MIT Sloan School of Management

MIT Sloan School Working Paper 4960-11

Trinity Health: Using Digitization, Unification,

and Data Analytics to Tame the Quality, Cost,
and Accessibility Problems of Healthcare

Hüseyin Tanriverdi, Kui Du, and Jeanne W. Ross

© Hüseyin Tanriverdi, Kui Du,

and Jeanne W. Ross

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 CENTER FOR Massachusetts
INFORMATION Institute of
SYSTEMS Technology
RESEARCH

Sloan School Cambridge

of Management Massachusetts

Trinity Health:
Using Digitization, Unification, and Data Analytics to
Tame the Quality, Cost, and Accessibility Problems
of Healthcare
Hüseyin Tanriverdi, Kui Du, and Jeanne W. Ross
December 2011

CISR WP No. 385 and MIT Sloan WP No. 4960-11

 2011 Massachusetts Institute of Technology. All rights reserved.

 Research Article: a completed research article drawing on one or
more CISR research projects that presents management frameworks,
findings and recommendations.
 Research Summary: a summary of a research project with
preliminary findings.
 Research Briefings: a collection of short executive summaries of key
findings from research projects.
 Case Study: an in-depth description of a firm’s approach to an IT
management issue (intended for MBA and executive education).
 Technical Research Report: a traditional academically rigorous
research paper with detailed methodology, analysis, findings and
references.
CISR Working Paper No. 385

Title: Trinity Health: Using Digitization, Unification, and Data Analytics to Tame
the Quality, Cost, and Accessibility Problems of Healthcare
Authors: Hüseyin Tanriverdi, Kui Du, and Jeanne W. Ross
Date: December 2011
Abstract: Trinity Health of Novi, Michigan has sought to tame healthcare’s quality, cost, and
accessibility problems by using enterprise-wide digitization, unification, and analytical
decision making. It started by making strategic commitments to an enterprise-wide
digital platform and a unified operating model. These commitments created a foun-
dation for analytical decision making and organizational improvements. Operating
units across the enterprise sought to adopt standardized information systems appli-
cations, standardized clinical and operational processes, and standardized data types
and definitions. The standardization of applications, processes, and data definitions
increased the quality of performance metrics and fostered performance benchmarking
across similar operating units. Transparency of performance results strengthened
accountability and fostered collaboration and best practice sharing across operating
units. Lower performing units started to learn and adopt the best practices of higher
performing units. This organizational learning enabled Trinity Health to increase the
quality and efficiency of its care. The resources freed up by the efficiencies were used
to increase the accessibility of Trinity Health’s services to poor and uninsured patient
populations. Going forward, Trinity Health faces challenges in maintaining and up-
grading its digitization, unification, and analytics foundation as it acquires new entities
and co-evolves with the rapidly changing healthcare industry; expanding the foun-
dation to all entities in its continuum of care; and building more sophisticated
analytical skills and expertise to enable a more predictive enterprise.
Keywords: digitization, unification, data analytics, healthcare, Trinity Health
24 Pages
 Massachusetts Institute of Technology
Sloan School of Management

Center for Information Systems Research

Trinity Health: Using Digitization, Unification, and Data Analytics

to Tame the Quality, Cost, and Accessibility Problems of Healthcare

In 2011, the U.S. healthcare industry was exper-
iencing considerable turbulence. Healthcare ex-
penditures represented about 16% of the gross
domestic product (GDP) of the U.S.—the largest
share of GDP spent on healthcare among all major
industrialized countries. Those expenditures, how-
ever, were not producing commensurate benefits.
The U.S. ranked behind many developed countries
on critical healthcare outcomes such as life ex-
pectancy, infant mortality, and the number of phy-
sicians per capita. Access to care was also prob-
lematic for vulnerable patient populations such as
the unemployed and the uninsured.
Healthcare providers had long dealt with con-
stantly changing regulations. But healthcare re-
form legislation, along with changes introduced
by insurance companies and the healthcare pro-
viders themselves, was changing fundamental
business models in healthcare:
The healthcare industry is going through
a major transformation. Rather than re-
ward volume, it is transitioning to re-
ward value. One of the major implica-
tions for us is a reduction in reimburse-
ment. So we have to address costs.
—Kedrick Adkins,
President, Integrated Services
The growing pressure to address costs was just
one of many competitive pressures that health-
care providers were facing. New entrants like
specialty hospitals and minute clinics were in-
creasing competition and some markets were ex-
periencing excess healthcare delivery capacity. In
addition, healthcare providers were changing
their delivery models:
A lot of organizations are working very
hard to become more integrated across
the different types of care delivery mech-
anisms. Hospitals, physicians and long-
term care facilities are becoming more
integrated and forming care delivery net-
works that are more holistic.
—Paul Browne,
Senior Vice President, Systems Integration
(formerly Chief Information Officer)

This case study was prepared by Hüseyin Tanriverdi, of the University of Texas at Austin and a Visiting Scholar at the MIT
Sloan Center for Information Systems Research; Kui Du of the University of Texas at Austin; and Jeanne W. Ross of the
MIT Sloan Center for Information Systems Research. This case was written for the purposes of class discussion, rather than
to illustrate either effective or ineffective handling of a managerial situation. The authors would like to acknowledge and
thank the executives at Trinity Health for their participation in the case study.
© 2011 MIT Sloan Center for Information Systems Research. All rights reserved to the authors.
Many small healthcare organizations were una-
ble to compete in this environment. They were
being absorbed by larger organizations. These
mergers heightened the competition among the
large providers.
Trinity Health, one of the country's largest
healthcare systems, was attempting to address
competitive challenges by implementing a more
unified operating model across its highly dis-
tributed facilities. Toward this objective, Trinity
was developing a coherent set of shared IT-ena-
bled business processes. Management referred
to this set of processes and the underlying sys-
tems as a digital platform:
We believe that organizations that are
going to be most successful in healthcare
are those that can deliver high quality
care in a very consistent manner; those
that can be very cost effective in doing
so; and those that can be adaptable to
the rapidly changing regulatory require-
ments. We believe that being on a com-
mon digital platform across our enter-
prise allows us to be more agile with
respect to all three of those.
—Paul Browne,
Senior Vice President, Systems Integration
(formerly Chief Information Officer)
Trinity Health’s digital platform provided a
foundation for organizational analytics. Trinity
Health management believed that, by informing
operating and strategic decisions, this platform
positioned the organization for long-term success:
Given the violent turmoil taking place in
the industry, you have to manage differ-
ently, and it requires a different set of
information. We believe one of the reasons
we have been successful is our ability to
identify what needs to be different, and to
Tanriverdi, Du, and Ross
create, report, and disseminate that infor-
mation.1 —Kedrick Adkins,
President, Integrated Services
Trinity Health Background
Trinity Health, a Catholic healthcare delivery
system devoted to a ministry of healing and hope,
was formed in 2000 through a merger of Holy
Cross Health System and Mercy Health Services.
Headquartered in Novi, Michigan, Trinity offered
services in 10 states (see figure 1). In 2011,
Trinity Health had 55,000 employees, 9,000 phys-
icians, and operated about 47 hospitals, 401
outpatient clinics/facilities, 31 long-term care
facilities, numerous home health and hospice pro-
grams, and senior housing communities. Its 2011
revenues were about $9 billion, which generated
net income of $683 million. On the basis of
revenues, Trinity Health was one of the largest
Catholic healthcare systems in the U.S.
When Trinity Health was formed, it operated as a
conglomeration of geographically dispersed and
autonomous operating units. In 2005, Joseph
Swedish became CEO and introduced a concept
known as the Unified Enterprise Ministry
(UEM). “Unified” referred to an ability to build a
highly aligned and unified healthcare delivery
system that leveraged scale and skill. “Enter-
prise” reflected the willingness to accept business
and even entrepreneurial risk. “Ministry” ac-
knowledged Trinity Health’s Catholic heritage,
and its commitment to community benefits and
serving the vulnerable.
The UEM concept articulated the foundation of
Trinity Health’s vision, mission, core values,
and efforts to increase the quality and reduce the
costs of care. Swedish noted that embracing
UEM would require greater standardization
across the enterprise:
In such a diverse organization, we have
to be able to standardize process so that
1
“Real-Time Performance Data that Guides Leadership
Decisions,” Fall/Winter 2009 Leadership Special Report,
HFMA Learning Solutions, Inc., www.hfma.org/leadership.
Available at http://www.trinity-
health.org/documents/News%20Coverage/CPORTAL_00571
5.pdf.
Page 2 CISR Working Paper No. 385
 we can create the kinds of efficiencies
and effectiveness that are necessary to
provide higher quality care and develop
a better cost structure.2
Following the UEM concept, Trinity Health
gradually created Unified Service Organizations
(USOs) to provide enterprise-wide shared
support services. Initially, support services at
Trinity Health had been provided by individual
operating units or by one of the ministry
organizations (MO), which governed geograph-
ically clustered sets of operating units (see
figure 2 for a high-level view of Trinity Health’s
organizational structure).
Creation of USOs accelerated in 2007, when
Kedrick Adkins joined Trinity to become the
President of Integrated Services, Trinity’s term for
global shared services. Eventually, clinical func-
tions also started to form USOs. For example, a
Unified Clinical Organization (UCO) and a USO
for Health Networks were set up in 2010 to
respectively coordinate the clinical operations and
physician practices across Trinity Health. As of
2011, the Integrated Services unit governed
approximately 15 USOs including functions such
as IT, finance, treasury, supply chain, risk man-
agement, HR, operational performance leadership,
and clinical engineering management.
One of the first USOs was Trinity Information
Services (TIS), which centralized the enterprise’s
IS organizations. TIS was allocated approx-
imately 25% of Trinity Health’s capital invest-
ments (about $100 to $120 million annually) for
investments in IT infrastructure, enterprise-wide
IT applications, and field-specific IT projects.
The TIS operating budget accounted for about
3% of Trinity Health’s annual revenues.
TIS was instrumental in enabling a more unified
enterprise operating model. More than half of
TIS’s 1500 employees were located in the home
2
J.R. Swedish, “A Pacesetter in Catholic Health Care,
Trinity Health Is Attracting National Attention for Its
Delivery System Unification, IT Initiative, and Access-to-
Care Ministry,” Deloitte Health Care Review, December
2005. Available at http://www.trinity-
health.org/documents/News%20Coverage/TH_PC_HEAL
THCAREREVIEW2005.pdf.
Tanriverdi, Du, and Ross
office to support enterprise-wide shared IT ser-
vices, such as the data center and enterprise-wide
applications. The other 600 IT professionals were
organized under the Client Services organization
of TIS and located in operating units to run local
IT services such as networks, desktop assistance,
and field-specific IT applications such as radio-
logy and cardiology imaging systems. IS direc-
tors in the operating units served as the “go-to”
people for all local IT needs, responsible for
integrating local IT plans with enterprise-wide IT
plans of TIS. These local IS directors had dual
reporting relationships to the Client Services
organization of TIS and local executives of the
operating units.
Building a Digital Platform
Prior to the merger of Mercy and Holy Cross to
create Trinity Health, both organizations had
permitted a best-of-breed strategy at their oper-
ating units. As a result, the IT landscape at Trin-
ity Health in its earliest years resembled a
patchwork quilt (see figure 3). But long before
the organizational concept of the Unified Enter-
prise Ministry, Mercy Health Systems had laid
the groundwork for a systems environment that
could support enterprise-wide business process
integration and standardization.
Even before Mercy and Holy Cross merged,
managers in the Mercy organization had become
concerned about the large number of IT capital
investment proposals emanating from individual
operating units. The U.S. National Institutes of
Health (NIH) had begun to issue reports indicating
that hospitals were making significant mistakes in
patient care that could be prevented with the use
of advanced clinical information systems. Aware
that vendors were offering integrated suites of
solutions, Mercy’s leadership team asked the IT
leadership team how they should approach IT
investments. The IS leadership team recom-
mended a common systems approach:
As the requests for IT capital invest-
ments were coming forward in the Mercy
organization in early 2000, the cor-
porate senior management team took a
step back and asked the IT leadership
team if we should continue to perpetuate
Page 3 CISR Working Paper No. 385
 this idea of each hospital implementing
its own systems or if there was an
alternative approach that made sense.
The IT leadership team put forward the
idea that we should pursue common
systems, an integrated IS organization,
and select a few strategic vendors to
pursue a best-of-suite strategy as op-
posed to a best-of-breed strategy.
—Paul Browne,
Senior Vice President, Systems Integration
(formerly Chief Information Officer)
Soon thereafter, Mercy initiated the Genesis
Strategy, a $400 million initiative that sought “to
transform healthcare from paper-driven, highly
variable, and redundant processes that depend on
human vigilance to standardized, streamlined,
reliable, and safe care.”3 The Genesis initiative
standardized PCs and consolidated datacenters.
Genesis also provided a common software
package across the enterprise for each of five key
functions: electronic health records (EHR), com-
puterized physician order entry (CPOE), adverse
drug event (ADE) alert, revenue management,
and supply chain management.
Because Trinity Health was initially run as a
conglomeration of autonomous operating units,
the Genesis strategy, even after the merger,
focused on just the hospitals that had been part
of the Mercy organization. But successful im-
plementations within the Mercy group led to an
expanded effort:
As we began to execute the strategy and
began to have some early success in the
2004/2005 timeframe, the organization
made a decision to make the Genesis
strategy an enterprise-wide strategy for
all of our hospitals. We have spent the
better part of the last decade digitizing a
lot of manual and paper based processes
in our hospitals across the country.
—Paul Browne
3
A. Shepherd, “A Little Bit Country, a Lot of
Technology,” For The Record, Vol. 20, No.24, November
24, 2008. Available at http://www.trinity-
health.org/documents/News%20Coverage/FORTHEREC
ORD_DECEMBER08.pdf.
Tanriverdi, Du, and Ross
The Genesis project defined Trinity’s critical
enterprise-wide applications. The original proj-
ect scope was ambitious, encompassing 25-30
different applications that touched 90% of the
staff working in a hospital. Implementation
teams encountered constant demands to do some
customization of the software at the different
operating units, but Trinity instituted govern-
ance processes to limit variation:
Customizing solutions to each MO is
extremely dangerous for a system like
Trinity Health. We could end up with 25
different approaches to how you do med-
ication reconciliation across Trinity if
we followed customization. And if that
were the case, I would have to develop
in my electronic health record 25 dif-
ferent pathways for each and every one
of those organizations. And every time I
needed to update it, I would have to do
25 different revisions. —Paul Conlon,
Senior Vice President,
Clinical Quality and Patient Safety
In 2011, about $5.5 billion dollars of Trinity’s
$9 billion in operations were running on Trinity
Health’s digital platform, and the systems land-
scape had become more standardized, as depict-
ed in figure 4. The digital platform helped the
organization respond faster to changes in its
environment. For example, when pharmaceuti-
cal companies issue new adverse drug interac-
tion warnings, the common systems environ-
ment enabled Trinity Health to code the changes
in its adverse drug event (ADE) alert application
once and scale it up to all operating units
rapidly. Standardization of billing processes led
to similar benefits:
Billing processes in care delivery organ-
izations are largely driven by a coding
structure called ICD-9, which is the
international classification of diseases. All
hospitals in the United States are
accountable within the next two years for
being able to bill based on ICD-10. When
you move from ICD-9 to ICD-10, you go
from somewhere around 25,000 billing
codes to about 200,000. In Trinity Health,
the process and technology changes
Page 4 CISR Working Paper No. 385
 required to make that change are
significant. But because we share a digital
platform and unified processes, we will be
making those changes, and implementing
and testing them once. Similar
organizations that are on disparate
platforms will have to do that for each
care delivery organization they operate.
—Paul Browne,
Senior Vice President, Systems Integration
(formerly Chief Information Officer)
Driving Benefits from the Digital Platform
Although Genesis was intended to standardize
business processes, not just IT applications, the
first order of business was adoption of common
systems. As a result, implementation teams some-
times made the decision to sacrifice common
processes in order to make progress toward com-
mon systems:
When we first designed our electronic
health record, we did a lot of replication
of what was done in paper. We gave a
lot of deference to avoid alienating
physicians in particular. That slowed us
down and created a lot of hospital by
hospital variation that was probably un-
necessary and unwise. But at that time it
was much more important to elevate
adoption than it was standardization.
—Paul Conlon,
Senior Vice President,
Clinical Quality and Patient Safety
Despite the use of common systems, data and
processes varied considerably from hospital to
hospital:
Some of the Ministry Organizations used
to bill certain things as a billable supply,
while other MOs did not bill for the item
at all. Some MOs would roll that supply
up into, say, the bed charge, or procedure
charge. So we were not consistent with
what we were billing and how we were
billing it. Use of common systems and
reporting tools highlighted these varia-
tions. Today, all of the MOs work to
Tanriverdi, Du, and Ross
gether to promote consistency and im-
plementation of best billing practices.
—Nancy Rocker,
Manager, Decision Support Services
Over time, management turned its attention to
eliminating unnecessary variation in clinical and
business processes:
The organization quickly discovered that
just because we put in common IT sys-
tems didn’t mean that everybody used it
the same way. That was realized fairly
early in the clinical journey. In the last 5
years, we have between 300 and 400
common clinical processes that have
been rolled out across the organization.
A great deal of standardization has tak-
en place. —Kyle Johnson,
Vice President, IT Application Services
Managers found they had to pursue continuous
improvement and the realization of business
benefits.
We have been building standardized
supply chain processes for the past 8
years, and it has been a continual and
deliberate set of strategies to get where
we are. We implement scorecards to
measure our success. You can’t just
implement a process and then you will
see the rewards. You have to continually
measure them, and keep moving toward
your goal. —Pam Alexander,
Director, Supply Chain Management
The efforts of the supply chain USO paid off;
management documented savings of $81 million
in fiscal year 2010. The Unified Revenue Org-
anization could point to $100 million in incre-
mental revenues that same year.4
Management observed that the organization was
acquiring momentum toward greater digitization:
As our organizations see different pro-
cesses becoming digitized, it creates
even more hunger and an even greater
4
Trinity Health Annual Report 2010.
Page 5 CISR Working Paper No. 385
 interest in digitizing and automating
even more areas than we had envi-
sioned. —Paul Browne,
Senior Vice President, Systems Integration
(formerly Chief Information Officer)
Acquisitions of new hospitals and a maturing
market for packaged software modules presented
new opportunities for Trinity to reuse and extend
its digital platform.
Leveraging Data and Analytics
The most immediate impact of Trinity’s digital
platform was operating efficiencies, but the most
important long-term contribution of the digital
platform may have been the ability to collect and
analyze enterprise data. By 2011, Trinity Health
had accumulated a repository of approximately
8.4 million unique electronic health records
(EHRs), one of the largest in the nation. All of
Trinity’s operating units captured and used data
stored in the EHR repository (see figure 5):
The way we implement the common
applications is somewhat unique in
healthcare, in that it is not just each
hospital running its implementation of the
same software. We literally have a single
electronic medical record system for the
entire enterprise. This distinction is im-
portant because when it comes to our
analytics, it really allows us to leverage a
lot of the underlying data standardization
that we’ve done by implementing the
common transactional systems.
—Paul Browne
Essential to effective analytics was Trinity’s
unified data warehouse (UDW) which housed
the EHR repository and transaction data from
the entire organization (see figure 6 for a sim-
plified structure of UDW). Initially, people
throughout Trinity Health were concerned about
the quality of the data. Development of the
digital platform introduced some data stan-
dardization, but inconsistencies had to be iden-
tified and resolved:
We put a common cost accounting system
in the majority of our Ministry
Organizations; however, lack of stan-
Tanriverdi, Du, and Ross
dardized cost accounting assumptions
created a lot of variation between hos-
pitals. People did not have confidence in
the data. Inconsistent source systems and
processes have been, and continue to be,
addressed. We created a cost accounting
governance team to drive a common cost
accounting approach. We are in the
process of refining the cost accounting
assumptions, making sure that what is in
the system makes sense… We have to
look at what makes sense from a common
organizational standpoint.
—Nancy Rocker,
Manager, Decision Support Services
Data consistency and quality problems reduced
the quality of metrics and inhibited the adoption
of analytical performance benchmarking prac-
tices across similar operating units. Manage-
ment encouraged individuals not to wait for
perfect data:
They had the mindset that if the data is
not right, they don’t use it. But if you
don’t use it, it will never get fixed... We
have gotten over that hurdle. We now
say, use the data, know that we have got
to fix the data, actually fix it, continue to
use it, and refine it… As we continue to
use the data, it becomes crisper. It be-
comes more reliable. —Tom Centlivre,
Director, IT Strategy Planning
Functions throughout Trinity Health started
using the data from their standardized systems
to benchmark results across operating units.
While imperfect, that data helped establish a
habit of using data and then improving it:
Most of the Ministry Organizations
adopted what I will call simple models,
which were perhaps inaccurate, but pro-
vided them a certain degree of stability
in reporting. Now we’ve moved to a
higher degree of accuracy.
—Paul Sahney,
Vice President and
Chief Revenue Officer
Trinity Health established a Performance Lead-
ership Organization, which applied analytics to
Page 6 CISR Working Paper No. 385
identify performance improvement opportunities.
This organization also provided six sigma and
process excellence expertise to operating units:
We have designed and implemented a
web-based portal containing a series of
dashboards that pull together key metrics
and statistics. The information collected
is representative of the various functional
areas at Trinity Health—whether it is
clinical, safety, financial, strategic, or
operational. The dashboards allow lead-
ers across the system to view per-
formance against established targets,
their peers, and industry benchmarks best
practice. They have the ability to drill
down, identify areas of opportunity,
resulting in proper deployment of
resources. For example, if patient
throughput is identified as an area of
focus, the user would be able to identify
the service line, DRG, and types of
discharges that would result in improving
performance. The web-based dashboards
promote alignment between leadership
and managers, the sharing of best
practices across the system, while
supporting a culture of continuous
learning and accountability.
—E.J. Ledesma,
Director, Performance Leadership
As the performance results became more trans-
parent, the operating units became more ac-
countable for their results. Lower performing
units started to collaborate with higher perform-
ing units to find ways to improve their results.
These collaborations increased the quality of
care across the enterprise.
You can analyze the data and determine
best clinical outcomes. If we determine
that for abdominal aortic aneurisms,
Chicago does way better than the rest of
our Ohio and Michigan hospitals, we want
to know why. They will analyze that data
and see what we need to do to the way we
plan care in Ann Arbor and Columbus,
and how we can take advantage of the best
practice that we just learned. —Sue Paris,
Vice President of IT Client Services
Tanriverdi, Du, and Ross
Analytics were also applied to strategic deci-
sions, such as mergers and acquisitions:
We are a very financially and indicator-
oriented organization. Our financial
group is looking at the financial metrics
on an everyday basis. Our clinical group
is looking at quality metrics on an every-
day basis. The planning group is looking
at market share on an everyday basis.
These metrics are reported in dashboards
on an ongoing basis. We are able to
identify the deteriorating performance
before it really becomes very obvious. We
can see the data and project that out. If
you’re not seeing any upward improve-
ment in indicators, then you could say, in
two to three years it is only going to get
worse. So, it may be time to sell.
—Maria Szymanski,
Senior Vice President and
Chief Development Officer
Making Progress on the
Enterprise-wide Journey
By 2011, Trinity Health had a robust digital
platform and was applying analytics to perfor-
mance metrics and a variety of key decisions.
But progress on standardizing systems, business
processes, and data was uneven across the
various parts of the organization. Figure 7
shows when and how key USOs built their
business process and analytical capabilities.
As a result of the different approaches to building
capabilities, USOs varied in their levels of unifi-
cation and digitization in 2011 (see figure 8). For
example, the Unified Supply Chain Management
Organization started standardizing its appli-
cations, processes, and data in the early 2000s, so
that by 2011, most MOs and hospitals were using
the same supply application, supply purchasing
process, and data definitions for supply items. In
contrast, Trinity Health had just started to unify
its Organizational Talent and Effectiveness
(OTE) organizations:
We are in mid-stream here where our
technology platforms like our payroll
systems are not all on the same platform
yet. We are all migrating towards People-
Page 7 CISR Working Paper No. 385
 Soft for HR and Kronos for timekeeping
systems. We are trying to get those
standardized across the enterprise.
Because we have that variability, it is
more difficult for us to report the ana-
lytics. We don’t have common systems that
talk to each other as well as we would
like… We are fairly decentralized on the
OTE side, but we are in the process of
getting much more centralized and more
standardized across the enterprise.
—Paul Swanson,
Vice President,
Organizational Talent and Effectiveness
Because USOs took different paths to digitization
and started at different points in time, they were at
different levels of analytical sophistication in 2011
(see figure 9). All USOs started their analytical,
evidence-based decision making and organi-
zational improvement journey with retrospective
reports and performance benchmarking. They
sought to answer “what,” e.g., what was our
clinical, financial, and operational performance in
the past reporting period? They used metric
reports, graphs, trend lines, and simple models and
visualizations to make sense of what happened.
These efforts started to develop a metric-based
management culture and promoted performance
benchmarking.
Performance benchmarking led to “why” types of
questions that examined cause-and-effect rela-
tionships, e.g., why is this hospital performing
better than the others? Why does this clinical
practice not lead to the same outcome in the other
hospital? Most USOs lacked the advanced ana-
lytical skills and expertise required for building
explanatory models, so they engaged in human-
intensive, collaborative sense-making activities.
Subject matter experts utilized metric reports,
descriptive data, visualizations, and data drill-
down capabilities to understand and explain why
there were performance variations across the
operating units.
Ultimately, most USOs aspired to go beyond the
“what” and “why” questions to do predictive
modeling. Initially, at least, they would collab-
orate with consultants and research universities
Tanriverdi, Du, and Ross
to tap into advanced analytical skills and ex-
pertise for building these models. By becoming
more predictive in their clinical and operational
decisions, and detecting discrepancies between
planned and actual results in near real time,
USOs aimed to make informed interventions
sooner and increase their clinical, operational,
and financial performance further.
Figure 10 summarizes the status of each of the
key USOs in their unification journey and
analytics capabilities.
Instituting Enterprise-wide
Governance Structure for Analytics
To ensure effective analytics, management had
to determine who owned the data, who could
define data types and definitions, who could
have access to the data, and who would make
key policy decisions. To address these kinds of
issues, Trinity Health instituted a formal,
enterprise-level governance structure for ana-
lytics, as depicted in figure 11.
At the top level of the governance structure, a
clinical and business intelligence executive ad-
visory committee provided strategic direction
for analytics initiatives across Trinity Health.
About half of the top management team of
Trinity Health participated in this committee.
Tom Centlivre, Director, IT Strategy Planning,
served as the de facto BI and analytics leader
across the enterprise and coordinated enterprise
analytics initiatives in accordance with the man-
dates of this committee. He focused on
developing Trinity Health analytics capabilities
in four areas: (1) governance, (2) technology
base, (3) function-specific analytics, and (4)
predictive modeling.
Data standards and definitions were the respon-
sibility of the data standards and quality steering
team. This team, consisting of representatives
from USOs, had enterprise-wide responsibility
for data standards. Since the analysis was per-
formed in the USOs and MOs, members of this
team could identify priorities for data manage-
ment efforts.
Within TIS, an Enterprise Information Delivery
Services (EIDS) team managed the organi-
Page 8 CISR Working Paper No. 385
zation’s data warehouse to enable business
intelligence and analytics. This team of about 45
IT professionals delivered information and dev-
eloped analytical applications. They did not do
the analysis, but they worked with the analysts
who were based in the MOs and USOs. The
focus of the EIDS team was enterprise-wide. If
an individual MO requested an analytics
application, the EIDS team would seek out a
corporate sponsor:
So, let’s say if it was in the clinical quality
area, then we would go to Paul Conlon
[SVP, Clinical Quality and Patient
Safety], and say, “Hey Paul, Columbus
[an MO] thinks that this is something that
Trinity Health really needs, are you
willing to sponsor it?” If so, we would
write up a charter and take that charter to
our project approval committee, and do a
dollar estimate and a time estimate. If the
charter got approved, then we would write
up a more complete statement of work,
take that through the project approval
committee process, and then we would
implement it for all of Trinity Health, not
just for that MO. —Joan Hall,
Director, Enterprise Information
Delivery Services
Improving Performance Outcomes by Using
Trinity Health’s Unification, Digitization,
and Analytics Foundation
As summarized in figure 12, Trinity Health’s
commitments to unification, digitization, and
analytics created a foundation for achieving
organizational benefits and taming the quality,
cost, and accessibility problems of healthcare.
What is fascinating is that you make a
commitment, you go through a period of
chaos as you are beginning to manage
the go-lives, you go down the trail for a
while, and then you ask the question,
“Are we really accomplishing what we
expected?” We have finished our ap-
praisal—in fact, an audit—and we know
that we have a truly powerful model. We
Tanriverdi, Du, and Ross
know that we made the right decision for
the right reasons.5 —Joseph Swedish,
President and CEO
Trinity Health used this foundation to improve
the quality and efficiency of its care. These im-
provements started to receive external recog-
nition, including being named by the “Thomson
Reuters 100 Top Hospitals®: Health System
Quality/Efficiency Study” as one of the top 10
U.S. health systems. Additionally, 12 Trinity
Health hospitals were named to the “Thomson
Reuters 100 Top Hospitals®” list.6
Delivering the quality and efficiency of care
also enabled Trinity Health to increase the ac-
cessibility of its care to poor and uninsured
patient populations as noted in the Trinity
Health Annual Report 2009: “Our experience
shows that when we serve together—through all
of the efficiencies and improvements gained—
more resources can be devoted to our sacred
work: improving care for all, including com-
munity health programs for the poor and unin-
sured. That is why we serve together.”
Retrospective metric reporting and performance
benchmarking is often considered to be a moder-
ate level of analytical maturity. But by using it at
the enterprise-wide level, Trinity Health leveraged
it as a source of advantage over its rivals.
We are probably 5 to 7 years ahead of
most organizations on the health care
side. We have unified service organiza-
tions, standardized and unified practic-
es, processes, and language across the
enterprise. When we get to the data
level, they really help us understand the
business within Trinity. I think a lot of
places [rivals] desire to get to this stage,
5
J.R. Swedish, “A Pacesetter in Catholic Health Care,
Trinity Health Is Attracting National Attention for Its
Delivery System Unification, IT Initiative, and Access-to-
Care Ministry,” Deloitte Health Care Review, December
2005. Available at http://www.trinity-
health.org/documents/News%20Coverage/TH_PC_HEAL
THCAREREVIEW2005.pdf.
6
Trinity Health Annual Report 2010.
Page 9 CISR Working Paper No. 385
 but most have not even begun… So I do
think it is a competitive advantage.
—Kyle Johnson,
Vice President, IT Application Services
Going Forward
By 2011 data analytics had become strategic for
Trinity Health for at least four reasons:
First, from a clinical standpoint, we have
8.4 million digitized clinical records. In
that repository, there are best practices
on how we should treat patients for
certain illnesses, situations that will help
us define how we achieve the highest
levels of quality. But we have got to mine
the data and extract those best practices
to enhance our care delivery. Second, I
think it will help us identify what the most
cost effective care is. We can use the data
to predict our operating and financial
performance in a way that it gives us an
opportunity to intervene. Third, the data
is critical to us for setting standards.
Fourth, there is a wealth of information
that helps us target customers or patients
in different markets, help us to evaluate
our costs. The key is being able to mine
the data and use it to help us answer
questions. —Kedrick Adkins,
President, Integrated Services
But management identified significant challeng-
es to generating the potential benefits of data
analytics. One challenge was to maintain and
upgrade the digital platform. External factors
such as the tough economic climate, the
turbulence created by health reform, innovations
in medical science and information technologies
had the potential to pull the applications,
processes, and data of the operating units of
Trinity Health in different directions. Internal
factors such as the growing scope of digitization
and analytics could also potentially pull the
unification efforts in different directions.
Another challenge was the need to extend Trinity
Health’s digitization, unification, and analytics
foundation to all of the entities in its integrated
healthcare delivery system. The development of
Tanriverdi, Du, and Ross
the foundation had primarily focused on the
major hospitals. Other entities such as physician
offices, specialty hospitals, health and hospice
programs, senior housing communities, and
rehabilitation centers had only recently begun the
journey to move on to the digital platform:
We have been traditionally a very acute
care, hospital focused organization. Like
most other organizations, we are under
the gun to get physician practices, long-
term care, and homecare integrated. We
have embarked on a major employment
of physician practices going forward. We
also have long-term care and homecare
in some of our markets. From a BI and
analytics perspective, we are starting
down the road of data collection and data
storage into a common repository so that
we can understand the care of patients
across the continuum of the care.
—Tom Centlivre,
Director, IT Strategy Planning
A third and related challenge was to maintain the
unified enterprise model as Trinity Health
engaged in mergers and acquisitions. Some of
Trinity Health’s acquisitions were relatively
small entities. They did not have the system,
application, process, and data sophistication of
Trinity Health. Others were large, established en-
tities with advanced systems, applications, and
analytical skills. Should Trinity Health leave
them alone or unify them?
Finally, Trinity Health was facing a challenge as
to how to create, nurture, organize, and govern
more sophisticated analytical skills and exper-
tise across the enterprise. Trinity Health was
lacking the sophisticated statistical and model-
ing skills needed for predictive modeling.
We do not have deep bench of analytical
skills. We have primarily data retrieval,
data storage, and application building
resources; and we work with the busi-
ness owners to identify the analytical
applications that they would like. What
we don’t have is a center of excellence of
Page 10 CISR Working Paper No. 385
 statisticians and quants who handle the
different types of analytical questions
and thoughts. —Tom Centlivre,
Director, IT Strategy Planning
Trinity Health could create and cultivate skills
in-house or source them externally. It could
create a centralized analytics competency center
or let each USO develop its own analytics
competency center. Perhaps the most critical
Figure 1
The Geographic Presence of Trinity Health
Tanriverdi, Du, and Ross Page 11
skill was to ensure that analytics at Trinity
Health would lead to better decisions:
As we get comfortable with predicting,
how do we move that back into our trans-
actional systems so that at the point of
decision making we have evidence-based
information and analytics rather than just
the human hunch. —Tom Centlivre
Source: Trinity Health’s internal documents
CISR Working Paper No. 385
 Figure 2
Simplified Organizational Structure of Trinity Health

Home Office President and

CEO

EVP, Health EVP, Chief President, EVP, Hospital EVP, Trinity Institute
EVP, Chief Clinical
Networks Administrative Officer Integrated Network
for Health and
Officer Services Community Benefits

Unified Service Organization and Unified Supply

USO for Health Unified Clinical Trinity Information Unified Revenue
Organizations Networks
Talent
Organization Services (TIS) Organization (URO)
Chain …
(USOs): ~15 Effectiveness (OTE) Organization

Enterprise
VP, Shared Information
VP, Client Services Delivery Services
Services
(EIDS)

Ministry MO-2: Saint MO-3: Saint

MO-1: Mercy MO-4: Saint MO-19: Mount
Organizations Alphonsus Joseph Mercy
Health Agnes Medical … Carmel Health
Health Health
(MOs): ~ 20 Partners Center System
System System

… … … …

Field: ~47 Hospitals,

Mount Carmel Mount Carmel
~401 Outpatient Mount Carmel
New Albany St. Ann's Grove City Taylor Station
Clinics/Facilities East Hospital Surgical Hospital Hospital Urgent Care Surgical Center
(Columbus) ( New Albany) (Westerville)

Source: Interviews and Trinity Health’s internal documents. Used with permission.

Tanriverdi, Du, and Ross Page 12 CISR Working Paper No. 385
 Figure 3
IT Landscape of Trinity Health Circa 1999
Tool Diversity  Process Diversity  Variable Performance
Eastern Division Western Division
Silver Columbus, Port Huron, Clemens, Ann Arbor, Battle Grand Muskegon, South Dubuque, Mason City, Sioux City,
Operating Units Spring, MD OH MI MI Pontiac, MI Livonia, MI MI Creek, MI Rapids, MI MI Bend, IN Clinton, IA IA IA IA Boise, ID Fresno, CA

Patient Adm inistration

Registration HBOC Plus HBOC

HBOC SMS Med 2000 HBOC Health- SMS Med HBOC SMS Med HBOC
Patient Accounting STAR Series4 HBOC Series Quest Series4 STAR Series4 STAR
Health-
Medical Records Quest
QuadraM ed
3M 3M Quadramed 3M 3M
DRG Grouper

HSS HSS
APC/APG Grouper
Enterprise Resource Planning (ERP)

General Ledger People Sof t Global People Soft People Soft

Payroll/Human SMS Med GEAC GEAC

Resources Series4 Ceridian SMS Med SMS Med
A/P Series4 Series4
Materials HBOC Global HBOC HBOC
Management
Self Self Self
Develo ped TSI Developed Developed
(A nalysis & TSI Mainf rame TSI AS400 TSI AS400
M ainframe (Analysis & (Analysis &
DSS)
Cost Accounting DSS) DSS)
McKesson
Contract SARMC
HBOC
Management

Clinical System s

Physician Order
Eclipsys
Management
SMS SMS
HBOC Plus HBOC HBOC
HBOC STAR MedSeries TDS TDS SMS MedSeries4 MedSeries HBOC STAR
2000 Series STAR
Order Entry 4 4
In-
CWS CWS Cerner In-House
Results Reporting house/3M
ADEs Cerner Cerner Cerner Cerner
Clinical HBOC Care HBOC Care LifeServ
Eclipsys TDS TDS Eclipsys
Documentation Manager Manager Petronics
United
HBOC Cerner Cerner HBOC
Cerner Sunquest Classic Classic Cerner Classic Classic Cerner Clinical Cerner
STAR Pathnet Pathnet STAR
Laboratory Pathnet HBOC ALG Millenium Millenium Labs Sunquest Millenium Sunquest

Cerner Cerner Cerner HBOC Cerner Cerner Cerner Cerner HBOC Cerner Cerner Cerner Cerner
Mediw are
MsMeds MsMeds MsMeds Series MsMeds MsMeds MsMeds MsMeds STAR MsMeds MsMeds MsMeds MsMeds
Pharmacy Hospital WORX
Surgery RES-Q
Omni-server
Management Healthcare Per-Se' Omni-server Medline
ORSOS Systems
HBOC Pathw ays
Patient Scheduling HBOC Pathw ays HBOC Pathw ays
HBOC ADAC HBOC ADAC HBOC Per-Se' HBOC
Radiology STAR IDX MARS II Series MARS II STAR ADAC MARS II Consort STAR

Transcription Softmed Dolbey Softmed Dolbey Softmed Medrite Softmed Dict aphone Softmed SARMC Sof tmed

Source: Trinity Health’s internal documents

Tanriverdi, Du, and Ross Page 13 CISR Working Paper No. 385
 Figure 4
IT Landscape of Trinity Health Circa 2010

Common Tools + Best Practice Processes = Performance Excellence

              

Implementation Completed
Implementation in Progress Source: Trinity Health’s internal documents

Tanriverdi, Du, and Ross Page 14 CISR Working Paper No. 385
 Figure 5
Unified Electronic Health Record Across Trinity’s Integrated Healthcare Delivery Network

Long-term
Home Care Tertiary
Care Facility Hospital
Senior Program
Living Community
Community Hospital

Unified Electronic
Health Records
Specialty
Care Clinic

Primary
Care Clinic

Source: Interviews

Tanriverdi, Du, and Ross Page 15 CISR Working Paper No. 385
 Figure 6
Simplified Structure of Trinity Health’s Unified Data Warehouse

Existing BI Applications

Data Sources Millennium Operational

Quality
Millennium
copy Reporting Reporting
copy
PI/E (VIsta)
PI/E (1.5TB)

CernerCerner Executive Genesis

Millennium
Millennium Information Optimization
HospitalClinical
Patient Clinical (EIS) Scorecard
(25 TB) PI-EDW
(10 TB) Net Revenue Patient
Budget Financials
HealthQuest (NRB) (PFS)
Patient Revenue
Service Line
Unified Profitability

PeopleSoft
Data Warehouse (UDW) (SLP)

Financials GL (11 TB)

Supply Chain
Information
(SCIS)
STAR
Patient Revenue Clinical
Analytics
(CAAP)

Insurance Claims &

Remits Research/
(BC, Medicare) Ad-hoc
GL Statistics Queries
GL Settlement
Lawson APR DRG Application Legend
Implant Severity URO Contractuals
BI
Cost Accounting Current External Apps Report
Patient Source data copy
Application
NextGen Satisfaction Internal and External
Interfaces
3M Phys Office Grouping Rules Future Value-add Operational
Benchmark Core Engine Source apps Data store
Options

Source: Trinity Health’s internal documents

Tanriverdi, Du, and Ross Page 16 CISR Working Paper No. 385
 Figure 7
Digitization and Unification Journeys of Key Service Organizations

Source: Interviews and Trinity Health’s internal documents

Tanriverdi, Du, and Ross Page 17 CISR Working Paper No. 385
 Figure 8
Unification Levels of Service Organizations through Digitization

Unification
through
Legend
Digitalization
Data Application Process

High

Medium

Low

Supply Chain Revenue Clinical Quality Cost Organization Performance Business

Management Management and Patient Accounting Talent and Leadership* Development**
Safety Effectiveness
Notes:
* Unified Performance Leadership organization relies on an Executive Information System whose data sources are processes and
applications of other USOs.
** Unified Business Development Organization conducts data analyses for merger, acquisition, divestiture , and collaboration
transactions. Most of these data analyses are manual, human-intensive activities, rather than digitized and automated ones.

Source: Interviews and Trinity Health’s internal documents

Figure 9
Sophistication Levels of Digitized Analytics at Unified Service Organizations (USOs)

Sophistication
level of digitized Legend

analytics Current level of sophistication of digitized analytics

Aspired sophistication level for doing digitized analytics

Predictive
modeling

Explanation
of cause-and-
effect
relationships

Retrospective
reporting and
benchmarking
USOs
Supply Chain Revenue Clinical Quality Cost Organization Performance Business
Management Management and Patient Accounting Talent and Leadership Development
Safety Effectiveness

Source: Interviews and Trinity Health’s internal documents

Tanriverdi, Du, and Ross Page 18 CISR Working Paper No. 385
 Figure 10
Analytics at Each Unified Service Organization (USO)
Progress of USOs Along the
Unified Service Four Dimensions of the
Organizations (USOs) Virtuous Cycle of Analytics
Unified Supply Chain Data:
Management Has a single database for all supply
Organization: chain information. Supply transaction
Accountable for data is centrally available in Trinity’s
managing the majority unified data warehouse. Data type and
of Trinity Health’s non- definitions are consistent across
labor expenses operating units. Data quality is high.
including procurement,
Application:
accounts payable,
Uses a common information system for
purchased services,
all purchasing transactions across
asset management,
operating units.
biomedical
engineering, capital Process:
asset acquisition, Supply chain processes are centralized
construction, real at the home office and regional service
estate, and utilities. centers. Unification level of the
processes is high.
Analytical skills and expertise:
Supply chain workforce is able to
architect IT-enabled supply metric
reports and benchmark supply
performance within and across
operating units.
Analytical Questions Addressed by the USO
Current:
 How productive is the procure-to-pay process?
 Is the organization buying the right product, at the
right price and time, and from the right vendor?
 Does the purchase comply with purchasing policies
and processes?
 How do performance metrics of operating units
compare against their own goals and to those of the
peers?
Aspiration:
 How will a particular brand or vendor item impact the
medical outcome?
 What should the organization have paid for a
particular item, and what did the organization actually
pay for it?
 What is the price variance across ministry
organizations and across physicians, and why?
 What will be the predicted cost per DRG (Diagnosis
related group) or per procedure?
 What is the cause if the supply expense per
operational revenue goes up? Is it cost inflation or
changing case mix?
 What will be the impact of different movements in
patients or service-line products with respect to the
supply chain?

Unified Revenue Data: Current:

Organization (URO): Revenue-related data such as patient  What is a hospital’s accurate revenue? What is the
accountable for all demographics, insurance information, revenue recognized at a monthly basis?
revenue-related services consumed, billing and  What happened to revenue at the patient level?
activities including payment information are all captured  What causes unexpected revenue decrease?
contracting, pricing, centrally in the unified data  What are gaps in revenue practices across operating
billing and collections, warehouse. Data definitions were units? What are improvement opportunities?
patient registration, standardized before application
Aspiration:
health Information deployment. Data quality is high.
 What is the revenue recognized at weekly or daily
management, and
Application: basis?
reimbursement
Uses a common information system for  What will be the best budget for the next period based
revenue management activities across on revenue forecasts?
operating units.  What is the probability of capturing full charges from a
particular patient instead of incurring bad debt and
Process:
charity?
Half way through a five-year process
 What will be the predicted cash value of every patient
unification journey.
account after services are provided?
Analytical skills and expertise:  What will be the revenue impact of economic trends
Revenue workforce is able to architect and changing population characteristics?
IT-enabled revenue metric reports and  What price increase rate can we negotiate when our
benchmark revenue performance costs rise?
within and across operating units. It is  What will be our future business volume?
also developing predictive modeling
skills and expertise to predict revenues
at the patient and service line levels.

Tanriverdi, Du, and Ross Page 19 CISR Working Paper No. 385
 Progress of USOs Along the
Unified Service Four Dimensions of the
Organizations (USOs) Virtuous Cycle of Analytics
Organizational Talent Data:
and Effectiveness Uses a database residing in the
(OTE): pension system as the major data
Accountable for all HR- source for its analytics. Human
related activities resource data is not yet in the unified
including data warehouse.
compensation,
Application:
benefits, retirement,
Started to deploy a common HR
pension, employee
application. About 75% of the
relations, labor
workforce is on a common payroll
relations, learning and
system; about 30% is on a common
development, culture
timekeeping system.
transformation, change
leadership, diversity Process:
and inclusiveness, and Just started with process unification.
general HR support. Developing a shared service center at
home office.
Analytical skills and expertise:
OTE workforce is able to use some
data from the pension system to
produce basic OTE reports on an as-
needed basis.
Clinical Quality and Data:
Patient Safety: Some data are centrally available in
Accountable for clinical the unified data warehouse; others are quality and patient safety across operating units?
quality and patient self-reported by operating units
safety, including the through a web tool. Data definitions
measurement and are not yet consistent across operating  Which patients are likely to face higher levels of
reporting of clinical units.
quality and patient
Application:
safety outcomes,
Uses a common EHR system across
identification of
operating units.
improvement
opportunities for Process:
quality and/or safety, There is variance in clinical processes
and implementation of across operating units. Process
the improvements unification is in progress.
throughout the system
Analytical skills and expertise:
Exploits clinical informatics, process
design, and financial analytics skills to  What are the correlations between care paths and
generate metric reports and
benchmark clinical quality and patient  What is the unknown scientific knowledge embedded
safety within and across operating
units. It also collaborates with
universities to develop predictive
models of patient safety.
Tanriverdi, Du, and Ross Page 20
Analytical Questions Addressed by the USO
Current:
 What is the current status of a hospital’s workforce
structure such as age and tenure of nurses?
 How many employees in a hospital or department will
retire in a certain period of time?
 What is the turnover rate of employees?
 What are the engagement levels of employees?
Aspiration:
 What is the effectiveness of an HR decision such as a
salary cut? Is the outcome consistent with the
planned?
 What is the variance in the same practice across
operating units such as the length to fill a position,
and why?
 What are the productivity and the utilization levels of
the workforce?
 Is a hospital or department right staffed in terms of
both the number of employees and the skill sets they
represent?
 Given the level of patient volume and case mix, what
will be the optimal level of staffing for safe and
effective patient care without losing quality?
 What is the optimal scheduling solution to match
workforce to resources such as operating rooms?
Current:
 What are the levels of core measures on clinical
 What are the patient satisfaction levels?
 What serious adverse events have happened?
certain risks such as falling from bed or sepsis? What
are the contributing medical and demographic
factors?
 What are the clinical and financial outcomes of a
clinical quality initiative?
Aspiration:
 What are the defects in care and what are the risk
factors for patient safety issues?
 What is the impact of medicines patients have taken
before coming to hospital on the decisions about new
medicines to be given to them in the hospital?
processes and patient outcomes?
in the EHR data that medical researchers can unveil?
CISR Working Paper No. 385
 Progress of USOs Along the
Unified Service Four Dimensions of the
Organizations (USOs) Virtuous Cycle of Analytics Analytical Questions Addressed by the USO
Cost Accounting: Data: Current:
Provides operational Relies on multiple raw data sources  What are the profitability, revenue, volume, bad debt,
reports linking medical such as general ledger system, billing charity, collection levels, and other financial and
records, billing system, and medical records. It also operational indicators by service lines?
information, and daily collects primary data such as relative  What is the trend in the number of surgeries a
operations; and value units (RVUs) and cost drivers. physician did?
generates Users perceive the data quality to be  How much labor time does a typical medical procedure
retrospective analysis poor. take?
on cost profitability of  Does a patient remain within Trinity Health-owned
Application:
service lines across facilities when he/she is discharged to a nursing home
The majority of operating units are
Trinity Health. or rehabilitation center?
running a common, home-grown cost
 Are there errors in coding and classification of
accounting application.
patients?
Process:  Do hospitals use resources correctly? For example, are
There is inconsistency in cost intensive care patients put in intensive care beds?
accounting processes across operating
Aspiration:
units.
 Given the experience of other physicians with the
Analytical skills and expertise: same specialty, what business could a physician
Cost accounting team is able to design expect to get if he/she joins Trinity? What
cost accounting methods and systems reimbursement will the hospital get by having this
to generate metric reports on service physician?
line profitability, physician productivity,  What is the accurate cost of a particular medical
and clinical procedure costs. procedure? How can a hospital price its healthcare
services?
Operational Data: Current:
Performance Relies on financial, operational, and What is the performance of each MO or hospital
Leadership: clinical data generated by other measured by financial metrics, quality metrics, safety
Assists hospitals in functions and industry benchmarks. metrics, and strategic metrics?
using process Faces data definition differences and What is the performance of each MO or hospital
excellence, lean and nomenclature challenges across relative to its peers and best practice?
six sigma management operation units.  Where exactly is the cause of performance gaps?
principles to obtain  What are the areas an MO or hospital can improve on?
Application:
productivity gains in What will the performance look like after the
Uses a common executive information
labor management, improvement?
system for metric reporting and
and improvements in
benchmarking across operating units. Aspiration:
emergency department
 What will some performance indicators look like if the
and operating rooms Process:
current trend continues?
Uses common performance
improvement processes.
Analytical skills and expertise:
Uses six sigma and process excellence
skills to design IT-enabled metric
reports and dashboards to benchmark
and improve process performance.

Tanriverdi, Du, and Ross Page 21 CISR Working Paper No. 385
 Progress of USOs Along the
Unified Service Four Dimensions of the
Organizations (USOs) Virtuous Cycle of Analytics
Business Data:
Development: Relies on internally and externally
Accountable for available data on acquisition,
structuring, divestiture, and joint venture targets.
negotiating, and Data types and definitions are
closing transactions consistent. Data quality is high.
such as mergers,
Application:
acquisitions,
Does not use automated tools or
divestitures, and joint
applications for its core activities.
ventures in Trinity
Health. Process:
Each transaction is unique although
analysis processes are common.
Analytical skills and expertise:
Conducts manual, quantitative and
qualitative analyses of acquisition,
divestiture, and joint venture targets.
Source: Interviews and Trinity Health’s internal documents
Tanriverdi, Du, and Ross Page 22
Analytical Questions Addressed by the USO
Current:
 How well does an acquisition target do in terms of
financials, operations, quality, patient satisfaction,
licensure, and compliance?
 Is a target going to be accretive or dilutive to Trinity
Health? How long would it take to happen and what is
the path?
 Which operating units are consistently
underperforming along multiple metrics such as
financials, market share, and care quality? Should
they be divested? Is the timing good for selling a poor
performing unit? What are the market trends and
sales opportunities?
Aspiration:
 What will be predictive elements that indicate future
poor performance of hospitals and other operating
units?
CISR Working Paper No. 385
 Figure 11
Governance Structure for Enterprise-wide Analytics

Clinical and Business Intelligence • Consists of senior executives

• Provides strategic direction on analytics across
Executive Advisory Committee
Trinity Health

Director, IT Strategy • Coordinates enterprise-wide

Planning analytics initiatives

Data Standards
• Consists of representatives from unified service organizations
and Quality
• Coordinates and mandates data definitions and standards
Steering Team

…. …. Unified Service
Supply Chain Cost Accounting Clinical Quality
& Patient safety
Organizations
collaborate across the
home office, MOs, the
Home Home Home field (e.g., hospitals
Office Office Office
and other care units)
MO Field MO Field MO Field
and Enterprise
Information Delivery
Services to jointly
IT IT IT
develop analytical
solutions
…. ….

Enterprise • Maintain the unified data warehouse

Information • Collaborate with various functions in developing and maintaining
Delivery Services analytical solutions
Source: Interviews

Tanriverdi, Du, and Ross Page 23 CISR Working Paper No. 385
 Figure 12
Performance Effects of Trinity Health’s Digitization, Unification, and Analytics Foundation

Performance
outcomes
| Higher Quality | Lower Cost | Higher Accessibility |
Collaboration
Accountability Agility
Organizational
Improvements Transparency Prediction

Unified
Data

Unified Advanced
Processes Analytical
Virtuous Cycle Skills and
of Analytics Expertise

Unified
Applications

Strategic
Unified IT Platform
Commitments
Unified Service Organizations

Source: Framework developed by authors based on the analysis of the case data

Tanriverdi, Du, and Ross Page 24 CISR Working Paper No. 385
 About the MIT Sloan Center for Information Systems Research
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