Post on 27-Mar-2020
transcript
Using The Dashboard To Identify Measures To Drive Improvement
Martin Lieberman, DDS Associate Director of Graduate Dental Education
NYU Lutheran Medical Center
My Journey
• Private Practice Dentist • Neighborcare Health • Quality Improvement • Institute for Healthcare Improvement • IMPACT • Measure, Measure, Measure
Who Uses Dashboards?
• “Shorter, more focused dashboards that are reviewed on a frequent basis are associated with higher performance. According to the results of this dashboard analysis, hospitals that use dashboards with fewer measures are more likely to be in the high-performance group, suggesting that higher-performing hospitals have developed dashboards that focus on areas they see as critical for quality.”
Kroch et al. (2006)
2500
3000
3500
4000
4500
5000
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Total Visits for All Clinics
0
5
10
15
20
25
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Percent No Show
3.0
6.0
9.0
12.0
15.0
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Supply Cost Per Encounter
0
20
40
60
80
100
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Treatment Plan Completion Rate
0
10
20
30
40
50
60
70
80
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Percent Children
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Visits Per Hour
80
100
120
140
160
180
200
220
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Unit Cost
15%
25%
35%
45%
55%
65%
75%
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Percent Medicaid
2.50
3.00
3.50
4.00
4.50
5.00
5.50
6.00
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
RVUs Per Visit
Measure, Measure, Measure • Management
tool • Clinic Leadership • Clinic • Senior
Management • Board • Telling our story
6
Model for Improvement
• The Model for Improvement enables an organization to approach quality improvement through rapid cycles of change and continual feedback on the effectiveness of those changes.
• When used in conjunction with the Chronic Care Model, the Model for Improvement can lead to positive, sustainable changes in the quality of health care.
Quality Improvement (QI)
• An approach to the analysis of performance and efforts to improve it
• Measuring where you are, figuring out ways to improve
• Data collected establishes “baseline” for an aspect of the dental program, and QI process develops methods to improve from the baseline
• Avoids attributing blame • Creates systems to increase/decrease outcome
Old Way (Quality Assurance)
Quality Better Worse
New Way (Quality Improvement)
Reject defectives
Profound Knowledge in Action Requirement, Specification, Goal
No action taken here
Quality Better Worse
Action taken on all
occurrences
Opportunity for Improvement
Actual
Desired The Gap
• Access to care (visit) • Type of service (sealant) • Cost (lower) • Adverse patient event (latex allergy) • Oral health outcomes (BP)
Plan-Do-Study-Act Cycle
Ideas Action Learning Improvement
Do Study
Act Plan
• Identify problems and create a plan
• Implement the plan • Monitor and document
results • Begin analysis of the data
• Complete the data analysis • Compare data to predictions • Summarize what was learned
• Demonstrate improvement • What changes are to be made? • What is the next cycle?
Using the Cycle to Improve
D S P A
D S P A
Ideas
Improvement
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
Spread
What Do We Do Next ?
Use the Dashboard for Quality Improvement
• There are differing levels of capability to effectively and efficiently use the data and implement quality improvement plans
• Readiness questionnaire in the User’s Guide – designed to help you and your organization think through how to best use a dashboard before initiating its use.
Use the Dashboard for Quality Improvement
• Start small • Establish baseline data for the Dental
Dashboard measures • Develop specific goals • Identify areas for improvement (don’t just watch
the dashboard, use the dashboard) • PDSAs • Over time, make course corrections • Regularity
Create a Balanced View
The “Triple Aim”
Improved Health
Reduced Cost
Improved Care
Discussion