Tech-fueled

Performance ImprovementCost-effective, collaborative solutions for us all

Washington State Hospital Association Annual Meeting

10.11.18

Norderstedt, Germany

Prague, Czech Republic

Moscow, Russia

Wokingham, UK

Zuchwil, Switzerland

Recife, Brazil

São Paulo, Brazil

Bogota, Colombia

North Ryde, Australia

Beijing, China

Shanghai, ChinaOsaka, Japan

Tokyo, Japan

Fukushima, Japan

Chennai, India

Mumbai, India

Singapore

Irvine, California

Cincinnati, Ohio

Jacksonville, Florida

West Chester, PennsylvaniaSomerville, New Jersey

Raynham, Massachusetts

Palm Beach Garden, Florida

Seoul,

South Korea

o 26 state-of-the-art facilities

o On-demand, online learning

modules

o Virtual reality training

o Over 210,000 surgeons trained

annually

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Priorities of Healthcare Executives

• Managing costs – 65% of executives plan to increase efforts to control the cost of care management.

• Engaging and satisfying consumers – Nearly 60% of those surveyed plan to broaden the scope of telehealth;

45% want to increase investment into patient engagement initiatives such as mobile apps.

• Clinical quality – Half of executives indicate their organizations would be increasing their quality reporting to

CMS, and 36% said they’d be increasing their reporting to private payors.

• Data analytics – 53% of executives are exploring ways to improve patient care and supply chain management

via advanced data analytics.

• Population health – To improve patient outcomes, 45% plan on expanding post-acute care services via

community partnerships, and 40% plan on expanding the care team by working with various healthcare

professionals, such as nurse practitioners, care coordinators and pharmacists.

3Source: Premier, Inc.

400,000

James J Patient Safety 9:122, 2013 4

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The High Cost of Medical ErrorsNUMBERS ARE ESTIMATES FROM 2008

2,500

Excess deaths

$10MILLION

Average cost

of missed days

of work

$13THOUSAND

Average cost

per medical error

$19.5BILLION

Total medical

mortality and

short-term

disability costs

Source: Jon Shreve et. al., The Economic Measurement of Medical Errors

Disproportionate Share Hospitals

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How is a hospital to invest in quality

improvement given the pressures

and state of the market?

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To partner with patients with kidney disease and their caregivers to achieve

health, longevity and quality of life equivalent to the general population.

By harnessing the inherent motivation and expertise of all stakeholders

to improve care, spawn innovation and conduct research that improves

health and outcomes.

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Pediatric IBD Learning Health Network

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PROPORTION OF PATIENTS IN REMISSION

87 GI Care Centers

>25,000 patients

> 750 physicians

>40% of all patients with

IBD

APR 2007 OCT 2008 AUG 2010 AUG 2012 JUN 2015

APRIL2016

80%

59%

Centers >75% registered

Source: Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease.

Pediatrics. 2012; 129: 1030-41

Outcome Bottom vs. Top Quartile

Operative Times 40% Longer

Complications & Readmissions 3X Greater

Mortality 5X Greater

The Problem

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“…responsibility for training, credentialing, and

privileging surgeons to use new technologies belongs

to physicians and the hospitals where they work.”

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Objective Structured Assessment of Technical Skills

(OSATS)

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24 hrs vs. 24 days!

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C-SATS Expert-only OSATS

Accuracy Excellent Excellent

Speed Hours Weeks to Months

Cost $2.50 - $5.00/Hour $250 - $500/Hour

Objectivity Unbiased Subject to bias

Scalability Millions of

crowdworkers available

24/7/365

Difficult given time and

cost limitations of

experts

Crowdsourced Skills Assessment Beats Standard

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.98 correlation

21CONFIDENTIAL 21

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C-SATS is an online performance

management system for accurately

appraising and improving professional

technique in 1/10th the time and cost of

traditional peer review.

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How C-SATS Works

Private, Secure Website

ReviewersMachine Learning

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C-SATS Hardware

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Experts Participate in the Reviewer Pool

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Within minutes, C-SATS analyzes 300

to 500 data outputs for each video

performance and presents reports with

data visualizations and actionable

insights to managers and practitioners.

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Personalized Surgeon Dashboard

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MONITOR TRENDS, COMPARE RESULTS AND RECEIVE SUGGESTIONS

Learning Opportunity:

watch a high-scoring

video alongside your own

Learning Opportunity: watch a

video of an Expert’s case to

identify opportunities to improve

Expert Comments: qualitative,

actionable feedback

Personalized Feedback

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Personalized Feedback

“One thing that I have found to help improve my efficiency in this step of the case; when using a right

handed needle driver, it's faster to start at the left cuff. Place the stitch and bring it all the way through

until the anterior vaginal wall stops the stitch at the loop. That will stabilize the loop and make it much

easier for the surgeon to place the needle through the loop. Use your 3rd arm to actually follow the

stitch. You have created a great anterior vaginal cuff, so you really don't need to grab that with the 3rd

arm. Keep traction on the stitch with the 3rd arm and it will manage your cuff for you. Also, the needle

is big. You did a good job holding it in the middle of the needle, but right at the very end you were

trying to go through both anterior and posterior cuffs with one throw...That will often lead to the needle

going off to the side, and frustration. If you really want to try to go through both at once, place the

point of the needle where you want it, then move your whole arm until the point comes out where you

want it, then rotate your wrist.”

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Insights from Artificial Intelligence

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32CONFIDENTIAL

Computer Vision AI

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Video Library

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HIPAA-SECURE ACCESS TO YOUR CASE VIDEOS ANYTIME, ANYWHERE

Access C-SATS Video Library

Training Opportunities

C-SATS offers several learning mechanisms…

• Objective qualitative feedback from reviewers

• Best-in-class video review broken down by procedure steps

• Customized simulation curriculum tailored to the surgeons’ GEARS score

• Access to expert case studies

• C-SATS Academy

• Opportunities for Tele-mentoring

POST-ASSESSMENT PERFORMANCE IMPROVEMENT

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Organizational Dashboard

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SEE TRENDS AND RANKINGS ACROSS YOUR SURGICAL TEAM

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Outcomes Impact

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TOP QUARTILE VS. BOTTOM QUARTILE

37%

69 mins.lower

Operative

timeIntra-operative

direct costs

33%

$1,800lower

Total

procedure cost

26%

$2,600lower

Inpatient

length of stay

33%

1.9 daysfewer

46%lower risk

30-day

readmissionComplications

20%fewer

Improvement

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Improvement

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Improvement

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Reduction in Variation

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Reduction in Variation

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Representative Customers

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Robotics

Open SurgeryLaparoscopic

Surgery

Beyond Surgery

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Beyond Surgery

Better Together

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Questions?Derek Streat | dstreat@its.jnj.com

Vice President of Performance Improvement Solutions,

Johnson & Johnson Institute

Co-Founder & CEO, C-SATS

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Thank you.

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