain their best performance on their own. That’s where coaching comes in.” - Barry Blitt

What is Andragogy? How GNOSIS meets the needs of adult learners Assessment, Individualized Learning, • Andragogy is the study of how adults learn and the lead theorist that Analytics: developed and studied adult learning principles is Malcolm Knowles. Assessment Testing varying forms of knowledge (concepts, skills, • Knowles four principles of adult learning: judgment)

• Be involved in the planning and evaluation of their instruction Learning path is prioritized from most to least need Provides self-awareness (strengths & areas to improve) • Learn best through actual experience that includes making mistakes as

the basis for learning activities Questions assess Knowledge and Judgment through • Are most interested in educational topics that have immediate relevance case scenarios, script concordance theory, evidenced based national standards, expert experience, etc. to their job Relevant, self-directed, & respectful of learning principles • Learn best when the instruction is problem-centered, not just content- Analytics provide immediate feedback to the clinician with centered, and is experiential – “Knowledge is not like a hard drive-it is a benchmarking once assessment is completed and year over process of building circuitry in the brain.” year learning with milestone/tracking of progress - Mike Connell, Learning Expert Opportunity for Mastery that allows time & repetition in key areas

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What is GNOSIS? How does GNOSIS work?

1 Clinicians complete a comprehensive assessment…

and GNOSIS evaluates their level of knowledge and judgment. 320+ hospitals are now using GNOSIS The data is used to benchmark, their proficiency scores.

40,000+ assessments of doctors and nurses

4,000+ assessments & learning paths are completed monthly

How does GNOSIS work? How does GNOSIS work?

1 Clinicians complete a comprehensive assessment… 2 GNOSIS delivers a personalized learning path…

and GNOSIS evaluates their level of knowledge and judgment. based on their proficiency in each practice area, with content The data is used to benchmark, their proficiency scores. prioritized by the level of learning need. Clinicians “test out” of the material they have mastered based on the assessment.

How does GNOSIS work? How does GNOSIS work?

2 GNOSIS delivers a personalized learning path… 3 Clinicians begin learning…

based on their proficiency in each practice area, with content where they want, when they want, and only what they need. prioritized by the level of learning need. Clinicians “test out” The content is delivered in 2-8 minute content “snacks” while of the material they have mastered based on the assessment. addressing a variety of learning styles designed for active adult learners.

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How does GNOSIS work? How does GNOSIS work?

3 Clinicians begin learning… 4 GNOSIS generates competency data…

where they want, when they want, and only what they need. for the individual and the team, by practice areas in each The content is delivered in 2-8 minute content “snacks” while course. Reports are available to identify specific areas of risk addressing a variety of learning styles designed for active adult learners. as well as clinical areas that need education and training.

How does GNOSIS work? How will you use the data?

4 GNOSIS generates competency data… 1. Measure engagement

for the individual and the team, by practice areas in each 2. Measure proficiency course. Reports are available to identify specific areas of risk as well as clinical areas that need education and training. 3. Measure learning

4. Measure risk

5. Measure outcomes

1. MEASURE ENGAGEMENT 2. MEASURE LEARNING

Engagement increases by nearly 5 times when clinicians learn on GNOSIS Improve proficiency in lowest performers by 37 percentile points

Nurses Physicians

80% 2nd Assessment 75% Engagement Engagement After increased increased learning by 3 times by 6.7 times 1st on GNOSIS Assessment 25% 12% +37

Percentage of accredited course time spent on learning in long form

Percentage of accredited course time spent on learning in GNOSIS *Sample based on 700+ physicians and nurses completing personalized learning path for GNOSIS Obstetrical Hemorrhage. Performance gains result from assessment 1 compared to assessment 2.

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3. MEASURE PROFICIENCY 4. MEASURE RISK

Compare clinician’s competency in knowledge and judgment Reduce risk by over 50% with targeted learning

100% All U.S. BEFORE APS WITH APS

80% claims/1000 - YOU deliveries - 55% avoided JUDGMENT TeamFacilityU.S. average average average 5.8 60% - in claims YOUR FACILITY - exposure

40% -

YOUR TEAM - 2.6

Facility.average Teamaverage 20% U.S.average -

YOUR GROWTH 2008 2011

0 20% 40% 60% 80% 100%

KNOWLEDGE *Data provided by BETA Healthcare Group representing over 200 healthcare care facilties in California.

5. MEASURE OUTCOMES Individual Performance Dashboard Shoulder Dystocia

John Reduce clinical costs by improving outcomes by nearly 40% Nurse

- BEFORE GNOSIS WITH GNOSIS - # of - - Reduction of Massive - 13 Transfusion - 5 MTPs Protocols - - (MTP) - 8 ------Apr ‘14 – Oct ‘14 Nov ‘14 – Apr ‘15

*Data provided by Texas Children’s Hospital at AWHONN annual convention

Healthcare system performance is …. Individual Nurse Assessment Results Fetal Assessment and Monitoring

100% Clinicians Judgment Ave. Score Hospitals Nurses APS Hospital Knowledge Ave. = 70% Hospital Average 80% APS Facilities 80% System Average Hospital B Hospital A System Hospitals APS average

70% Hospital System Average Hospital C 60%

APS Hospital Judgment Ave. = 61% Judgment 60% 40%

50% Hospital D 20%

Hospital E 40% Hospital F 0% Hospital G 0% 20% 40% 60% 80% 100% 30% Knowledge 30% 40% 50% 60% 70% 80% 90% Fetal Assessment and Monitoring, Nurse, 1st time Assessment scores only Source: APS GNOSIS database Knowledge Ave. Score n=99 Nurses in 1 hospital; 23 24

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Same Hospital and Nurse Average Score by Practice Area Individual Provider Assessment Results Fetal Assessment and Monitoring Fetal Assessment & Monitoring

100% Clinicians Providers For Your Consideration Hospital 1 Average 80% System Average • Practice Areas Because APS average there is a wide pattern of variation and some outlier scores the comparison to National 60% Peer group is below the 50th percentile. This Judgment speaks to the wide pattern of variation so 40% the first task is to understand the variation and have individuals complete 20% their Learning Paths timely. Then reassess at a defined time in the future to monitor 0% improvement. 0% 20% 40% 60% 80% 100% Knowledge

Data as of 02/24/15, Source: APS GNOSIS database Fetal Assessment and Monitoring, Providers, 1st time Assessment scores only Source: APS GNOSIS database Fetal Assessment and Monitoring, Nurse, 1st time PPM scores only n=35 Providers in 1 hospital; Residents are not included n=104 Nurses; n=8,965 nurses in 257 national hospitals. Note: Only facilities with >5 PPMs are included. 25 26

Same Hospital and Provider Scores by Practice Area Nurse Individual Results for 1st Assessment Fetal Assessment and Monitoring Fetal Assessment & Monitoring Overall high scores but there is a wide variation among individuals for both Knowledge and Judgment

For Your Consideration • Practice Areas The majority of Providers are in the high scoring quadrant with a minority in the lowest scoring quadrant. The three areas that show the greatest variation are Practice Areas 2, 3, 5 and 8. Focus on the lower scoring individual and insure they complete their learning paths timely. Reassess at a point in the future and monitor progress.

Data as of 02/24/15, Source: APS GNOSIS database Fetal Assessment and Monitoring, Providers, 1st time PPM scores only n=34 Providers at Hospital 1; n=2,667 Providers in 209 national hospitals. Note: Only facilities with >5 PPMs are included. 27 28

Nurse Individual Results for 2nd Assessment Fetal Assessment and Monitoring Second assessment results show less variation and higher scores