Prisma Health’s Jonathan Gleason, M.D., on Re-Imagining the Clinical Operating System

South Carolina-based nonprofit healthcare system Prisma Health recently announced it has been working closely with Press Ganey, the experience measurement, analytics, and advisory services company, on a new technology-enabled Clinical Operating System (cOS) to support how the organization functions.

Jonathan Gleason, M.D., executive vice president and chief clinical officer at 19-hospital Prisma Health, recently spoke with Healthcare Innovation about the how his organization has put the new model in place. 

Healthcare Innovation: Is this a new way for healthcare organizations to collaborate and measure performance or is it pulling together solutions that had been siloed into one platform?

Gleason: It’s a different way to operate. How that manifests itself in the organization is through a tech-enabled management system, which is a core set of workflows that team members on units, either acute care or ambulatory, use to do their work on a daily basis. Rather than having a fragmented system for the management of patient experience and a separate system and tools for the management of safety and a separate system and tools for the management of quality and a different system and set of tools for the management of efficiency and a separate system and a set of tools for the management of team engagement, we integrated all of those into one holistically designed management system. 
If you do this core set of workflows, you are also therefore doing safety, quality, patient experience, efficiency and team engagement. It's just about integrating all of those into one set of workflows and making it simpler. There is a tech overlay that supports that integrated management system, and it's also memorialized in a playbook, so that there is just one set of workflows the team is executing on daily. 

Another key part of cOS is that you're measuring the volume of the work and managing to the workflows happening at all times and also the quality of the work. Rather than giving the team a set of tools and giving them a set of goals to achieve outcomes, you're actually managing to the workflows on a daily basis.

HCI: Was there a recognition at Prisma that it needed a more integrated and centralized management system to give this kind of view of clinical operations?

Gleason: We heard clearly from our teams that we needed to improve the overall experience of giving care. One of the core issues that clinicians face is an overly complex operating model and the fact that they're asked to do many different things by many different teams and many different tools and workflows. The overall impact of that is a really difficult experience for them, and there's an overflow of that onto the patients. If the team isn't doing well and feeling great, then the patients aren't doing well and feeling great. Our teams were telling us that the amount of work was complex and unachievable, and we needed to simplify and streamline all of it. That's where the vision for cOS came from. We said we’re going to have one tech-enabled management system, one set of tools, one set of meetings, one set of activities that enables them to do all those things at the same time.

HCI: Did Prisma co-develop this with Press Ganey? Or are you the first customer?

Gleason: I would say we've been developing this over the last several years, and Press Ganey has come alongside us, and we are now accelerating all of that with their incredible resources and tools through partnership to continue to co-develop this.

HCI: Let’s give an example from a clinical team, like huddles that teams do in the hospital. Does this change how they would do them, or just the platform in which they're connecting on?

Gleason: It changes both. In many organizations, you might have multiple types of huddles that are occurring. You're doing a safety huddle, a patient experience huddle, an efficiency huddle, a throughput huddle. When you create one integrated workflow, it's one huddle. There needs to be an integration of those, so that you can accomplish all of those goals within one tech-enabled management system. 

There also is a coaching component to the clinical operating system, where the leaders and managers in the organization are observing and supporting their team members while they're taking care of patients, so you get real-time feedback. And it actually doesn't feel like auditing. It feels warm and engaging, and our team member engagement scores have never been higher since we've done this. 

Plus, you can go to a place where you have a fully executed operating model, and you can measure that on a daily basis. So I can come to work and know that all of our carefully designed workflows are happening every day. 

HCI: Do you get kind of a dashboard view of this?

Gleason: That's right. So we can come in and see that all of our operating units are executing on these workflows at all times. But I will say that having a fully executed, clearly defined set of core workflows in the organization can feel cold and corporate. The challenge is that the folks who work in healthcare are unbelievably amazing people. The doctors, and nurses are brilliant; they are luminaries. So they have to be able to meaningfully and efficiently improve the tech-enabled management system if they need to. 

There are two things happening in cOS. One is the tech-enabled management system that's fully executed at all times; the other is the ability for team members to be able to impact the ongoing improvement of the clinical operating system. Part of this whole system is that when team members tell us that we should be able to improve the system, they do that within the system, so we have to be very good as a learning organization. So the brilliant, wonderful contributors, the clinicians, can actually put their fingerprints on the clinical operating system and change it if needed. 

HCI: Are you expecting to see impacts on patient experience scores or patient safety measures?

Gleason: We have seen significant improvements in team engagement, our safety culture, our length of stay. So efficiency in the organization has been improved very significantly. Our quality outcomes have also significantly improved. And the net impact of that is is obviously better patient experience. We've seen significant improvements in patient experience, particularly on the ambulatory side. Our “likelihood to recommend” score is above 92% at this point, which is very, very high-performing. And it's exactly the same team as before. The only thing that's different is they have a better system to operate in. Ot's like giving a golfer a better driver, right?

HCI: Usually, when we talk to clinicians or interview chief medical information officers about workflows, they're usually talking about what's happening in the EHR. How connected is this system to Prisma’s EHR? 

Gleason: It’s very integrated into the EHR. There are core components of the tech-enabled workflows that happen within the EHR, and other components that happen outside of the EHR.

One of the key technology components of the cOS is a single insights platform that gives everyone access to how the organization is doing at all times, so that everybody knows where they can go to get information. The frontline team members have the same information that I have. Of course, that's happening outside of the EHR. We try to put links to all of the non-EHR components and to the EHR so people can quickly move back and forth. 

HCI: Has this been rolled out across your whole health system or are there still areas of Prisma that are in the process of deploying it? 

Gleason: This is our operating model. It's all done.

HCI: What was the timeline for that?

Gleason: We launched the clinical operating system in October 2022, so at this point we are just over three years into operations. Engagement has been profound, and the patient experience as well. All of those things have a significant impact on the organization.
Operating margin in the company has improved pretty significantly over that period of time as well. I think overall and long-term, everyone is going to be moving away from this poorly integrated set of workflows on the front line. Healthcare is going to develop a more streamlined, holistic operating model. And cOS is on the front end of that.

HCI: Will Press Ganey now work to sell this to other health systems?

Gleason: Yes, with Press Ganey we want to make this type of approach available to everyone. There's been an enormous amount of interest in it and that certainly is the plan. We want to really enable health systems to simplify and streamline. I see it as upstream from healthcare really being able to enjoy the benefits of AI and automation. I see this as the groundwork.