Quality Improvement and Performance Indicators
Prepared by : Samah Darwazeh
Thalassemia Center
Data Collection for Quality Monitoring
The organization’s leaders identify key measures (indicators) to monitor the organization’s clinical
and managerial structures, processes, and outcomes. ( QPS.3,JCIA 2005)
Data and Information
In health care, we are awash in a sea of data
We are data rich , but are also information poor
Data and Information
Data : Raw facts and figures collected as parts of the normal functioning of the organization .
Information : Data which have been processed and analyzed in a formal, intelligent way to make the data useful
Data are numbers; information is what numbers mean
Example
E.g. a sudden increase in the no. of patients who manifest certain symptoms of disease wont be deciphered ( difficult to understand) until this numerical increase is analyzed to determine true factors and causes .
Performance Indicators
“What gets measured gets done”
“If you measure it , you can improve it”
Performance Indicators
Indicators are numerical values that reveal the condition of a process –how well it is performing , or how present performance compares with past
Performance measurement
Definition : Is an indicator or quantitative tool that reveals an
organization’s performance in relation to specific process or outcome.
Performance measurement ( indicators )
In a very simple situation , you can improve performance without measuring or quantifying it .
E.g. No need for sophisticated statistical analysis to know that dim lighting in dispensary leads to medication error .
But, today , health care procedures are complex, and performance is not easy to measure
Quality Performance Indicators
Well defined
Variable
Measurable
Monitors quality of an important aspects of service
Well defined
• Very clear and precise .
• All staff will understand it the same way . No deviations in interpreting it .
•E.g. ( Mortality rate, Morbidity rate , no. of C- sections with complications , waiting time for O.P.D
Variable
•Cannot be fixed , but Should be a variable that changes and is affected by your performance
Measurable
The indicator should be presented in either ways :
No. e.g. ( no. of medication errors ).
% e.g. (percentage of patient satisfaction ).
Rate e.g. ( Morbidity rate).
Ratio e.g. (Rate of nurses/patient in ICU) .
Monitor quality of an important aspect of a service
Decide what is the important aspects of the service. Usually it should be linked to the out come or the
effect on the customer whether internal or external
Types of quality performance indicators
Based on the importance of activity , there are 2 types of indicators :
• Rate based indicators
• Sentinel Even Indicators
Where you accept the variation
E.g. : Customer satisfaction indicator we may accept 90% and find it good
E.g. : Morbidity rate 1% may be acceptable and good .
Rate Based Indicator
Sentinel Based Indicator
What is the Sentinel Event Is an unexpected occurrence involving death or serious
injury to the patients.
• They need immediate investigation and response .
The terms “ sentinel event” and “medical error” are not synonymous; not all sentinel events occurs because of an error and not all errors result in sentinel events .
i.e. the indicator should show 100% compliance otherwise we have a fault in our system process .
E.g. : Blood transfusion should have 0% mistakes , we cannot accept even 1 mistake
In sentinel events ,we aim at zero defect
Sentinel Based Indicator
Indicator Types
Structure indicator ( input )
Process indicator ( System )
Outcome ( out put )
Any Activity or function has the following
Input Process output
( Resources )
( Structure )
(System )
(policy & procedures)
( Outcome)
Structure ( input ) indicator
Related to the resources and facilities
e.g. the Ratio of nurses/bed; if my standard is to provide excellent patient care then the ratio of nurse/bed is an indicator
e.g. : 1/3, it is applicable everywhere or in Thalassemia could be 4/1.
choose the indicator that suits your standard to monitor it
Related to the system and procedures
E/g . Waiting time of patient in O.P.D No. of lost or delayed files/clinic . % of newborns discharged without circumcision No. of medication errors/month No. of incident reports/month
Process Indicator ( system )
Outcome indicator
Related to the outcome/results of the services that we offer
E.g. % of post operative infections.
Morbidity rate
% of patients satisfaction
Example : ( Surgical procedure )
Input/structure Indicator :No. of nurses /procedure.No. of operations done per room
Process indicator :
% of cancelled operations
% of delayed operations
Output Indicator :Mortality rate .% of complications Rate of post operation infection
Criteria for choosing performance measures ( indicators) in heath care
The organization will get lost in the endless maze of measurement opportunities.
No need to waste time and money measuring less important process while crucial procedures are ignored .
QPS.1.2
The leaders prioritize which processes should be monitored
and which improvement and patient safety activities should be carried out.
How to choose ?
High risk areas
High – Volume areas
Problem –prone areas
High risk areas
Patients who are particularly vulnerable , fragile or unstable
Consider the risks involved in providing care to
this group .
What potential results of failing to provide correct treatment .
High risk areas
What data will you need to gather ? How should you interpret them?
E.g. ( Trauma Care , Transplant patients , elderly population , HIV/AIDS patients .
High Volume areas
Comprises services that are offered frequently , or to large numbers of patients .
E.g. Admission procedures, patient education .
E.g. Demographics ( what population(s) does your organization serve ? Does your service targets particular age group or diagnostic category ?any particular treatment approach ?
Problem prone areas
Are those where, historically , procedures have produced unsatisfactory results .
Where are these problems located ? What are their causes?
Areas of overlap among these categories
Example : Your organization may serve diabetic patients
( High- risk ) in great number ( high volume )and it maybe that outcomes for this population, while sometimes meeting expectations, are often poor ( problem prone )
Performance Measurement according to the JCIA
Clinical monitoring includes: patient assessment laboratory and radiology safety and quality control programs surgical procedures use of antibiotics and other medications and medication errors use of anesthesia use of blood and blood products.
Monitoring includes: availability, content, and use of patient records infection control, surveillance, and reporting procurement of routinely required supplies and medications essential to meet patient needs reporting of activities as required by law and regulation
Performance Measurement according to the JCIA
Monitoring includes: risk management utilization management patient and family expectations and satisfaction staff expectations and satisfaction patient demographics and diagnoses surveillance, control, and prevention of events that jeopardize the safety of patients, families, and staff
Performance Measurement according to the JCIA
..but make the
DATA
Adverse Patient Outcomes Data
UNIT JAN FEB MAR APR MAY JUNUnit 1
Falls/PD 9 5 14 6 8 5Med E/PD 8 5 9 4 7 5Restr/PD 2 1 3 3 2 3HA Dec/PD 2 3 2 4 1 2
Unit 2FallsMed ErRestr
Indicator / Monitor
Falls/Patient Days
012345
AU
G
SEP
OC
T
NO
V
DE
C
JAN
FEB
MA
R
APR
MA
Y
JUN
JUL
Medication Errors per 1000 Patient Days
05
1015
AU
G
SEP
OC
T
NO
V
DE
C
JAN
FEB
MA
R
APR
MA
Y
JUN
JUL
Preventable Adverse Drug Events
How they occur
Administration
34%
Dispensing4%
Transcription6%
Prescribing56%
Administration
Dispensing
Transcription
Prescribing
Overtime Hours
0
50
100
JAN
FEB
MA
RA
PRM
AY
JUN
JUL
AU
GSE
PO
CT
NO
VD
EC
A Mulitple Line Graph
0
2
4
6
8
10
AUG
SEP
OC
T
NO
V
DEC
JAN
FEB
MAR
APR
MAY JU
N
JUL
Falls/100 Patient Days HPPD Budgeted HPPD
Staff HPPD* and Number of Falls
*HPPD=Hours per patient day
Control Chart
Number of Medication Dispensing Errors per 1000 Doses
0
0.5
1
1.5
2
2.5
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG SE
P
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG SE
P
OCT
NOV
DEC
UCL
LCL
Mean
Doses
Surgical Care Unit JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Sick time per FTE 6.6 3.1 3.8 3.8 5.2 2.3 4.9 4.3 3.4 5.3 4.3 3.4
Vacancy % rate 14 14 23 23 20 5 12 11 8 12 10 12
Patient Satisfaction Pain Management 4.2 4.3 3.6 3.6 3.4 4.3 4.1 4.1 4 4.3 4.2 4.5
Falls per 1000 Pt Days 2 2 6 6 7 3 2 2 3 4 3 2
Matrix Example
Brainstorming
After understanding the JCI required area of monitoring , and the priorities we discussed
earlier . what do you think it should be monitored at the Thalassemia Center in each
area ?
Thank You !Thank You !