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Supercharging Change at the Front Lines of Healthcare Phillip Morehouse, Director Performance Excellence Cape Breton District Health Authority CIHI 2014 Heath Data Users Day Halifax, NS
Supercharging Change at the Front Lines of Healthcare
Phillip Morehouse, Director Performance Excellence
Cape Breton District Health Authority
CIHI 2014 Heath Data Users Day Halifax, NS
Knowledge • Understood • Accepted • Triable • Fits the process
Data • Relate to the problem • Relevant frequencey • User friendly & visual • Who should get the data?
Action • Usually requires facilitation • Influenced by barriers to change • Learning/testing cycles
Shewart and Deming
Systems thinking- process driven
Variation exists
Starts with a concept of improvement
Testing and learning cycles
Data and feedback driven
Design DesignDesign Design Approve
Implement
Conference Room
Real World
Design
Conference Room
Real World
Approve(If Necessary)
Implement
Test and Modify
Test and Modify
Test and Modify
REF: HI Innovative Series- Seven Leadership Leverage Points for Organization- Level Improvement in Health Care- Second Edition.
Initiated March 2010
MAC/CEO involvement
One test per month alternating between Lab & DI- March 2010
Behavioural Factors ◦ Pre-disposing factors: Distribution and review of test ordering guidelines “Do You Need That Scan” (Canadian Association of Radiologists)
◦ Re-enforcing factors: Identify the top 50% of physicians + peer comparison Cost of testing
Laboratory Diagnostic Imaging
ESR PSA CEA Folate Vitamin D 25-hydroxy Vitamin D 1, 25-dihydroxy Urine C&S (No change) Lipid Profile Throat Culture Rapid Throat Screen (No change) ANA Testosterone BUN TSH & Free T4 Liver- ALT
Lumbar Spine X-Ray Chest X-Ray Portable Chest X-Ray Abdominal Ultrasound (No change) Pelvic Ultrasound CT Head Thyroid Ultrasound CT Lumbar Spine CT Chest Barium Swallow Barium Enema OBS Ultrasound-Early Rib X-Ray
0-5% No Change
5-10%
10-20%
> 20%
• Reduced direct costs • Reduced follow up
testing/consultation • Increased capacity • Reduced wait times • Reduced radiation
exposure
Test/Exam Analysis Time= <15 hours
Since March 2010- $1,197,374
# of Tests
Test/Exam Variance
% Variance
Annualized Value
Lab Tests
17 (57,612) 16.7% $151,125
DI Exams
13 (14,280) 9.5% $215,013
Total
30 (71,892) 14.4% $366,138
Utilization Project Analysis (March 2010 – April 2013)
10 family practices participated, MOU’s signed Over 1100 patients with Type 2 Diabetes, over the age of 18 and not
living in a nursing home Monthly data submissions and feedback reports Facilitated quarterly workshops designed by participants
Incentives: ◦ Office support; Mainpro C & M1 credits, financial compensation for data
collection and participation.
Quality Collaborative: Diabetes
•PDCA •EMR-chronic disease •Motivational interviewing
•Foot exams •Retinopathy screening process •Nutrition
0.010.020.030.040.050.060.070.080.090.0
100.0
Perc
ent o
f T2D
M p
opul
atio
n Comparison of baseline to final clinical and process measures
for the CBDHA Quality Collaborative
Baseline, N=1119 Final, N=1065
Sept 2012
2011 ◦ 91 C-difficile cases ◦ 15 deaths
2012 ◦ NS Auditor General/Public Health Agency of Canada/ Infection Prevention & Control NS
2013 ◦ Hand Hygiene Program & Database ◦ Pilot on 2 Medical Units Hand Hygiene auditing at the unit level Front line empowerment- individual pins and trophies
Pre-Intervention Post-Intervention % Difference
Unit 1 86.25% 93.00% 6.75%
Unit 2 86.50% 90.75% 4.25%
DHA 82.50% 82.25% -0.25%
Achieving Excellence in Performance
Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Avg.
2012/13 nd nd 44 45 55 37 58 72 68 48 71 71 57
2013/14 65 42 41 51 58 53 61 59 55 65 52 68 56 2014/15 50 63 69 77 54 78 69 66
DHA 8/MAC/Infection Control - Hand Hygiene Compliance Physicians Only - District Monthly (Fiscal)[Percentage]
Key Performance Indicator System
Attachment: Hand Hygiene Fact Sheet June 2014.pdf
Performance- Infection Prevention & Control
Performance Excellence Nov 2014
Key Performance Indicator System ◦ Financials
Required Organizational Practices (ROPs) ◦ One day audit ◦ Unit level data
Global Trigger Tool ◦ Adverse event identification
Hand Hygiene Rates ◦ Facility entrances ◦ Pushing the data ◦ Volunteers
Engage staff and physicians with knowledge and data
Data relevance + frequency + visual display Simple Actions and Improvement resources Manage to learn- PDCA Celebrate success!!!
