Objectives
• Learn to define what a measurable quality metric entails
• Discover how to create meaningful dashboards that drives change
• Learn how to use Excel as your data collection friend
• How to do an internal review of current measures and opportunities to improve
Tools Provided
• These slides in pdf
• Blank Quality Playbook
• RHC Performance Improvement Template
• CCM Completion Chart
• Eight Forms of Waste
• Guide to Quality…..Shhhhhh
Why Are We Talking About Report Cards?
• National Standards
• Benchmarking
• MIPS/MACRA
• Most of all….Consumers are Watching!
Quick Review
Driving Quality Metrics that Produce Results
• Think STEEEP
• IOM Six Domains of Health Care Quality
Safe
• Avoiding harm to patients from the care that is intended to help them
Timely
• Reducing waits and sometimes harmful delays for both those who receive and those who give care
Effective
• Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse)
Efficient
• Avoiding waste, including waste of equipment, supplies, ideas, and energy
Equitable
• Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Patient-centered
• Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuing that patient values guide all clinical decisions.
Three Types of Measures
• Structure
• Process
• Outcome
Structure Measure
• Evaluate the infrastructure of health care setting and ability to deliver care (clinics, organization and resources)
• Staffing
• Staff skill and capabilities
• Policy & Procedures
• Availability of resources
Process Measure
• Used to determine the extent to which providers consistently give patients specific services that are evidence-based
• Think: did the patient receive the recommended care or not?
• Focused on areas of prevention and chronic disease management
Outcome Measures
• Evaluate patients’ health as a result of the care they have received.
• Looks at effects the care has had on their health, health status, and function.
• Can be more challenging to gather the data and hard to hold patients accountable to the recommended treatment
Ongoing Climb:
Always be asking, “ How can
we do things better?”
Safe
Timely
Effective
Efficient
Equitable
Patient-Centered
Included a review for:
Structure
Process
Outcome
Very Brief Intro to Lean
Single-Piece
Flow
Lean Toolbox
The Three Principles of Lean
1. Engage the people who work in the process to improve the process
2. Focus on creating value from the customer’s perspective
3. Bring measurable and sustained improvement
20
Lean Principle #1: Process
“A bad process
will beat
a good person
every time”
- W. Edwards Deming
21
Lean Principle #2: Customer
Customers judge value on:
• Speed – How quickly do I receive it once I request it
• Accuracy – The information is correct and responded to my request
• Understandable – The information is easy to read and understand
• Convenience – It is convenient for me to get it, I can get it when I want it (and not when you are willing to give it to me)
Lean Principle #3: Sustainment
“If you don't know where you are going, you will
wind up somewhere else.”
- Yogi Berra
23
Eight Areas of Waste in Healthcare
As you learn to “see” your
processes in new ways, you
develop what are called “eyes for
waste” so you can identify the
waste and then eliminate them in
a systematic method.
8 Types of Wastes -- DOWNTIME
How Does Waste Affect Me?
Causes physical fatigue
Causes emotional fatigue
Increases frustrations
Increases stress
Causes you to blame others
Steals your time
Enough About Definitions
What makes a good quality metric
A good measure drives change
Making a Measure Work for You
• Is it meaningful?
• Does it make sense?
• Is it measurable?
• Do you have staff buy-in?
• What is the area of impact? Process? Outcome?
Where to Start?
• Problematic Area(s)• Community needs
• Primary population
• Primary disease(s)
• Staff engagement
• Meaningful
• Baseline data
From Managers/Staff
• No time
• Not meaningful
• Cannot fix it
• Staff won’t collect
• Late data
• No analysis
• No plan of action
• Staff cannot speak to the improvement
If someone came in and asked you what you do or have done
for quality improvement
………….could you answer them?”
First Impressions
• Ease of appointment scheduling?
• Same day appointments
• Same day nurse phone calls
• Wait times in waiting rooms/exam rooms
• First time patient experience
Rooming
• Complete questions • Fall screening?
• Depression screening?
• Prevention screenings?
• Chart inclusive and ready for provider?
• Full medication reconciliation review?
• Any labs that should be on the chart?
• Referral/consult reports?
Physician Support
• Involve providers in the process of defining and selecting quality metrics
• Selecting metrics on the basis of medical evidence that proves a positive correlation with quality outcomes
• Holding providers accountable for quality measures that are reasonably within their control
• Streamlining the collection of data so as not to detract from the quality of the patient experience
Data Collection Tool
Making Excel a Friend
Graph Selection
Types of Graphs
• Area
• Column
• Bar
• Line
• Pie
Common Elements of Graphs
• Colors
• Depth
• Axes
• Labels
• Title
• Legend
Benefits and Pitfalls
• Benefits• Visually communicate results
• Analyze information from multiple periods, entities, sequences, etc.
• Patterns
• Pitfalls• Data overload
• No conclusion
• Spreadsheets
Deceptive Graphs
• Emphasize or de-emphasize changes by affecting the axis
• Use different scales or starting points
• Use percentages to show growth
• Avoid trend lines
• Avoid displaying actual values
• Delivery
Deceptive view
IDEA – PDCA Tool
IDEA
• Improvement Opportunity
• Data Collection Methodology
• Explain Findings
• Action Steps
PDCA/PDSA
• Plan
• Do
• Check/Sustain
• Act
Presenting the Data: In Dept.
Second half
Let’s Break it Down
Where does the data go?
Data Points…
The Reporting
Summary
PERFORMANCE IMPROVEMENT
Dashboard Reporting
Simple
Visual
Relevant
Benefits of Dashboards
• Organize
• Summarize
• Focus
• Present
• Quick
• Easy to understand
• Interactive
Keep it Simple
Reporting to Board/Committees: The Dashboard
Metrics and Data Build Your Dashboard
Board Report Example
Our Data Collection Tool Summary Dashboard
Another Tool For You
Employee Engagement
• Don’t forget to share your data!
Questions