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If a member is unwilling to abide by any of the foregoing obligations, then such member shall promptly return this Report and all copies thereof to The Advisory Board Company. ©2015 The Advisory Board Company 31972 2 advisory.com Table of Contents Executive Summary . 6 Advisors to Our Work . 7 Introduction: A System in Trouble. .11 Chapter 1: Encourage Clinicians to Share Information Effectively . 25 Tactic 1: Institution-Wide Commitment to Team-Based Care . .30 Tactic 2: Required Interprofessional Training for Clinicians. .36 Tactic 3: Nurse Evaluations of Doctor Performance . .39 Chapter 2: Employ a New Type of Team Leader . .43 Tactic 4: Hospitalists: In-Hospital Generalist Decision Makers. 49 Chapter 3: Construct Reliable Group Decision Processes . 77 Tactic 5: Structured Interdisciplinary Bedside Rounds (SIBR®) . 84 Tactic 6: Case Review Conferences. .93 Special Report: Patients: The Untapped Resource. 101 Conclusion: The Missing Piece of the Puzzle. .117 Templates and Tools. .121 ©2015 The Advisory Board Company 31972 3 advisory.com In Service to Our Health Care Members 4,200+ 2,500+ 2,000+ Hospitals and health care Health care Hospitals using our organisations in our membership professionals employed performance technologies RESEARCH PERFORMANCE CONSULTING TALENT AND INSIGHTS TECHNOLOGIES AND MANAGEMENT DEVELOPMENT Memberships Offering Strategic Global Peer Collaboratives Powered Seasoned, Hands-On Support and Partnering to Drive Workforce Guidance and Actionable Insights by Web-Based Analytic Platforms Practice Management Services Impact and Engagement • Dedicated to the most • Millions of admissions flow • 3,600+ years of “operator” • Impacted the achievement of pressing issues and concerns through our technology platforms experience in hospital and 88,000+ executives, doctors, in health care doctor surgeries clinical leaders, and managers • Over 3 million user sessions • 300+ industry experts on call annually • Principal terrains: growth, • 19,500+ outcomes-driven margins, doctor alignment, workshops tailored to partners’ • 200+ customisable forecasting • Key challenges addressed: and the transition to value specific needs and decision-support tools margin improvement, doctor alignment, payer contracting, • Range of engagements from Survey Solutions quality improvement, and strategy to best practice • Customised strategies for patient experience installation to interim improving employee and management to fully doctor engagement managed services 238,000+ $700+ 2,300+ 8,400+ health care leaders million in realised engagements employee-led served globally value per year completed improvement projects ©2015 The Advisory Board Company 31972 4 advisory.com Global Research and Insights Programs Supporting Hospital Executives with Best Practices, Strategic Guidance, and Decision-Making Support Clinical Global Centre for Global Forum for Health Global eHealth Clinical Investment Operations Board Nursing Executives Care Innovators Executive Council Insights Transforming Care Quality Building the World Class Leading the Successful Supporting IT Strategy Clinical Strategic Planning and and Efficiency Nursing Organisation Enterprise and Planning Investment Guidance Best practice research to Research for an international Research and insights for chief Research and analysis to help On-demand strategic guidance support senior clinical and network of nursing executives executive officers and other hospital information technology and clinical technology operational leaders who work charged with leading the largest senior executives to support (IT) departments effectively plan investment advice to help tirelessly to provide safe, and most critical element of the their efforts to guide their and implement key initiatives and leadership make successful effective, and efficient care for health care workforce organisation to sustainable achieve organisational strategic investment decisions that reduce their communities excellence and prosperity IT goals organisational risk • Improving clinical quality • Achieving excellence in care • Strategising and planning • Improving governance and • Identifying strategic growth and patient safety quality and safety amid disruptive change management of IT opportunities • Maximising capacity and • Managing nursing diversity • Strengthening financial • Leveraging IT to improve care • Optimising investment choices utilisation and culture management quality • Minimising risk of capital • Partnering with clinicians • Improving the patient • Increasing staff productivity • Achieving return on IT investments experience and engagement investments • Managing patients with • Delivering insight into future chronic diseases • Enhancing nursing staff • Providing leadership for • Optimising business disruptive innovation efficiency and productivity organisational performance intelligence and executive data strategy Serving Senior Clinical Serving Chief Nursing Serving Chief Executives