In our VitalBlog we frequently share our thoughts and opinions on healthcare-related topics.


Dr. Lester Wold wrote this on Monday, December 19, 2016

An approach to achieving the goal of improved patient outcomes, efficient care delivery and cost effective health care delivery: an interview with Dr. David Ballard. STEEEP

Dr. David Ballard is the Chief Quality Officer for Baylor Scott & White Health.  He has had a long and distinguished career in supporting innovative approaches to evaluating and improving the delivery of health care services.  Dr. Ballard serves as President of the STEEP Globaly Institute.  “STEEEP Global Institute is directed by a distinguished leadership team with decades of healthcare industry experience in strategic quality management, rapid-cycle process improvement, and data-driven clinical decision support. The knowledge and expertise of these individuals guide the STEEEP Global Institute's systematic and evidence-based approach to improving healthcare quality along the six dimensions of STEEEP care”. (See: 

This interview explores some of the dimensions of STEEP and related issues which are having an impact on the delivery of health care in a rapidly changing environment of both service delivery and payment reform.


What do you feel is the major problem that needs to be addressed in the US to address the triple aim?

The Institute of Medicine’s six aims for the delivery of health care are essential to achieving the Triple Aim™. Baylor Scott & White Health (BSWH) coined the acronym “STEEEP” (safe, timely, effective, efficient, equitable, and patient centered) care as a way of communicating the principles to all stakeholders in the delivery of care.

The STEEEP framework has also been an important driver of BSWH’s clinical transformation strategy and achieving the Triple Aim. The Triple Aim framework includes the following three elements: improved experience of care, improved health for a population, and reduced cost per capita. In order to effectively achieve the Triple Aim, the STEEEP quality improvement framework should be implemented.

What is STEEEP’s role relative to addressing those needs?

Improvements made in all STEEEP metrics laid the foundation for BSWH to extend beyond the six aims and incorporate population health strategies to achieve the Triple Aim by reducing unnecessary variation, costs, waste, and errors, while simultaneously improving outcomes, access, and satisfaction. The STEEEP framework provides guidance on aligned governance, strategy, tactics, and resources.


Is there a role for information technology in that regard?

Information technology is an essential component to “hardwire” best practices and diffuse STEEEP health care to all levels of clinical care. In order to achieve improvement an infrastructure needs to be put in place in order to support the diffusion such as strong leadership through steering committees, proper information technology, and educational/training programs. All of this can be difficult to manage and execute, but once best practices are disseminated and operationalized patients can expect the same level of care wherever they go within the system - private practices or hospitals, rural or community based. Baylor Scott & White Health is adapting the diffusion framework originally developed by the Mayo Clinic (see below) to assist with the dissemination of best practices. This framework recognizes the role of information technology in supporting successful diffusion. 

Can you comment about the role of information technology in supporting STEEEP health care and value based delivery?

Most care within BSWH is managed using an electronic health record (EHR).  The EHR provides a platform to help standardize care, promote appropriate utilization, and enhance delivery of value based care.  In particular, clinical decision support including order sets, management tools, and alerting rules provide escalating levels of guidance at the point of care for physicians, nurses, and members of the entire care team.

Additionally, increased interoperability between EHR systems -- both within BSWH and among the various other health providers in the region – helps to ensure up-to-date clinical data are available wherever patients seek care.Model-of-Diffusion

Accelerating the use of best practices: The Mayo Clinic model of diffusion. Jt Comm J Qual Patient Saf. 2013; 39(4):167-76

In the future, how do you see organization such as the STEEEP Global Institute working with eHealth providers such as VitalHealth Software?

I see SGI collaborating with eHealth providers by providing clinical decision support content – including standardized guideline compliant order sets, tools, and alerts.  Additionally, we are improving our analytic capabilities to draw insights from the enormous amount of data accumulating within digital repositories.  These discoveries can help identify missed opportunities to improve the health of populations, expose excessive or inappropriate variations that contribute to low value care, and suggest ways to improve satisfaction for both patients and providers by reorganizing care delivery.  Many of these insights could benefit patients more broadly if built into eHealth tools to assist either at the point of care or during evaluation of the current services provided to a population.

SGI is currently exploring an opportunity to collaborate with a technology solutions EHR company to expand their business model by housing over 600 BSWH order sets in a content library. This would allow the eHealth provider a competitive advantage as they become a technology solutions company. They will be able to offer order set content to health care organizations lacking the clinical expertise and/or capacity to develop an order set from “scratch.”


VitalHealth Software is a fast growing healthcare IT company. Major shareholders are Mayo Clinic (U.S.) and the Noaber Foundation (NL). VitalHealth provides cloud-based eHealth solutions for Collaborative Health Management with the mission of “Improving the health of millions of people through eHealth solutions.” VitalHealth offers integrated solutions in markets such as integrated care, Patient Reported Outcome Measurement (PROs), Routine Outcome Monitoring (ROM), patient engagement and eMentalHealth. All solutions are based on the VitalHealth Platform, a flexible cloud-based platform for healthcare applications.

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