1. Cost, quality and efficiency are
top goals of health systems, but
they must balance the added
complexity of clinical priorities.
Doctors, nurses and front-line
staff want to improve patient
outcomes, but evidenced-based
care is not as simple as passing
out a protocol. Affecting care
across a health system requires
recognizing that preferred clinical
practices should be exercised
in the context of thousands of
clinicians and tens of thousands
of individual patients.
Liken this approach to businesses that
look to their employees to drive change.
A Boston Research Group, which ran
the equivalent of an “MRI” on the
current state of governance, culture, and
leadership in businesses worldwide, found
that employees working in a high-trust
organization are 22 times more likely
to take a beneficial risk—which, in turn,
enables eight times the levels of innovation
as compared to the competition.1
Hospitals, too, can spark innovation
by trusting clinicians to lead the way.
Clinician-led transformation can help
hospitals to achieve standardized patient-
centric care that improves outcomes,
prevents harm and reduces costs. This
model has been successful in organizations
such as Trinity Health, where they are
saving an estimated $20,000 a day and
improving medication reconciliation,
patient safety protocols and various acute
conditions, such as sepsis and heart failure.
Accenture: Insight Driven Health
Want Scalable Clinical
Transformation? Hand the
Reins to Clinicians.
1
“National Governance, Culture and Leadership
Assessment” study, Boston Research Group.

2. Create an open forum for clinical change
The first step in engaging clinicians is
getting them to the table and including
them in the solution development. This
may begin with simple logistics—meet at
the dates, locations and times of day that
best suit the clinicians’ busy schedules. For
example, leadership at Trinity Health was
able to convene 14 busy neurosurgeons
from around the country by hosting an all-
day meeting at a central location. They were
there to redesign spine surgery and knew
their guidance would be acted upon.
Hospitals must also create a collaborative
body unlike the traditional hospital
“committee” where the enthusiasm turns
cold just as fast as the coffee. It is, rather,
a collective of practicing clinicians truly
empowered to lead. The aforementioned
Boston Research Group survey indicated
that C-suite respondents were about three
times more likely to see their organizations
as more self-governing, more inspiring
and less coercive compared to the overall
employee population.2
In contrast, hospital
leaders must honest about the current level
of clinician involvement, and be willing to
relinquish control.
Lip service is a disservice to the process
The clinician-led collaborative may include a
mix of physicians from competing practices,
and naysayers who may be eager to criticize
the process rather than endorse it. Hospitals
can convert the doubters into doers by
proving rather than saying that clinicians
are the decisionmakers.
At Trinity Health, clinician-led teams drove
the agenda at collaborative meetings
and had the authority to change it. They
discarded some of the hypotheses initially
put forth by the hospital and developed
models that they owned.
They formed a 55-person enterprise-wide
collaborative to focus on developing a
standardized care model for patients
having spinal surgery. Clinical leaders and
surgeons collaboratively designed the
care delivery model using evidence-based
preferred practices to help set a standard for
excellence in spine care while implementing
processes to reduce non-labor cost.
The collaborative at Trinity Health
implemented spinal surgery clinical
tracking and monitoring systems that
have allowed better monitoring of clinical
outcomes and tracking of implant usage
and costs. Key metrics include non-labor
direct variable cost, total part cost, and
implant utilization. The initiative has
impacted more than 3,000 lives and may
yield annual cost savings estimated at
$12.7 million when fully implemented.
The clinician-led model in action:
Sepsis Campaign at Trinity Health
Trinity Health’s clinician-led collaborative is helping to optimize care for sepsis
patients and improve the quality of care delivery by combining preferred practice
workflows, technology enhancements and established clinical interventions. The
enterprise-wide program aims to:
• Use evidence-based guidelines for early sepsis identification and management.
• Deploy standardized tools and processes for the early recognition of severe
sepsis across the care continuum.
• Leverage current and new EMR functionality to hardwire sepsis bundles, alerts,
prompts and treatment protocols.
This team effort involving both corporate and local entities resulted in improved
outcomes, reduced costs and lives saved:
• Mortality rates for patients with sepsis decreased from 15.8 percent to
12.7 percent.
• More than 400 lives were saved between 2011 and 2012.
• Direct variable costs were reduced by $16M between 2010 and 2011.
Scalable success
There is little argument against using
evidence-based approaches. Clinicians,
however, may more readily adopt protocols
that better allow for their interpretation,
judgment and contextualization with their
patients in mind.
In addition to gaining momentum through
clinician buy-in, protocols are also more
effective when scaled. Protocols are
often initiated in a specific department
or two, and therefore have a limited
impact on patient outcomes. Trinity Health
synchronized and expanded evidence-based
protocols across their 49 hospitals in 10
states with approximately 11,000 physicians
and 10,000 nurses to achieve a cumulative
social benefit.
2
“National Governance, Culture and Leadership
Assessment” study, Boston Research Group.

3. Trinity Health formed an 80-person
enterprise wide collaborative to focus on
developing a standardized care model
for patients with heart failure. Clinical
leaders and practicing front-line clinicians
collaboratively designed a new care
delivery model using evidence-based
practices to identify heart failure patients
on admission, expedite clinical milestones
during the inpatient stay and facilitate
safe and timely discharge using transition
coaches to link the patient to outpatient
care services and to ensure the care plan
was followed upon discharge from the
inpatient setting. Key metrics identified by
the collaborative as measures of success
include direct variable cost, length of stay,
readmission rate and ICU utilization. The
implementation of standardized processes
has improved quality, effectiveness and
efficiency of care delivered while impacting
more than 6,500 lives and moving toward a
potential annual savings of $5 million.
Let the data drive prioritization
An assembly of clinicians will often mean
differing opinions on preferred practices
or myriad opinions on quality, efficiency
or patient safety. The collaborative can go
straight to the facts and allow credible data
to reveal the truth.
This is a departure from traditional redesign
approaches that are based purely on
external benchmarks and tend to identify
cost-reduction opportunities in a silo. The
collaborative can work from the health
system’s own data to examine patterns
or look for variation and use internal best
practice modeling to highlight variances.
The Trinity Health team went after variations
in the data, focusing on patient safety,
clinical outcomes and more consistent
practices. If the data analysis was not
meaningful to the entire team, they would
recalculate the numbers to get to an
acceptable hypothesis. The data drove the
redesign, not the opinion of outside experts
or administrators.
Bring rigor and discipline to the process
Once the team prioritizes opportunities for
improvement, there must be clear steps
forward. Well-intentioned initiatives are in
progress at hospitals across the country, but
the rubber will never meet the road if there
is no coordinated effort. For example, Trinity
Health had a sepsis program in the works
at six of its 49 Ministry Organizations. After
introducing a robust, disciplined, industrial-
strength project management model
and implementing standardized clinical
protocols, the Trinity Health clinician team
ultimately achieved consistent execution of
a sepsis program that is saving lives across
all 49 ministries (see sidebar).
Clinicians are precise when administering
care and will appreciate the same standards
when it comes to process, protocols and
workflow. The collaborative should follow
detailed work plans that outline roles and
responsibilities. Each meeting must begin
with an agenda, end with an action plan
and have clearly delineated responsibilities
and timelines for follow-up.
Measurement is key to maintaining
momentum. Hospitals should establish
dashboards in each clinical area to measure
process and outcome metrics. The data
should be appropriately transparent and
shared with key stakeholders on a frequent
and regular basis to illustrate whether the
organization is achieving its targets. Trinity
Health used dashboards with green, yellow,
and red indicators to reflect progress, or
lack thereof, and to identify focus areas for
corrective actions. This approach encourages
accountability and enables ongoing
improvements that are based on evidence.
Toward clinician-led transformation
Clinicians can be a driving force in helping
hospitals to achieve better care, improved
outcomes and a lower cost of care delivery.
Hospitals across the country are making
progress every day, but initiatives are often
executed within a single department. An
inclusive approach will move such successes
beyond the department walls. If clinicians
own the protocols and the hospital supports
scaling them across the entire system, there
will be even more lives—and dollars—saved.
In the case of Trinity Health, they have
standardized care practices and removed
$17 million in annual costs (or $20,000
a day) associated with unnecessary care
and overutilization—all signs of a high-
performing hospital.
Though Accenture has resources who have
training in the medical field, by providing
such resources, Accenture and its resources
are not intending to provide medical advice
or engage in the practice of medicine.
Likewise, Accenture is not a law firm and
none of its personnel are intending to
engage in the practice of law and/or provide
legal advice in any jurisdiction. Clients
retain the responsibility for compliance
with all applicable federal, state and
local laws and regulations and applicable
medical and professional standards.

4. Accenture: Insight Driven Health
Insight driven health is the foundation of more
effective, efficient and affordable healthcare.
That’s why the world’s leading healthcare
providers and health plans choose Accenture for
a wide range of insight driven health services
that help them use knowledge in new ways--
from the back office to the doctor’s office. Our
committed professionals combine real-world
experience, business and clinical insights and
innovative technologies to deliver the power
of insight driven health. For more information,
visit: www.accenture.com/insightdrivenhealth.
About Accenture
Accenture is a global management consulting,
technology services and outsourcing company, with
approximately 259,000 people serving clients in
more than 120 countries. Combining unparalleled
experience, comprehensive capabilities across all
industries and business functions, and extensive
research on the world’s most successful companies,
Accenture collaborates with clients to help
them become high-performance businesses and
governments. The company generated net revenues
of US$27.9 billion for the fiscal year ended Aug. 31,
2012. Its home page is www.accenture.com.
Copyright © 2013 Accenture
All rights reserved.
Accenture, its Signature, and
High Performance Delivered
are trademarks of Accenture.
For more information, including the full
report on Trinity Health’s clinician-led
transformation, please contact:
Manuel Lowenhaupt, M.D.
manuel.lowenhaupt@accenture.com
Kathleen T. Lennon, R.N.
kathleen.t.lennon@accenture.com