Inception Health
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Inception Health

Deinnovation ≠ Denervation:

How We Use Healthcare Delivery Science To Deimplement Lower Value Interventions and Expand Higher Value Ones

Enter Healthcare Delivery Science

Simply, deinnovation or deimplementation is not denervation.

Healthcare delivery science adds an additional layer of higher reasoning that critically evaluates processes, helps determine value, and supports a case for either program expansion or deimplementation.

A Feedback Loop Example

  • Timeliness
    Nurses were often aware of the patient’s decline and began or completed the appropriate intervention before the EWS triggers and the VCT calls
  • Workflow Interruption
    Nurses were often called about an EWS alert while they were busy implementing the appropriate medical interventions.
  • Accuracy
    Nurses perceived the EWS algorithm to be inaccurate, citing many anecdotes of false positives and false negatives, especially with the EWS’s inclusion of subjective nursing assessment data, such as urine colour and patient mood.
  • Actionability
    Nurses felt the overall program rarely offered actionable, novel suggestions, however, some nurses appreciated the EWS and VCT as a safety net.
  • Underappreciation of core nursing skills
    Nurses emphasised the value of in-person assessments and were concerned with the reliance on technology by a hands-on profession.
  • Opportunity cost
    Nurses cited the need for additional hands-on support and criticized spending on the EWS during a time of hospital financial stress.

Shifting Resources

Simply put, we couldn’t keep doing everything.

Summary or TL;DR

  • We often resist parting with familiar practices, processes, or features even though they may not provide desired value.
  • Deimplementing processes can return value to people as much as implementation of new processes.
  • Healthcare delivery science, rigorous looks at operational problems, can identify areas where value may be maximized
  • We have had experience with deimplementing an exciting program that did not deliver desired value to bedside nurses, and then shifting resources to a new high needs area (COVID-19 RPM) where healthcare delivery science identified higher value per resources.

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Brad Crotty MD MPH

Chief Medical Officer, Inception Health | Chief Digital Engagement Officer, Froedtert & the Medical College of Wisconsin Health Network