GOAL:In an era of rapidly expanding healthcare data-much of it generated by consumers-healthcare organizations face both opportunities and challenges. This article presents a framework, a classification of data sources, and a set of analytical methods to establish more robust, timely, and impactful approaches to listening to consumers and capturing their voice. METHODS:We conducted an extensive review of the literature on data sources that carry the voice of healthcare consumers, including sources that organizations have not fully used. Through this review and team discussions, we systematically classified data sources and matched them to appropriate analytical methods. PRINCIPAL FINDINGS:We categorized three sources of consumer voice data: (1) traditional, (2) organic, and (3) observational or behavioral. We also identified three corresponding categories of analytical methods: (1) conventional analytical techniques, (2) machine learning and natural language approaches, and (3) real-time insights with user-centric analyses. Together, these sources and methods provide multiple pathways to generate timely and actionable insights into consumers' needs, preferences, and experiences. PRACTICAL APPLICATIONS:Healthcare organizations should develop a system that harnesses consumer-generated and observational data alongside traditional sources and apply the appropriate analytical methods to each. Doing so enables leaders to deepen their understanding of consumer experiences and preferences, incorporate the voice of the consumer into decision-making, and ultimately, improve the delivery of patient-centered care.
GOAL:This research provides a framework for developing, adapting, and implementing an innovative, system-wide Gemba Board program in a multidisciplinary hospital setting to improve quality and patient safety through high-reliability concepts and continuous process-improvement tools, such as Lean methodologies and Six Sigma for quality improvement. METHODS:The Harry S. Truman Memorial Veterans' Hospital (Truman) piloted a two-phased Gemba Boards deployment model. Methods were developed for staff engagement and contribution to a culture of improvement using metrics like engagement levels, return on investment (ROI), and comprehension evaluations of high-reliability principles. The first phase involved establishing Gemba Boards in all departments, while the second phase focused on sustained evaluation and refinement of the system. PRINCIPAL FINDINGS:Gemba Boards, deployed in 69 departments at Truman, yielded more than 3,000 improvement ideas and a documented ROI of $2.85 million over 5 years. The implementation led to significant qualitative and quantitative impacts on clinical, operational, and administrative services, enhancing collaboration and psychological safety among staff. PRACTICAL APPLICATIONS:This study demonstrates that widespread adoption of a Gemba Board framework leads to higher levels of quality, patient safety, and efficiency. It provides a practical, replicable framework that other healthcare systems can adopt. Future studies should analyze trends and outcomes to inform decision-making in diverse healthcare settings.
GOAL:In January 2021, the Centers for Medicare and Medicaid Services (CMS) updated outpatient evaluation and management (E/M) coding guidelines, allowing orthopedic providers to choose between medical decision-making (MDM) or time-based billing. Providers can now bill based on the severity of symptoms with MDM or the total time spent on chart review, documentation, and coordinating care with time-based billing. Given the new CMS guidelines, it is necessary to evaluate the impact of these changes on provider confidence and accuracy with E/M billing and assess the implementation utility of coding education with updated guidelines in an effort to increase comfort and accuracy. METHODS:This study, conducted in two phases in 2021 and 2023, assessed orthopedic providers' confidence and accuracy with coding under the new CMS guidelines. In the first phase, providers were surveyed on their confidence with different coding levels (Levels 3-5) and comfort using MDM and time-based billing. Providers' coding accuracy performance was measured via monthly coding audits and compared to survey responses. Each provider then participated in one-on-one educational sessions on the new guidelines with a focus on improving their confidence and accuracy. In the second phase, the providers who completed the first survey took a follow-up survey to reassess their comfort and coding accuracy. PRINCIPAL FINDINGS:We found a significant improvement overall for all providers in confidence across all levels after education, with residents showing the greatest improvement in Levels 3 and 4, and advanced practice providers (APPs) showing the greatest improvement in Level 5 (p < .05). There was a significant decline in comfort with MDM among APPs and attending physicians or providers (i.e., attendings), and a significant increase in comfort with time-based billing among APPs (p < .05). After coding education, accuracy significantly increased for all providers overall (p < .05). By group, only attendings demonstrated a statistically significant increase in accuracy (p < .05). The findings suggest that mandatory education in the setting of new guidelines enhances coding confidence and accuracy but varies among providers, which may be explained by variable financial motivators and familiarity with old guidelines. Subjective confidence was not predictive of objective coding accuracy (p < .05), suggesting that providers may overestimate their coding abilities. PRACTICAL APPLICATIONS:Previous studies have demonstrated that accurate documentation of E/M care significantly improves charge capture and reimbursement. Tailored coding training for providers based on deficiencies identified during coding audits, rather than areas of self-reported weakness, may be implemented to address deficits in coding accuracy, ensuring that all providers can navigate coding and billing effectively, and consequently contribute to better financial outcomes for healthcare systems.
