Healthcare Stewardship

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One of the best options is by using an enterprise data warehouse that has been specifically designed to work with a healthcare analytics system. In addition to ready access to the data, there also needs to be accountability for that data. This leads us to the second component — good healthcare data stewardship. Data stewardship is the aspect of healthcare data governance that focuses on providing the appropriate access to users, helping users to understand the data, and taking ownership of data quality. Can you name an organization where one person knows all the different systems in use and can speak with authority on the data within those systems?

This may seem like a lot of data stewards, but the best person to perform this role is the person who knows the most about how and why the data is collected in each of the various source systems. This will promote good data stewardship because it will eliminate the fragmented data systems. In a fragmented IT environment, there are many diverse data systems and each system has different modes of access.

The trouble is, with so many different systems and modes of access, it is extremely challenging to manage access centrally. This is why the job usually defaults to the individual IT administrators responsible for maintaining the systems — the only ones who know how to give access.


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A fragmented IT environment also makes it challenging to manage an organization-wide data dictionary. Some healthcare information systems do a good job of documenting metadata — the underlying data that communicates the origin and other details about data, much like a dictionary entry — while others do it very poorly.

Having a centralized place to search for data elements and browse data structures is next to impossible in a fragmented IT environment. The standardization of technology allows the development of more centralized access policies. Good data warehouse architecture allows a data steward to own a piece of the data warehouse that maps to their specific knowledge about a specific source system or a specific data mart created within the warehouse.


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The data steward is an expert in a particular data mart and is the appropriate person to decide who gets access to that area in the enterprise data warehouse. Once you have identified data stewards, you need good tools to let the data warehouse user community know who these data stewards are. If a user wants access to the data warehouse, how will they know who to go to for access to a particular area of the warehouse?

How will a user understand what data is in a particular table, or who to go to if there is a quality issue with the data? There is a fiscal reality to consider in health care costs. That is why stewardship is one of our professional responsibilities. To be effective as stewards, though, certain conditions must be met. To be trustworthy, a steward must be trusted.

Stewardship and governance toward universal health

There must be a mechanism for the steward to report back to the owner about how the resources have been managed. This requires exchange of information between the profession and government. Stewardship is also embedded in the social contract between society and physicians.

Society provides us with autonomy, trust, self-regulation, monopoly, status and rewards. In turn, we provide compassion, availability and accountability, working for the public good with altruistic service. There is an obligatory relationship between society and physicians in this regard. If either society or physicians vary their terms in the contract, there is an unavoidable and corresponding variance by the other party. The link between these two parties in this contract can be described as professionalism.

See an illustration of this concept accompanying this article. Every time you see a patient, think of it is an opportunity to reshape the health care system. We can do this by positively shifting the social contract equation to improve the relationship, not only with that patient, but also with society in general. Ultimately, this will create a positive patient experience, provide happiness and system success. Management changes cannot do this. We can do it only through the individual choices each of us makes, every time we interact with a patient.

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Integration is an approach to health care that involves a high degree of communication, collaboration and coordination among providers and patients to meet the needs of the whole person. Integration around the individual patient or a defined population creates a seamless patient experience. This is the most effective approach to prevention, acute care and chronic illness management. It also affords opportunities to address social determinants of health. The need for an integrated health care system is based on changing patient attitudes and demographics, advances in technology, the increased need for chronic illness management and, importantly, on the failure over recent years to improve health outcomes by simply doing more of the same.

Among Commonwealth countries, Canada ranks 5th of 11 in expenditures and 10th in performance.

Instead of regarding the patient as a consumer of health services produced by providers in a system managed by the providers, we must shift our thinking toward the concept of co-production of health services by providers and patients working together to create what the patient values, in a co-managed system. We should move from viewing health care as a commodity produced by a system of providers to the view that it is a collection of services co-produced by patients and providers, based on the values of the patients.

This will lead to patient-centered integration. The traditional quadruple aim of health care patient experience, population health, per capita cost and provider experience is system-focused, and should evolve to a model where patient and provider co-produce health outcomes that the patient values. The principles of integrated care that relate to physicians are stewardship, professionalism and co-management.

I have written before about stewardship as part of the social contract between the medical profession and society. For these principles to be realized, the role of providers in several areas needs to evolve. They include:. The traditional role of physicians as medical experts will continue. How we exercise that role will change based on evolution in patient expectations, value systems and fiscal realities. Information management, particularly patient access to it, will change. According to the Centers for Disease Control and Prevention CDC , the prevention and control of MDROs is a national priority — one that requires that all health care facilities and agencies assume responsibility.

Essential Stewardship Priorities for Academic Health Systems – National Academy of Medicine

The collaborative began Aug. Participating health care facilities will be offered:. Crader is the lead antimicrobial stewardship pharmacist at St. Bernards Medical Center in Jonesboro. Her work includes improving health care processes and provider knowledge to result in a positive impact on patient outcomes in both the inpatient and outpatient settings.