ebook-Thriving During Disruptive Change€¦ · of disruptive change. Regulatory demands, increased...

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Optimizing the business of healthcare EBOOK Interoperability Population Health Patient Engagement Fee for Value Thriving During Disruptive Change The Power of Clinical Optimization

Transcript of ebook-Thriving During Disruptive Change€¦ · of disruptive change. Regulatory demands, increased...

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Optimizing the business of healthcare EBOOK

Interoperability

Population Health

Patient Engagement

Fee for Value

Thriving During Disruptive ChangeThe Power of Clinical Optimization

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I. Healthcare Industry Trends: Why You Need Clinical Optimization 2 Transition from Fee-for-Service to Value-Based Purchasing 2 Population Health Management (PHM) 2 Patient Engagement 2 System Interoperability Within Your Organization 3

II. The Importance of Clinical Optimization 4 What is Clinical Optimization? 4 Healthcare Clinical Challenges 5 ClinicalOptimizationBenefits 5

III. Meeting the Change Management Challenge 6 Setting Goals and Objectives 7 Assembling the Change Management Team 7 OCM Strategies 8 Overcoming Resistance 8 Sustaining Change 8

IV. It Starts with Analysis 10 EHR/EMR Functionality 10 People Assessment 11 Process Review 12

V. The Continuous Cycle of Improvement: What You Should Be Doing Next 14

Summary 15Con

tent

s

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Few would argue that the healthcare industry is in the midst of disruptive change. Regulatory demands, increased patient responsibility,andshrinkingprofitmarginsareforcingacross-the-board changes in the industry. A report by McKinsey and Company points out that during times of disruptive change, incumbent industry leaders are often unseated. Those companies that survive develop a leaner cost structure while improving productivityandoperationalefficiency.1

To succeed, healthcare organizations need to take similar steps by developing a comprehensive clinical optimization program that alignsandimprovesgovernance,processworkflow,anduseoftechnology. Organizations that embrace such a program will not only survive, but will thrive during this ongoing period of industry disruption.

To succeed, healthcare organizations need to take similar steps by developing a comprehensive clinical optimization program that aligns and improves governance,processworkflow,anduseoftechnology.

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Healthcare Industry Trends: Why You Need Clinical Optimization

A clinical optimization program will ensure your EHR triggers the staff reminders for patientfollow-upandenhanceworkflowsfor patient care.

Part of the optimization program includes performing an assessment of your current EHR setup to determine opportunities for improvement. Other key facets examined as part of the process include analytics reporting to better understand your current patient population, building reports, creating forms that capture key information, and ensuring data is entered accurately andefficiently.

Patient EngagementIn order for value-based purchasing and population health management to be effective, patients must be more engaged in their care and treatment than they are today. Patients need to understand their care and treatment plans, costs associated

state operations and prepare for change. A clinical optimization program reviews workflows,patientaccess,EHRbuild,andutilization. The goal is to identify areas whereyoucanimprovequality,efficiency,obtain better reporting and analytics, improve patient/staff and provider satisfaction, and reduce costs. A compre-hensive plan considers provider and staff usability based on the design, build, andworkflowsofyouroperationand develops goals and action plans for future state deployment.

Population Health Management (PHM)Proactive wellness care and focused disease management that drives improved outcomes will not only improve quality of life for patients and families, but it will also enhance care and lower long-term costs. To sustain the PHM model, it is critical to ensure payment is worthwhile to the providers to sustain their business practice.

There are a number of factors driving change in the healthcare industry today. We review four trends that offer the most significantimpactontheindustry’scurrentstateoffluxandwhereclinicaloptimizationcan make an impact.

Transition from Fee-for-Service to Value-Based PurchasingNothing is more critical and important today than the transition to value-based purchasing. The current fee-for-service payment method is no longer a sustainable, healthy long-term business model. As reimbursements continue to shrink, providers must focus on quality, lower costs, and improved customer service. Healthcare organizations that provide effective, quality services will ultimately realize enhanced payments and increased satisfaction scores.

As we migrate towards value-based purchasing, it is critical to review current

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Insert Title

Transition from Fee-for Service to Value-BasedPurchasing

HealthcareTrends that

Drive the Needfor Clinical

Optimization

Population HealthManagement

SystemInteroperabilityWithin YourOrganization

PatientEngagement

with them and other options they may have. Looking forward, they will now be required to make decisions based on quality and cost oftheircare-decisionstheyhaven’tpreviouslyhadtomake.

Optimization will help develop an appropriate patient portal to assist patients and family members make those decisions intelligently.Theportalcanalsoidentifybottlenecksinworkflowsand patient access – especially in the areas of registration, scheduling, and nurse triage.

System Interoperability Within Your OrganizationIntegrating multiple EHR/EMR systems and other applications within a healthcare organization can be challenging. Your organization needs to employ tools to support collaborative systems that allow data sharing across platforms. Improving interoperability increases loyalty and quality of care. An optimization program can identify where your IT team should build interfaces and crosswalks that will help improve the quality of all the systems in the organization as seamlessly as possible and ensure that they work together.

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The Importance of Clinical Optimization

What is Clinical Optimization? Clinical optimization is the process of improving patient care by streamlining access to data, facilitating clinician collaboration, refiningprocesses,andstrengtheningoutcomes.Clinical optimization is not simply about improving the functionality of yourorganization’selectronichealthrecord/electronicmedicalrecord (EHR/EMR) system, although that should be a key outcome.Totrulybenefitfromaclinicaloptimizationinitiative, youneedtoreview,refine,andimproveallworkflowsand processeswithagoalofmakingthemmoreefficientand improving patient outcomes.

If clinical operations are bogged down in workarounds, ineffective workflows,unhappyphysiciansandpatients,andunderutilized technology,itwillbedifficultfortheorganizationtomeetnewindustry demands and remain competitive.

CLINICAL OPTIMIZATION:

STREAMLINE DATA ACCESS

FACILITATE CLINICIAN COLLABORATION

REFINE PROCESSES AND WORKFLOWS

STRENGTHEN OUTCOMES

IMPROVE PATIENT OUTCOMES

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ClinicalOptimizationBenefitsOne way to address these challenges is by implementing a comprehensive clinical optimization program. Doing so can providebenefitsincluding:

• Improved quality of care and outcomes• Improvedstaffefficiency• Enhanced quality patient care• Increased patient satisfaction• Heightened provider and staff morale• Increased user system adoption• Betteralignmentofworkflows,processes,andsystems• Improved ROI on system implementation

Clinical optimization is a continuous process. Success depends on a program of engagement, communication and collaboration from all stakeholders. Before embarking on a program, ensure that your leadership is on board and has outlined and communicated expectations for the entire organization.

Givenwhatisatstake,theimportanceofclinicaloptimizationcan’tbe overstated.

Healthcare Clinical ChallengesSome of the challenges that healthcare organizations face today include:

• Margin reduction from lower productivity and higher costs• Poor ROI on EHR/EMR investments• Disgruntled physicians due to new technology, reduced

reimbursements• Inefficient,paper-basedworkflowsincompatiblewith

EHR/EMR systems• Lack of IT resources to leverage full EHR/EMR functionality• Difficultiesmeetingandreportingonregulatoryqualitymetrics• Problems coordinating patient care• Low patient satisfaction• Staff resistance to change

Leftunchecked,theseissuescanthreatentheprofitabilityandtheultimate survival of an organization. These challenges must be faced and overcome for an institution to thrive.

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Meeting the Change Management Challenge

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Assembling the Change Management TeamTheChangeManagementTeamidentifiesandcommunicatesthevarious change management responsibilities required to attain the program goals. Having the right team in place establishes a strong governance structure and ensures that decisions can be made quickly. The roles on the team include:

Program Sponsor – The executive responsible for ensuring that appropriate resources are committed and problems are resolved in a timely manner. A game-changing clinical optimization program can only be successful with strong, consistent support from a senior executive.

Change Leader – An individual senior enough in the organization to be able to command the attention of the executive team. He or she is the principal troubleshooter with ultimate responsibility for problemandconflictresolution.

Steering Committee – Shares overall responsibility and oversight of the program with the Program Sponsor. The committee should regularly review progress, provide guidance, and help remove obstacles.

Employing the concepts of Organizational Change Management (OCM) can help overcome that resistance. OCM provides a framework for managing the effects of new business processes, changes in organizational structure, and cultural changes, all of which may be elements of a clinical optimization program. It helps identify and address issues that arise when people are asked to change the way they are accustomed to doing things. To be effective, OCM should ensure that changes are properly implemented and that the concept of change management is woven deeply into the fabric of your organization.

Setting Goals and ObjectivesEstablishingSMARTgoals(Specific,Measureable,Achievable, Results-focused,Time-bound)isanessentialfirststepinthe changeprocess.Clearlydefiningtheendstateisthebestway to engage stakeholders and provide them with a guiding vision for the project.

Inadditiontosettingbigpicturegoals,youshoulddefinenear term objectives – solid, tangible achievements that can be reached by following certain prescribed steps. Change objectives must link to the strategic goals of the organization and have widespread support.

Initiating the transformative change required in a clinical optimization effort will likely generate resistance and unforeseen obstacles

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Overcoming ResistanceThe team must identify and deal with both overt resisters (who openly criticize and sabotage the effort) and covert resisters (who quietly create problems and sow dissent in the hope that the initiative with eventually fail. The team then has to help uncover reasonsfortheresistanceandfindwaystoresolvethem.

It’scriticaltohelpemployeesworkthroughthepsychologicalprocess of change and turn them from active obstructionists into supporters.

Sustaining ChangeAfter implementing a change program, the challenge becomes sustaining the momentum and driving home the concept of ongoing change. This can be achieved in several ways including:

• Ongoing, visible executive support• Comprehensive planning by the entire team• Continuous review of relevant metrics• Stakeholder engagement through ongoing communication• A permanent support structure to provide resources to deal

with changes

Project Manager – Responsible for detailed planning and implementation, assigns tasks and oversees activity.

Project Team Members – Responsible for completing the various tasks necessary to achieve the goals and objectives.

Mid-level Managers – Responsible for supporting and communicating the change initiatives as well as allocating area specificresources.

Supervisors – Front line operatives should support, explain, and coach the staff through the various change implementations.

OCM StrategiesThere are a number of ways to ensure a successful organizational change program including:

• Agreement on a common vision for change • Focus on one change initiative at a time• A plan to educate employees on how their day-to-day jobs

may change and the reasons for it• Development of critical key metrics that should be reviewed

regularly to track progress• Establishment of reward structure, both monetary and social,

to encourage employees to take ownership of their new roles and responsibilities

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Results

Hallmark Health Medical Associates, Inc. (HHMA) is a group of more than 80 providers in eight local communities north of Boston. They wanted to maximize the use of its EMR, reduce time spent documenting, standardize the documentation process, and determinewhetherworkflowssupportedanoptimalworking environment for the physicians and staff.

Working with Hayes Management Consulting, HHMA initiated a clinicaloptimizationprogramthatidentifiedthreepilotclinicstodetermine opportunities for improvement and a rollout plan for the remaining sites.

As part of the effort, they established future goals, conducted agapanalysis,analyzedworkflowsandtheEMRsystem,the documentation process, and physician documentation standards. Hayes and HHMA developed actionable solutions for improving clinicaldocumentationandoperationsandidentifiedmorethan 60 optimization opportunities.

As a result, HHMA was able to reduce appointment types by 70%, scheduling time by 25%, and the problems list by 97%.

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SETTING GOALS AND OBJECTIVES

OCM STRATEGIES

OVERCOMING RESISTANCE

SUSTAINING CHANGE

ASSEMBLING THE CHANGE MANAGEMENT TEAM

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If either of those is dysfunctional or not finelytuned,theentireorganizationsuffers.

It’softendifficulttoextricateyourselffromtheday-to-dayresponsibilitiesandfindthe time to conduct a thorough assessment ofyourorganization.That’swhymanyorganizations contract with a consulting group to guide them through the process. A reputable partner will help lead the initiative and begin by reviewing your entire operationspecificallyfocusingonareassuch as:

• Workflows• Scheduling• Visit Procedures• Clinical Documentation• Tests and Procedure Ordering/Follow up• Prescription Ordering• Third Party Software• Practice Management Software• Reporting• Quality Control

Before laying out a path to clinical optimiza-tion, you must evaluate your current state. That begins with a thorough analysis of the people, processes and technology that make up your operational landscape.

Your analysis should be focused on two main areas of emphasis:

1. Theworkflowsinvolvingthetreatmentof your patients

2. Theintegrationofthoseworkflowswithyour EHR/EMR

EHR/EMR FunctionalityThe evaluation will also include a compre-hensive review of your EHR/EMR and how effectively it is being used. This will start with a system-wide assessment to discover thestatusofcurrentworkflowsandhowthey are integrated with the EHR/EMR. In manycases,organizationsfindthattheyare not taking advantage of many useful features contained in their EHR/EMR and other systems/applications. Part of a corrective action plan will include training staff to leverage these unused resources.

Following a comprehensive evaluation, your consultant will be able to report on your current state and recommend improvedefficienciestobothprocessandtechnology.Theywillranktheirfindingsby impact to the organization and the amount of effort that will be required to institute corrective action.

It Starts with Analysis

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A major hurdle during the evaluation is overcoming the mindset that an EHR/EMRcanfixallissuesinanorganization. While it can provide many positives, an EHR/EMRsystemwillnotfixbroken internalworkflows.It’simportantto understand that implementing a new EHR/EMR system or optimizing an existing one is an organizational initiative, not an IT project. The EHR/EMR is just one component of an interconnected operation.

Optimizationrequiresworkflow improvement, strong management, and organizational transformation. It requires close collaboration between all divisions of your organizations, including IT, clinicians, quality management, revenue cycle, patient access, operational management, andthebusinessoffice.Becauseoftheenterprise-wide nature of the effort, senior leadership needs to be involved at the beginning and provide a continuing presence throughout the entire process.

ResultsHayes Management Consulting worked with an ophthalmology faculty group to develop a clinical optimization plan. After rolling out their Epic EMR, they saw that visit levels dropped and never returned to the pre-Epic level. Physicians were spending two-to-three hours outside of clinic hours to close charts. Hayes helped initiate an optimization project that consisted of a full assessmentofstaff,systems,andworkflow.They uncovered more than 60 build op-portunities and more than 10 training gaps. They also recommended creating a physical work environment that encouraged the use of Epic in the exam room. This eliminated the need to constantly log in and out of Epic and other systems while improving patientflow.

People AssessmentYourstaffiskeytotheorganization’s success and working with them on an optimization project is critical. As the organization’smostvaluableasset,yourpeople hold the key to driving and sustaining positive change.

Thefirststepisevaluatingtheteamtoassess individual performance levels and identify training needs.

Once this process is complete, a comprehensive improvement action plan can be developed. When assessing staff, you should:

• Target staff responsible for each task• Share current and revised performance

goals with operational metrics for each critical business function

• Coach each staff member on how to reach or exceed performance goals

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• Provide regular feedback on outcomes • Lead the improvement efforts by

showing measured progress toward goals and continued coaching to address weak performance

• Broadcast improvements to the organization. Garner interest across the entire organization to embrace and be accountable for improved operational performance

• Acknowledge success

Theimprovementprocesscan’thappen if current outcomes and performance are not transparent throughout the organization. Utilizing data to train staff to be analytical problem solvers versus task or transaction-based workers is a major contributor to the success of a clinical optimization project.

Personnel development that focuses on individual productivity and quality

outcomes will help identify under- performers and stellar achievers. Having the right team in place, focused on the appropriate targets will go a long way to optimizing performance over time.

Process ReviewBefore improvements can be implemented, the current state of process control needs to be established. While assessing the operational functions and performance of the current operation, the organiza-tion should also be measuring outcomes for each critical business step to identify opportunities to streamline or automate processes to reach performance goals. In mature organizations, policies and procedures were often developed and implemented years ago. Ongoing performance looks to be acceptable and the organization - with multiple competing agendas – leaves things “as is.” This can be a primary reason healthcare organizations do not improve.

Documentingprocessesandworkflows is arguably one of the most dreaded tasks in healthcare management. It is time consuming, tedious work, but absolutely necessary at the very early stages of a clinical optimization project. A thorough process review will help highlight redundancies and time-wasting tasks and will quantify the outcome or performance expectation for each task.

Analyzing current processes also allows leadership to identify underutilized systems, poorsystemconfiguration,andmultiplework-arounds that have been put in place tocompensateforaninefficientprocess. In many cases, sub-optimal performance can betracedtoaninefficientprocess that has migrated away from documented procedures and automation. Streamlined and automated processes improve out-comes, reduce or re-align staff and eliminate waste from the system – all contributors to improved operational performance.

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Insert Title

A system-wide validation session is a good starting point for discovering the status of thecurrentworkflowprocessesandhowthey are incorporated into the system. These sessions should involve all levels of the organization and should focus on uncoveringbrokenworkflowsand disconnects between departments.

Anyworkflowthatisnoteffectiveisanimmediate candidate for optimization. One suggestion is to incorporate some oftheEMR’smodelworkflowtominimizebuild, but there should be a discussion toincludeeveryone’sinput.Finally,thereshould always be a compelling reason for eachworkflow,suchasimprovingefficiencyor patient safety. The reason should never be“becauseit’salwaysbeendonethatway.”

ResultsWaldo County General Hospital (WCGH) faced this challenge when they converted from a paper-based system to a 15-application Epic EHR implementation. WCGH was goingtobethefirstCriticalAccessHospitalintheMaineHealthSystemtogolivewithfullsuiteEpic.Leadershipwasconcernedaboutthehospital’sreadinessforclinicalchangebecauseofperceivedworkflowgaps. Hayes Management Consulting provided Clinical Readiness Project Management services to develop a readiness program and implementation toolkit. Consultants assessed currentstateworkflowsthroughstaffinterviewsanddocumentationreviews,createdworkflowcrosswalkdiagrams,reviewedgo-liverisks,andhelpeddeterminemitigation. Defectiveworkflowswerefixed,somedischarge/transferissueswereavoided,andnewstep-by-stepworkflowswerecreatedtopresentaclearerpictureforproviders.Asaresult,workflowgapsweresignificantlyreducedandstakeholderengagementimproved.The implementation was smooth and a structure was put in place to provide ongoing support. There was a decrease in the anxiety level of leadership and end users with an increase in the drive to be successful, creating a more smooth transition from a paper- based system to the Epic EHR. The structure provided in the Clinical Readiness Tookit is nowbeingusedfortheorganization’sadditionalimplementationsandiscustomizedbytheorganization’sownClinicalReadinessexpertwhohasbeentrainedandmentoredbythe Hayes Team.

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The Continuous Cycle of Improvement: What You Should Be Doing Next

Approvetheworkflows.Develop and approve the new future state workflows.Finalworkflowsneedtobeapprovedbeforemovingonto the later stages of optimization.

Build the changes. Once the priority list has been set, you can begin to build the changes to meet the future state vision/workflows.Somechangesmayaffectmultipleareasinthe organization so it is always best practice to contact all teams when dealing with large, integrated build tasks. Document all changes to reduce confusion and troubleshooting time later.

Test and validate changes. Conduct extensive testing for any changes with any possibly affected teams before going live. Begin with the EMR application testing to ensure that the pathways work correctly.Validatethenewchangestotheworkflowtoverifythefinishedproductalignswiththeoriginalgoals.

Train end users. Ensure that all end users who will be using the system on a daily basis receive comprehensive training. During the training phase, document any issues to help focus later training efforts.

Launching an effective change initiative is only half the battle. The greater challenge is sustaining the momentum and driving the change effort effectively. Walt Disney used to say that his theme parks were always in the “state of becoming.” The same can be said for your clinical optimization program. There is no endpoint and instead should become a continuous cycle of improvement.

The optimization process is an iterative progression with the organizationcontinuallyfindingbetterwaystotreatandcare for its patients. Here are the steps to be followed to ensure that the entire organization is proactively searching for solutions rather than simply reacting to problems.

Set the foundation. Revisit the original goals of the program todevelopaunifiedvisionforoptimization.Developastrong governance structure and thorough strategy. Instruct managers andsupervisorsandconfirmthattheyfullyunderstandthechanges appointment/visit number and why they were made. Ensure that they buy into the changes and will support them going forward.

Prioritize the changes. Prioritize suggested changes based on numberofusersandpatientswhowillbenefit,lengthoftimeandamount of resources required to implement.

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Support and follow-up. Aftergo-live,it’scriticaltoprovide support for end users. Answer questions quickly and document any adjustments that need to be made. Stay calm and patient as the organization works through this time of change. Start over again. Continuous improvement never ends. Organizations that are constantly looking to improve will be the ones who enjoy the most success.

10 Signs You Need Clinical Optimization1. Your clinical operation is bogged down with workarounds

andineffectiveworkflows2. Your patients are unhappy and your physicians are

disgruntled3. You’reusingonlyafractionofthefeaturesofyour

EHR/EMR system4. Processes are not standardized or documented5. Your EHR/EMR is not aligned with your strategic goals6. Getting to data is cumbersome and time consuming7. There’salackofcollaborationbetweenclinicians8. Information is not coordinated between departments 9. You’restrugglingtomeettheincreaseddemandsofthe

new healthcare environment10. Youfeelyou’refallingfurtherbehindthecompetition

Set the foundation Prioritize

the changes

Approvethe

workflows

Build thechanges

Test andvalidate changes

Train endusers

Startover again

Supportand

follow-up

The Continuous Cycle of

Improvement

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Creatinganeffectiveclinicaloptimizationprogramcanbechallenging.It’simportant to have senior level involvement, a solid governance structure, and a communications strategythatincludestheentireorganization.Whendoneright,itprovidessignificant qualitative and quantitative results. It can propel your organization past competitors, improve patient satisfaction, and enhance staff and physician morale.

At Hayes Management Consulting, we help optimize the business of healthcare by improving operational outcomes in a cost effective and sustainable way. Our consultants come from the frontlines of healthcare and weave these realities into everything we do. We know the external forces that affect healthcare organizations and we have developed a comprehensive toolset of products and services designed to enable you to achieve your ultimate goals. Contact us to see how we can help you with your clinical optimization initiative.

Summary

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1 How US healthcare companies can thrive amid disruption, Brendan Buescher and Patrick Viguerie, McKinsey Insights, June 2014

EMR System Optimization, Hayes Management Consulting Data Sheet

Maine Health System Epic Implementation, Hayes Management Consulting Case Study

Steps to Clinical Optimization, Hayes Management Consulting White Paper

How US healthcare companies can thrive amid disruption, by Brendan Buescher and Patrick Viguerie, McKinsey Insights, June 2014.

How to Start a Clinical Optimization Program, Hayes Management Consulting White Paper

Hallmark Health Medical Associates Clinical Optimization Project, Hayes Management Consulting Case Study

Clinical Services Optimization, Hayes Management Consulting Presentation

Clinical Optimization, Hayes Management Consulting Presentation

Ophthalmology Faculty Group Clinical Optimization, Hayes Management Consulting Case Study

Healthcare Change Management Strategies: A Roadmap to Success, Hayes Management Consulting White Paper

Sources

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Hayes Management ConsultingHayes Management Consulting is a leading, national healthcare consultingfirmthatpartnerswithhealthcareorganizationstostreamline operations, improve revenue and enhance technology to drive success in an evolving healthcare landscape. To learn how Hayes Management Consulting can help you with your clinical optimization, call 617-559-0404 or [email protected].

www.hayesmanagement.com

Optimizing the business of healthcare

1320 Centre Street, Suite 402 | Newton Center, MA 02459Phone: 617-559-0404 | Fax: 617-559-0415www.hayesmanagement.com | [email protected]