A4/B4 Integrating a Seamless Measurement Plan: Mini-Course - M. Rathgeber and H. Johns

transcript

MEASUREMENT PLANSQuality Forum 2012

Melanie Rathgeber

MERGE Consulting

rathgeber.melanie@gmail.com

Heidi Johns

BC Patient Safety & Quality Council

hjohns@bcpsqc.bc.ca

Objectives

1.Understand the link between measures for improvement projects and organizational measures

2.Identify potential outcome, process and balancing measures for your work

3.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)

Source: The Improvement Guide

What are we trying to accomplish?

How will we know that a change is animprovement?

What changes can we make that will result in improvement?

Act Plan

Study Do

Data is used to:

•set priorities

•determine target

•start benchmarking

Act Plan

Study Do

Measures:

•Key Measures•Data over time•Family of measures

Act Plan

Study Do

Measures:

•Key Measures

•Regular data over time

•Tells you how close you are getting to reaching your Aim

Act Plan

Study Do

Ideas based on data

Do you have a hunch that there is variation in turnaround times?

Does data verify this?

Can you test a way to decrease variation?

Cascade of Measures – from front line to Senior Leaders/Boards

Family of Measures Outcome measures

Based on your Aim statement What are we trying to accomplish? What is ultimately better? Voice of the patient/customer

Process measures

What are you changing – is it really happening? Voice of the system – what is being done differently? Change more quickly than outcomes

Balancing measures

What unintended consequences might occur?

Examples

Outcome

Process

Balancing

Family of Measures in Action – An Improvement Project

- What were the outcome/process/balancing measures?

- How were they chosen?

- How was the data useful in driving improvement?

- What was the data showing us?

Where do I start?• I have a hunch

• I need to determine

a target

• How am I going to get

the information

What actually do I want to

accomplish?

I really needed to develop my AIM• What was I going to DO • by WHEN • by HOW MUCH

• Had a hunch that wait times to receive service were very long

• Had listened to physicians that they were not happy with the process

• How do I tell everyone what we were going to do

Suggestion• Don’t tell,

• Don’t have the idea, let the group you gather come up with the what

• Gather the group, determine who is the right group by asking,

• Who is going to be affected by the change?

Back to the AIM• By September 2011 the completion of referrals from GP’s

and NP’s to the Unit will be 80% by using the correct process and forms.

• I needed to gather the data to see what the completion rate was

• What was the actual wait time to be seen at the Unit

Sidebar conversations• “I don’t think this will be that bad, wait times are not bad”

• “I complete the referrals it gets stalled at their office”

• “ I am not clear on what needs to be done, so we go with what the patient tells us and what we can glean from the referral”

Gathering the data

• Here is what I did………………….

Baseline Data

Tracking Key Process Measure over Time

Percent of referral forms fully complete

2926 24

April '11 May June July August Jan '12 Feb April

* Calculations to be confirmed

Starting to Track Time Between Receipt of Referral and Date First Seen

Patient1 Patient2 Patient3 Patient4 Patient5 Patient6

Family of Measures in Action – An Improvement Project

- What were the outcome/process/balancing measures?

- How were they chosen?

- How was the data useful in driving improvement?

- What was the data showing us?

Some tips for getting started

“Measurement should be used to speed things up, not to slow them down”

- IHI Breakthrough Series Guide

Some tips for getting started

1. Seek usefulness not perfection

2. Don’t wait for the information system

- IHI Breakthrough Series Guide

1. Seek usefulness not perfection

Key here is to understand the purpose of measures.

2. Don’t wait for the information system.

How “real time data” drives improvement.

Examples?

This can involve new ways of doing things.

New ways of doing things:

stretch yourself to…….

1. find ways of capturing data in a computer-less world.

New ways of doing things:

stretch yourself to…….

2. find ways to embed data collection into work-flow.

Taking data to your audience

Use a balanced set of measures

Display data over time

Essential when taking data to your audience – data over time.

pre-post test, p<.01

*hypothetical data – illustrative purposes only

Spreading change throughout your organization

How does this affect measurement?

Why we are not good at using data: we don’t have a plan of action

What is the plan if data is not at target?• Does it depend on patterns in data?• Does it depend on how much you are off?• What is the “signal” to trigger an action plan?• How was your target set in the first place?

Why we are not good at using data: we don’t have a plan of action

• How do leaders provide support for an area that isn’t meeting a target?

• How is the action plan followed up? What is the accountability? Are people aware of plans and expectations

• What is the plan when data does meet target?

Data Display Principles

Starting to Track Time Between Receipt of Referral and Date First Seen

Patient1 Patient2 Patient3 Patient4 Patient5 Patient6

Percent of Patients w ith Appropriate VTE Prophylaxis

Oct NovDec

June Ju

4 East

Shuswap

“SMALL MULTIPLES” – all info on one page

1/1/09

2/1/09

3/1/09

4/1/09

5/1/09

6/1/09

7/1/09

8/1/09

9/1/09

1/1/10

2/1/10

ProvincialReadmission Rate

40Large Teaching

Hospitals

010203040

Large Community Hospitals

010203040

Medium Community Hospitals

010203040 Small Community

Hospitals

Resources:

BCPSQC Measurement Report http://www.bcpsqc.ca/pdf/MeasurementStrategies.pdf

Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP (2009) The Improvement Guide (2nd ed).

Provost L, Murray S (2011) The Health Care Data Guide.

Back to Objectives

1.Understand the link between measures for improvement projects and organizational measures

2.Identify potential outcome, process and balancing measures for your work

3.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)

A4/B4 Integrating a Seamless Measurement Plan: Mini-Course - M. Rathgeber and H. Johns

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