Using The Dashboard To Identify Measures To Drive Improvement Martin Lieberman, DDS Associate Director of Graduate Dental Education NYU Lutheran Medical Center
Transcript
Using The Dashboard To Identify Measures To Drive Improvement
Martin Lieberman, DDS Associate Director of Graduate Dental Education
NYU Lutheran Medical Center
Presenter
Presentation Notes
- Use the Dashboard to identify targeted areas for improvement and develop improvement goals�
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
Presenter
Presentation Notes
The Chronic Care Model identifies the following six elements as essential to ensuring and improving the quality of care: Health Care Organization: For an oral health QI program to succeed, it must have the full support of the organizational structure and senior leadership. Community Resources and Policies: Stronger links between the Health Center and community resources (e.g., outside health care providers, schools, health departments) may improve the effectiveness of the oral health program and its referral system. Self-Management Support: Patients require support and appropriate information to better manage their health. Delivery System Design: To truly integrate oral health care with medical and other health care services, a Health Center’s entire delivery system must be coordinated. The use of a multidisciplinary team approach, ensures patients access and receive care efficiently, while also allowing providers to maintain current and centralized information. Decision Support: Oral health programs utilize evidence-based guidelines and protocols in daily clinical practice. Clinical Information Systems: To make appropriate clinical decisions, oral health providers need timely and clinically relevant information about each patient, as well as their total patient population.
• 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.
Presenter
Presentation Notes
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 with the Chronic Care Model, the Model for Improvement can lead to positive, sustainable changes in the quality of health care. Additionally, Health Centers can apply this model in conjunction with other established improvement processes.
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
Presenter
Presentation Notes
Quality Improvement is an approach to the analysis of performance and finding ways to improve it. It is aimed at improvement – measuring where you are, and figuring out specific practice changes to improve. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening. Data is collected to establish a “baseline” for an aspect of the Health Center’s dental program, and the QI process focuses on developing methods to improve future outcomes of the oral health program derived from the baseline data.
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
Presenter
Presentation Notes
Einstein: “the definition of insanity is doing the same thing over and over again and expecting different results” The QA approach to quality was grounded in enumerative methods: what is the state of the system? Does it perform to specs? QI approach is based on an analytic approach – how can we alter the system so that all products are predicted to confrom?
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)
Presenter
Presentation Notes
Once baseline metrics are established, oral health programs can more effectively determine where quality improvement opportunities reside and set goals for the program. As stated earlier, improvement decisions are influenced by numerous variables in Health Centers, including resources, talent, motivation, Board priorities, and population needs. Because program goals vary, each Health Center must develop unique steps to achieve its desired improvements.
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?
Presenter
Presentation Notes
The PDSA tool helps us take ideas to action to learning to improvement. Plan: As we stated earlier, we start by identifying the problem and creating a plan. Do: We then implement the plan, monitor results, and begin analysis of the data. Study: We complete our data analysis, compare what we have found to our predictions and summarize what we have learned. Act: We ask ourselves ”did we demonstrate improvement?”, “what changes are to be made?”, “what is the next cycle?” And the cycle starts all over again.
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
Presenter
Presentation Notes
It is important to start with very small scale tests. By small scale tests, I mean just of few patients, or just one provider for a short period of time. Once we have demonstrated improvement with our small and follow up PDSAs, we can then begin wide-scale testing and implement the change into our system. Starting with small scale testing prevents us from taking what we think is a good idea, but actually does not lead to improvement, and implementing it across the system.
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
Presenter
Presentation Notes
The Dashboard measures are designed to be used together to create a balanced view of organizational performance. The user’s guide provides suggestions to support you in selecting measures that work well together.
The “Triple Aim”
Improved Health
Reduced Cost
Improved Care
Presenter
Presentation Notes
By now you have all heard of “Triple Aim” in health care. The goal of the Triple Aim is to improve the patient experience of care, improve the health of populations and reduce the cost of health care. Health Centers and all other health care delivery systems will be working towards this goal now and in the future.
