The Why of Information Governance, Part 1

Inspiring a sense of urgency to advance the case for IG

Much has been written about advancing information governance as a strategic asset in the healthcare industry. We’ve focused on defining IG-the What. We’ve provided strategies for creating a program-the How. In this article, we shift the focus to the Why-inspiring a sense of urgency for building a compelling business case for IG.

At the 18th Annual HFMA Region 11 Healthcare Symposium, this perspective resonated with attendees of the session on “Adaptive Leadership in Information Governance.” Based on Simon Sinek’s concept of the “Golden Circle” from his book, Start with Why: How Great Leaders Inspire Everyone to take Action, the “Golden Circle of IG” is a concept designed to help the industry gain clarity about the Why, How and What of IG. Why should we care about IG? How does it help?

Explore a Different Perspective-Tell a Story

Healthcare executives need a fresh and inspiring way to talk about IG-to bring it to life. Intellectually, we understand how important it is, but we struggle to internalize and implement an IG mindset across the enterprise-thousands of employees, hundreds of departments, and multiple care locations.

We talk a lot about the importance of data integrity, being able to leverage information for business intelligence, for better decision making. These are clear priorities. Yet, there’s a higher purpose that must be better articulated-the why of IG for healthier individuals, healthier families, healthier communities and businesses.

The Why of IG is Human

Focusing on the human side of healthcare information governance defines the why. For example, imagine your child was accidentally given amoxicillin when the physician overrode the EHR alert. Or in another scenario, your neighbor is admitted for “sudden onset of chest pains with burning epigastric pain”, but because the complaint field in the EHR was too small, the entry was noted only as “epigastric pain” and your neighbor experienced a debilitating cardiac event days later.

The chain of events in the highly publicized case of a man who died from the Ebola infection also demonstrates the complexity of our health information systems. Some blamed EHR workflow; others said the EHR was not at fault. Consensus was that a series of health information supply chain events lead to a death.

There are also countless examples of errors and near misses because of the incorrect use of copy and paste. Common copy and paste errors result from coping histories forward and not realizing an important recent surgery is not included. Copying and pasting an outdated medication list has also been documented as a reason for significant medical errors with known instances causing death.

In 1999, the report To Err is Human reported that up to 98,000 people die from medical errors. Fast forward today, the number of preventable hospital errors has increased to 440,000. This puts medical errors as the third leading cause of death in the United States. Find stories within your own organization that put a face on medical errors to help you personalize IG.

The following chart summarizes the How of IG that is central to making the case for Why information governance.

Key Healthcare Concerns How IG Contributes
Demonstrate benchmark levels of quality and safety §  Reduces medical errors

§  Sets standards for capturing quality and safety metrics

Ensure accurate and timely reimbursement §  Supports coding quality by documentation of medical necessity

§  Supports standards based claims and claims adjudication

Succeed at performance-based contracting §  Facilitates team performance by access to timely and complete information

§  Reduces obstacles in the form of data silos

§  Builds trusted data to reengineer care processes

Facilitate mergers, acquisitions and new affiliations §  Clarifies information ground rules to facilitate integration

§  Avoids new risk and cost inefficiency

Reduce operating costs §  Reduces data storage – retention policies

§  Improves data quality – saves money in rework

Reference: Implementing Health Information Governance Lessons From The Field, Linda Kloss, 2015, AHIMA Press.

Everyone Plays a Role

Another essential aspect of IG is ownership. IG is everyone’s responsibility. Accountability is a core principle of IG, one that has not been sufficiently valued and reinforced by some organizations. Achieving accountability across the enterprise is one of the most complex leadership challenges.

There’s a tendency for individuals to take ownership within their own silos rather than take responsibility for the entire organization. This is no surprise given increased pressures in today’s healthcare environment. That is why maintaining a multidisciplinary IG team under the direction of senior leadership is so important.

As an example, consider an organization that has been working on MPI accuracy. Even after dedicated efforts, the error rate remains at 4 percent, or 96 percent accuracy. That represents a lot of errors in your system. There must be a way to measure performance and hold people accountable for their contribution to making errors. Data integrity demands it.

At the same time, it’s important to understand the variables that contribute to the issue. Here are three questions to ask:

  • What behaviors are preventing the organization from being more successful-achieving closer to 100 percent accuracy as in the above example?
  • What is the organization’s current culture on accountability? How can that culture work towards or against IG strategies?
  • To what extent does leadership expect shared ownership of data quality rather than silo ownership?
    Taking steps to understand culture and behaviors and remove obstacles can enhance accountability.

Behavioral Aspects of Implementing IG

In any type of change, it’s normal for people to experience loss and fear. We experienced stakeholder loss during the transition to the EHR and ICD-10. We are seeing similar patterns as we implement IG. Implementing different procedures or new technology can be disconcerting and disorienting. Making matters worse, sometimes leaders fail to take into account the kinds of losses people experience.

In addition to understanding losses, it’s also important to understand what people value. For example, the IG principle of transparency is not a value everyone embraces. It will be important to model transparency and make it safe to talk about near misses, for example. Being transparent regarding medical errors and the sharing of outcome data demonstrates to the community they serve that they are acting responsibly with a goal to improve healthcare delivery and engage the community in that goal. Effectively leading IG requires an understanding of stakeholders fears, losses, and values.

Accountability and transparency require sharing of data, mining of data and protection of data in an environment where performance is readily observed through systems. In some organizations people tend to shun newfound levels of transparency due to fear of consequences.

As organizations develop IG programs, it is wise to consider the behavioral realities of change:

  • Information crosses an entire system and impacts everyone in the enterprise
  • Some aspects of work will change as IG is implemented
  • Strategies should be informed by the recognition of loss and value conflicts
  • Help people see the intentions-benefits for individuals, families, communities

Consider the loss for physicians as they shift to documenting on computers. They chose medicine to interact with patients, not computers. For many, there’s a sense of loss. Understanding what’s changed for physicians in this example is important.

Here are two key questions to ask yourself as you design your IG change strategies:

  • What are stakeholders losing as a part of implementing IG?
  • What values and loyalties are at stake for each stakeholder when implementing IG?

What’s Your Why?

For healthcare, the Golden Circle of IG is about healthy lives and healthy communities. It’s critically important when we work with information and data, that organizations remember every EHR record is a patient. Every data entry leaves a digital footprint on a person. This is the Why organizations must articulate.

  • How can we convey the why in ways that are compelling, creative and realistic?
  • What will create urgency in your organization?

We invite you to join the conversation and share your stories.

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