Using Data in Quality Improvement. Presented by Laurie Francis, RN, MPH August 20, 2013

Transcription

1 Using Data in Quality Improvement Presented by Laurie Francis, RN, MPH August 20, 2013

2 Welcome! Type questions into the Questions Pane

3 Patient-Centered Primary Care Institute History and Development Launched in 2012 Public-private partnership Broad array of technical assistance for practices at all stages of transformation Learning Collaboratives Website ( Webinars & Online Learning Ongoing mechanism to support practice transformation and quality improvement in Oregon

4 PCPCH Model of Care Oregon s PCPCH Model is defined by six core attributes, each with specific standards and measures Access to Care Be there when we need you Accountability Take responsibility for us to receive the best possible health care Comprehensive Whole Person Care Provide/help us get the health care and information we need Continuity Be our partner over time in caring for us Coordination and Integration Help us navigate the system to get the care we need safely and timely manner Person and Family Centered Care Recognize we are the most important part of the care team, and we our responsible for our overall health and wellness Read more:

5 USING DATA in QUALITY: start where you are and start now! Presented by: Laurie Francis, RN, MPH Oregon Primary Care Association

6 Objectives Review levels of quality data Consider data-driven improvement approaches Explore role of culture

7 Outline Context in which data lives and thrives Levels of measurement and drive down connections Data is critical but not sufficient 8 slides 6 slides Supporting a culture of change that includes data What we know works and what does not Just DO it at the WORK level! 3 slides 6 slides

8 What we know -Truths It is a journey never ending GETTING BETTER PROBLEMS celebrate that Strategic data at all levels Pursuit of mission/goals Level of evaluation The critical few The constancy of purpose Drive down/cascading connections seamless The culture and supportive conversation is imperative Go for early, easy successes!

9 One Clinic s Story The Path Leadership role Organic evolution with staff The Right People on the Bus Data guru Strong teams Mini Measurement Summits Staff understanding and shared derivation in sight of priorities and mission Run charts everywhere..

10 Leading Data Driven Care Orgs Key ATTRIBUTES Build all care around improving health and wellbeing patients and staff Operational Focus Strategic Planning Customer Focus Alignment, alignment, alignment Constant Learning Leadership Create strong teams Staff engagement hire well, treat well, and remove when you blew it Results Workforce Focus Measurement, Analysis, Knowledge Mgmt. BLACK outline key measurement opportunities

11 Category Level QUALITY (MEASUREMENT/RE SULTS) Finance/Cost (MEASUREMENT/OP ERATIONS) Customer (CUSTOMER FOCUS) C a s c a d i n g High 70% of patients will have controlled hypertension Medium All provider teams will have 70% of their panel of patients HTN controlled Budget will track within 10% of projections Provider teams will see an average of 17 visits/day over each one month period 90% of staff/patients will have high levels of engagement 90% of dental patients will signify very engaged in Clinic Wonderful m e t r i c s Drive down to process where IMPROVEMENT OCCURS 100% of HTN patients will bring meds to medical visit and demonstrate how they take them 90% of patient visits will be billed within 48 hours Staff members will review patient selfmanagement goals at each visit

12 How GOOD By When? Mission and Drive Down To improve health outcomes in. Org X 1 70% of people with high blood pressure will be at or below 135/85 by Jan % of patients in MY panel will be in control Tomorrow we are going to call follow up Team Y 3 PROCESS

13 Team Level Process Measures Review medications with all HTN patients at each visit goal 100% Review after visit summary using TEACH BACK at each visit with HTN patients - goal determine baseline and improve by 50% 3+ Follow up call one week after patients starting on new antihypertensive goal 100% (but, again, figure out where you are starting)

14 Success FACTORS Time to meet with the process experts Focus on opportunity for improvement Use PDSA or A3 forms as guides Plot data over time Run Charts Mark date where improvement occurred on run chart Celebrate Positive Deviance Recognition

15 Team Y wants to improve PDSA areas PLAN. DO. STUDY. ACT A3 Header info (Problem Title, Owner, Date, etc.) Background Info Current State Goals Root Cause Analysis Countermeasures Effect Confirmation Follow-up

16 BP recorded at time of visit or Pts with uncontrolled BP TITLE PERCENTAGES 5/11 Time increments

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18 Run Chart Rules (indicating special cause variation) Six or more data points above or below the MEDIAN Five or more data points going continuously up or down nability/further_resources/techniques/spc.htm l

19 Stages of Data Grief SHOCK DENIAL this data is wrong ANGER this is a problem but not mine BARGAINING- the data is decent but patients won t comply ACCEPTANCE we need to improve! Navigate this conversation with honesty, compassion, and integrity

20 It sounds so easy but It often flops FEAR Blaming Push back Competing priorities Too much change EHR, leadership, providers Gimmicks: Slogans Use of extrinsic motivators and incentives

21 Culture eats strategy for lunch This is not an either/or proposition - strategy is still important! However, if your organizational culture is not aligned with your strategy, it will be nearly impossible to make progress. Start where you are

22 What is culture? Culture emerges from shared experience Shared beliefs, attitudes, values and norms of behavior Often implicit, unspoken or unconscious make explicit The way things are understood, valued and judged the way things are done around here AVOID culture killers - contradictions! Make values and commitments explicit then WALK the WALK (and when you screw up, apologize!) Davies, H.T.O, Nutley, S.M., Mannion, R. (2000). Organisational culture and quality of health care. Quality in Health Care, 9,

23 Keys to Culture of Improvement Lead by example with values, ethics, transparency, and humaness Create safety and drive out FEAR Problems are opportunities for improvement Problems are in the system, not in people The staff are the experts Recognize accomplishments AND attend to areas for improvement all the time

24 Sample Dialogue the good, the bad and the ugly Gallant Wow, look at this run chart. Tell me about it. What system changes did you make this is wonderful. What are your next steps? Would you be willing to share at the next mini measurement summit? Goofus Jeez, how come you are so far behind, Team Y? You have a problem. You better talk to Team X they are far ahead of you! This is not acceptable. You need to work harder We plan to tie pay to improvements.

25 Setting up for Success Effective organizational change and improvement work requires investing time up front Schedule time for people to do improvement work There s an old proverb of a wise man coming across a guy sawing a log with a dull blade. He says, If you take five minutes to sharpen that blade you'll saw five times faster. Nope, says the guy, I got no time for that, I gotta keep working. Help choose small, short term areas, succeed, and sustain! Create early, visible wins!

26 Where are you? Process measures in place but: No time to improve them Too many measures Not plotting them pull out a piece of paper, marker, and run chart rules Take something small wall chart of patients whose BP was controlled when they came in do for one week denominator total pt with BP that day, numerator those in control. See what you learn and then use PDSA form to outline next steps.. Have organizational measures but not team level not EMPANELED? Start with another measure huddles yes/no, room stocking chart number of missing items on dry erase daily, missed calls tick marks, staff engagement compared to visits/day Culture unsafe to improve Work on culture (ask staff, they will tell you!!) this WHILE still doing small PDSAs, celebrating, acting like Gallant, and keep on rolling

27 Is it an Impossible Mission??? Your mission, should you decide to accept it, is to become A LEARNING ORGANIZATION, constantly getting better One SMALL step at a time (This tape will self destruct in 5 seconds)

28 Resources Mentioned or Helpful Interactive Institute For Social Change epapers/goingleaninhealthcare.aspx Q Corp ( PCPCI (

29 Questions? Type questions into the Questions Pane

30 Closing Please fill out the survey after this presentation you can send us additional questions Webinar materials can be retrieved from our website, Additional questions?