Clinical Ops: a crucial piece of the puzzle in the patient journey

Imagine you’re building a virtual-first care provider focused on women’s health. You hired your first two physicians a few months ago and they could easily manage the full patient journey. From sending a reminder to the patient before the consultation to providing care and developing processes that drive and optimize company results. They managed it all.

The CEO recently signed a big contract with an insurance company and the patient numbers will go up by 300%. The team decided to hire one additional physician to manage the patient influx.

Despite thinking that hiring another physician would solve all their problems, the reality was quite different. They're frustrated. They only spend 40% of their time on providing care, the rest is spent on things like capacity management, quality improvement cycles, and onboarding new patients.

What was their mistake? The company didn't hire a Clinical Ops person.

Defining the ClinOps role

The term “ClinOps” has been popping up more and more in digital healthcare circles. But what exactly is it?

While it may look different in every organization, you can think of it as the role responsible for scaling the practice of medicine. We can break that down into three main buckets.

The first bucket focuses on translating clinical protocols into standardized processes. It's up to medical professionals to define what a treatment protocol would look like, but it's Lindsey, the ClinOps leader, who will translate that into a reliable, scalable, and repeatable process.

With a solid process in place, the second bucket is about ensuring the organization has the resources - the people, the tools, the training - to pull it off.

And because this role sits at the intersection of the practice of medicine and the day-to-day operations of a business, the last bucket is about navigating the goals and realities of a startup.

“Clinical Operations oversees all aspects of care delivery and patient experience - from onboarding to discharge. It’s their goal to make sure that clinicians can actually do what clinicians want to be doing, which is taking care of people.”

Here are some specific things our ClinOps leader, Lindsey, might be responsible for at the virtual-first women’s health clinic where she was just hired:

• Manage capacity and utilization targets: Ensure there is enough supply (healthcare professionals) to meet patient demand. When demand drops, downscale supply.
• Patient onboarding: Onboard new patients and look at ways to (partly) automate the process.
• Design Standard Operation Procedures (SOPs): Translate clinical protocols (e.g. if someone has hot flashes, this is the appropriate treatment) into an easy-to-understand SOP that everyone has access to.
• Design safeguards: Implementing safeguards to ensure clinicians follow SOPs (e.g. alerts when different medications are prescribed).
• Data analytics: Work together with the data team to get insights into which SOPs are (not) being followed (e.g x% medication is prescribed wrong) and share this information with the clinical team.
• Team management: Build, manage and motivate care team members (more about this below).
• Performance: Set goals for clinical performance (e.g average NPS is 55) and growth, report on operational performance (e.g 95% capacity utilization rate) and suggest improvements.
• Clinical onboarding: Make sure that new care team members joining the company are up-to-speed with the care delivery process and SOPs of the company as soon as possible

As you may have noticed, there is a strong connection between ClinOps responsibilities and the CareOps Lifecycle (but they are not the same).

The mission of ClinOps isn’t just to ensure that patients receive safe, high-quality care: it’s to help steer the entire clinical ship according to the organization's goals.

This makes it a critical role in any virtual-first healthcare company, where the care delivery process and care team are the product.

ClinOps and the clinical team

A strong partnership between ClinOps and the clinical team is crucial to delivering high-quality care. This collaboration can be structured in several ways depending on the company's org structure.

In some organizations, ClinOps reports to the Chief Operations Officer, sometimes to the Chief Medical Officer. This makes sense given the role's position at the intersection of operations and medicine.

Similarly, sometimes ClinOps manages the care team, while other times, the care team is managed by clinical leadership.

There’s no right or wrong between the two options above. It really depends on the needs of the organization, and there are tradeoffs with both. And while it's different within each organization, we would still love to share Shoshana Wirth's (ClinOps leader with +10 years of experience) opinion:

"Looking back at my past experiences, I would always go for option two. As mentioned earlier, ClinOps is responsible for clinical performance management and tying it back to the broad organization's strategy. Structuring your organization like option two makes more sense to me because it best utilizes the unique skillsets of your leaders, while ensuring accountability from the clinical teams on the targets and goals you've set."

Either way, the ClinOps and clinical team leads must collaborate seamlessly. ClinOps leaders are responsible for implementing best practices and clinical protocols defined by the clinical team lead. A strong partnership between the two is crucial.

Let’s go back to our virtual-first women’s health example. That partnership could look something like this:

• Our clinical leader, Dr. Kim, creates a protocol for menopause care
• ClinOps leader, Lindsey, translates the protocol into standard operating procedures (SOPs) that she asks the clinicians to read and reference
• Together they define what outcomes and metrics they want to track
• Lindsey trains the clinicians on how to manually record the data they’re tracking
• Lindsey manually pulls a performance report in Excel
• Every two weeks Lindsey reports back to dr. Kim with clinical insights and things that can be improved

ClinOps and product

Everything we’ve talked about so far can and has been done manually. But the point of being a modern healthcare company is to use technology to improve the delivery of healthcare.

So while our ClinOps leader may start by writing up SOPs in a Word doc and training clinicians to manually enter data, she knows that as the company scales, that’s not gonna cut it. This is where her product and engineering teammates come in.

Just as ClinOps is a way to scale the practice of medicine, technology is a way to scale the operations of a business. So product and engineering collaborate with ClinOps to buy and/or build tools that will do exactly this. Sofia Guerra explains this nicely in her article on Benchmarks for growing health tech businesses:

"Over time, companies can get better at managing the efficiency of their provider panels (i.e., increase the number of patients a provider can see over time) through better processes and technology, as well as by leveraging different types of providers operating at top of license (i.e., leverage health coaches, nurse practitioners). All of these levers can affect clinical quality and outcomes and thus require a delicate balance between technology deployment and robustness of clinical efficacy to improve how you deliver care."

Let’s look at the women’s health example one last time:

• Our clinical leader, Dr. Kim, creates a protocol for menopause care
• ClinOps leader, Lindsey, translates the protocol into SOPs
• Together they define what outcomes and metrics they want to track
• Lindsey then works with the product team to translate those SOPs into product requirements
• The product team brings the SOPs to life by building them into end-user applications.
• Clinicians don’t have to reference flowcharts or docs while they’re seeing patients. The logic of the SOPs has been baked into the technology they’re using.
• Together with the product team, Lindsey creates a dashboard to monitor performance
• Every two weeks Lindsey reports back to dr. Kim with clinical insights and things that can be improved

What we’re describing here is the ideal, but in reality, there’s a spectrum of how effectively these teams can work together. Much of that can be attributed to the nature of a startup, where resources are constrained, and priorities change daily.

Scaling fast is important, but collaborating between ClinOps, product, and clinical teams is equally important. There is a spectrum of how effectively these teams can work together, which is formulated well in this article. If they are not collaborating seamlessly, you may end up with what we call "Clinical Ops debt," which we will discuss in our next article.

But there’s another pattern that can’t be ignored.

The ClinOps role isn’t new to healthcare. Maybe that’s why the relationship between this role and the clinical team feels so natural and well-defined, even in a startup environment. These teams are speaking the same language.

That’s not the case with engineering, which in healthcare is usually called “IT” and quite literally housed in the basement. So naturally, it’s not uncommon to find a healthcare startup where the clinical team and the product team are struggling to understand each other.

As a role that requires both the right healthcare instincts and the ability to handle complexity and scale a business, we think ClinOps is exceptionally well positioned to help translate.

Putting it all together

ClinOps may not have the glamour of sales, and they're unlikely to be invited to a fancy dinner with clients, but we want to emphasize how important this role is.

Clinicians, nurses and other healthcare professionals went to school to work with patients, not to be data entry clerks. The beauty of ClinOps is that they facilitate this. It's their goal to make sure that care teams can focus on what they do best - providing care.

So no, they will not be invited to a fancy diner with clients. But yes, they will have a tremendous impact on the care delivery process and the improved outcomes resulting from this. Isn't that more glamorous than sales?

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If you enjoyed this blog post you can make us happy by sending it over to a (HealthTechNerd) friend, clinical operator or whoever is interested in this topic. Feel free to bait them with our mediocre memes :-).

Written by Rik Renard (Partnership Lead at Awell Health) and Liz Raad (Founder of Bumi).

Special thanks to Chelsea Karato (Head of Clinical Operations at Recora Health) and Shoshana Wirth (ClinOps leader with +10 years of experience) for the input.