Health apps for SharePoint, Part 1: Scalable, adaptive apps on tap to accelerate business transformation

13 May 2014 | Dr. Dennis Schmuland, Chief health strategy officer, U.S. Health and Life Sciences, Microsoft
Micosoft SharePoint 2013

When we launched Microsoft SharePoint 2013, we introduced enterprise-class Apps for SharePoint (see "Learn the Basics" infographic) as a new way for our enterprise customers to add functionality to their SharePoint 2013 sites at velocity and scale. Apps for SharePoint are sort of like apps for your Windows Phone, iPhone, or Android—with two major exceptions: scalability and adaptability.

Scalability. These apps can work for your entire enterprise, unlike single-purpose, stand-alone consumer apps that each user has to manually download to a personal phone or tablet. These are enterprise apps that any team or division can immediately put to work, These apps can accelerate business transformation and process improvement at a scale never before possible because any team or division or subsidiary can instantly find an app, download it, and put that app to work at the same time as everyone else in the organization.  This eliminates the sequential, one department at a time, multi-year “phased roll-outs” of new processes and change initiatives. Imagine the possibilities--with Health Apps for SharePoint instantly available to everyone in the organization, every leader and employee could quickly become a part of an accountable team to improve patient safety, clinical processes, or team performance in less time and at a lower cost.

When a healthcare system or developer publishes an App for SharePoint to the public SharePoint Store, that App can be found and immediately put to use by any health system that's already licensed for SharePoint 2013 or Microsoft Office 365. But for HIPAA security and compliance reasons, most health systems will want to meter and manage which apps they want to make available within the enterprise and which ones they don't. Some enterprises will develop great Apps for SharePoint 2013 in-house and will want to limit what authorized employees can install to those in-house apps. They can do so by placing only those apps in their app catalog. And if they do find valuable apps in the public SharePoint Store, they can make them available for internal use by whitelisting any public app they want to promote within their app catalog and blacklist all the unapproved apps. Apps are also available for Word, Excel, Outlook, Project, and PowerPoint—but we'll save that topic for future time.

Adaptability. Apps for SharePoint 2013 are easy to install, use, and remove. Teams and enterprises can adapt these apps to their unique needs by using out-of-the-box SharePoint 2013 functionalities like workflow, taxonomy, search, document libraries, lists, user profiles, social networking and interoperability with line-of-business applications like electronic health record (EHR) systems. 

What makes scalability and adaptability so relevant to health systems? In healthcare, process and culture change initiatives just take too long and cost too much. They're difficult to scale and a one-size-fits-all approach seldom works out because every health system has a unique culture, specific business needs, and particular shortcomings.

To illustrate how critical the scalability and adaptability of apps are to health system transformation, consider the fact that it's been nearly 15 years since the Institute of Medicine’s report To Err Is Human: Building a Safer Health System shocked the healthcare industry to action. Almost overnight, patient safety became a top priority goal for every health system. And yet, for all the board-level proclamations, process improvement grants, and grassroots patient safety movements since the IOM report, all we have to show for our noble efforts are pockets of limited success. Despite the ubiquitous availability of evidence-based patient safety guidelines and toolkits today, we still see massive and unwarranted variation in the quality and safety of care across our delivery system. On any given day, about 5 percent of inpatients are affected by a healthcare-associated infection; among chronically ill adults, 22 percent report a "serious error" in their care; and nearly 30 percent of Medicare inpatients are harmed in the course of their care, directly costing the federal government more than $4.4 billion annually (HHS OIG). Hand hygiene compliance is stuck at 60 percent and poor communication is cited as a root cause in nearly 70 percent of reported sentinel events. In addition, 74 percent of hospitals made no improvement last year over the prior year in addressing errors, accidents, injuries, and infections that kill or hurt their patients, according to the Leapfrog Group.

So what's going on here and why is progress in patient safety taking so long? Why haven't best practices in patient safety become mainstream throughout all 5,723 US hospitals by now? According to Mark Chassin, CEO of Joint Commission on Accreditation of Healthcare Organizations, there are two key barriers standing in the way of safer care: culture change and one-size-fits-all solutions (Improving the Quality of Health Care: What's Taking So Long? Health Affairs, October 2013).

Culture change. Transforming an organization previously designed and built around an episodic, volume-based care model into a high-reliability organization (HRO) designed around results requires radical institutionwide change in the organizational culture from the board level down to every frontline employee and contractor. Culture change and process improvements must inculcate the entire organization. Becoming an HRO requires health systems to confront not only the misuse of care (avoidable complications) but also waste and underuse (gaps in care. While most health systems have invested heavily in the clinical data infrastructure (EHR system), most have underinvested in the collaboration infrastructure needed to promote the top-to-bottom HRO culture change they need to drive organizationwide transformation. As a consequence, culture change is taking too long and costing too much. 

One-size solutions fit few. Over the past decade, downloadable patient safety toolkits have proliferated across the Internet, most of which are based on best practices proven to be effective within a single organization that’s successfully conquered, or at least mitigated, errors in some way. The assumption behind offering these toolkits online for all to use is that, for each of the errors these toolkits are designed to fix, every organization shares the same set of underlying causes and factors that contribute to the errors they have in common.

But, as it turns out, every health system tends to have a unique set of causes and factors that contribute to errors and waste—typically five or six. This means that an intervention that worked for one organization shouldn't be expected to produce the same results when applied to an organization with a different set of causes that contributed to the problem. The intervention needs to be adapted. 

To overcome this uniqueness factor, Chassis makes the case for adaptive robust process improvement (RPI) tools—a hybrid of Lean, Six Sigma, and change management methodologies that enable each organization to quickly diagnose its unique contributing causes and tailor an effective intervention that will work for them. 

So to accelerate the realization of the vision and advantages of high-reliability healthcare, every health system needs a scalable and adaptive collaboration platform to transform its culture and inculcate change from top to bottom. The platform must equip everyone in the organization with process improvement tools that adapt to their unique causes or contributing factors that lead to their patient safety failures. 

Enter Health Apps for SharePoint 2013. The scalability and adaptability of Health Apps for SharePoint can accelerate and make it easier for RPI tools to be more broadly deployed across multiple organizations and comprehensively employed within organizations.

So here's my challenge to the industry: What if every one of the 5,723 US hospitals and 200,000 US clinics could instantly download and put to work some of the most promising Health Apps for SharePoint? Would culture change and business transformation accelerate in your organization if you could put the following Health Apps for SharePoint in your app catalog?

  • Corporate Culture Change Management Dashboard: Tracks and visually maps your organization against a Leadership and High-Reliability Organization Maturity Model. Leadership could combine this app with a heat map to track top-to-bottom culture change.
  • Robust Process Improvement Team Site: Enables any department or team to instantly set up a process improvement team site with preconfigured templates, workflows, roles, lists, and a calendar to guide teams in driving out waste, defects, and costs, and in improving the speed, efficiency and outcomes of care. 
  • Robust Process Improvement Training Site: Includes training materials for instructors, trainers, and participants, and assessments, tests, and on-demand video instructional modules. Rapidly train your staff to run RPI initiatives from initial concept development through to sustainment of positive changes.
  • Checklist Framework: Enables any organization to quickly and easily create and manage checklists, surveys, and forms on any device; conduct analytics and alerts in real time; and integrate data captured on the front end with their back-end EHR or data warehouse.
  • HIPAA Book of Evidence: Provides practices to ensure full compliance with HIPAA privacy and security regulations and build the documentation they need to always be ready for an OCR audit.

Community Health Resource Portal: Enables any community to aggregate, locate, and share the abundant but often “hidden” community health resources required to address the social determinants of health and make those resources easy to find and schedule by any patient, provider, social worker, caregiver, or family.

What Health Apps for SharePoint would you put on your wish list to accelerate culture change and business transformation in your organization?

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Dr. Dennis Schmuland
Chief health strategy officer, U.S. Health and Life Sciences, Microsoft