SHN! Atlantic Sustainability and Spread October 2012

Transcription

1 SHN! Atlantic Sustainability and Spread October 2012 Mauri Williams RN MBA, MHA, NE-BC, CSSBB

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6 Datafication what is it? when data is brought to life through story telling and creative communications techniques Source: datafication.com.au

7 Datafication what is it? when data is brought to life through story telling and creative communications techniques Source: datafication.com.au

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11 Learning/Session Objectives Using data to tell a story Variation Common cause variation vs special cause variation Time charts (Time Series, Run Chart, Control Chart) Using data to make data based decisions 11

12 What s The Story? SSI SS1 Percent of Surgical Patients with Timely Prophylactic Antibiotic Administration Colon Surgery 12

13 SS1 Percent of Surgical Patients with Timely Prophylactic Antibiotic Administration Colon Surgery 13

14 Measures Center of the Data Mean Median Mode Spread of the Data Range Data Uses Data Over Time Data Before After Data Benchmarks Data Targets Interquartile Range Standard Deviation Shape of the Data Bell Shape Skewed Bi-modal Displays Dot Plots Individual Value Plots Box Plots Histograms Pareto Charts Time Charts Concepts Random Variation Common versus Special Causes Leading versus Lagging Measures Control Charts

15 Measures Center of the Data Mean Median Mode Spread of the Data Range Data Uses Data Over Time Data Before After Data Benchmarks Data Targets Interquartile Range Standard Deviation Shape of the Data Bell Shape Skewed Bi-modal Displays Dot Plots Individual Value Plots Box Plots Histograms Pareto Charts Time Charts Concepts Random Variation Common versus Special Causes Leading versus Lagging Measures Control Charts

16 Measures Center of the Data Mean Median Mode Spread of the Data Range Data Uses Data Over Time Data Before After Data Benchmarks Data Targets Interquartile Range Standard Deviation Shape of the Data Bell Shape Skewed Bi-modal Displays Dot Plots Individual Value Plots Box Plots Histograms Pareto Charts Time Series Concepts Random Variation Common versus Special Causes Leading versus Lagging Measures Control Charts

17 Process Variation Dr Deming s Profound Knowledge All Work Is Part Of A System Every System Has Variation Variation Can Be Reduced Management Is Responsible iplqi 17

18 7 Basic Tools: Histogram Problem: find the errors fs in physician orders

19 Fysician Orders The use of training farmhands for first-class farms in the fatherly handling of the farm livestock is foremost in the minds of farm owners. Since the forefathers of the farm owners trained the farm hands for the first-class farms in the fatherly handling of farm livestock, the farm owners feel they should carry on with the family

20 7 Basic Tools: Cause Effect Diagram Brainstorm potential causes Let s try this again...

21 The use of training Fysician Orders farmhands for first-class farms in the fatherly handling of the farm livestock is foremost in the minds of farm owners. Since the forefathers of the farm owners trained the farm hands for the first-class farms in the fatherly handling of farm livestock, the farm owners feel they should carry on with the family

22 Measures Center of the Data Mean Median Mode Spread of the Data Range Data Uses Data Over Time Data Before After Data Benchmarks Data Targets Interquartile Range Standard Deviation Shape of the Data Bell Shape Skewed Bi-modal Displays Dot Plots Individual Value Plots Box Plots Histograms Pareto Charts Time Charts Concepts Random Variation Common versus Special Causes Leading versus Lagging Measures Control Charts

23 Types of Variation 23

24 Special vs Common Cause Variation Variation Special Common Assignable Unassignable The cause Singular Plural is. Irregular Regular Unnatural Natural iplqi

25 Special vs Common Cause Variation Variation Special Common From a Non-random Random process that Unstable Stable is Out-of-control In-Control iplqi

26 Special vs Common Cause Variation Variation Special Common Results are Results are The customer unpredictable predictable feels that Service is undependable Service is dependable iplqi

27 27 Process Special Cause Variation Common Cause Variation Baking a loaf of bread Recording customer contact information Injection molding of plastic toys Source:Minitab16 Changing the oven's temperature or repeatedly opening the oven door during baking can cause the temperature to fluctuate needlessly. An untrained operator new to the job makes numerous data entry errors. Changing to a less reliable plastic supplier leads to an immediate shift in the strength and consistency of your final product. The oven's thermostat allows the temperature to drift up and down slightly. An experienced operator makes an occasional error. Slight variations in the plastic from a supplier result in minor variations in product strength from batch to batch.

28 Type of Action Special Common Special Examine single event; stop change Ineffective: will miss underlying cause Type of Variation Common Ineffective: may decrease performance Examine entire process; start change iplqi 28

29 Type of Action Special Common Special Examine single event; stop change Ineffective: will miss underlying cause Type of Variation Common Ineffective: may decrease performance Examine entire process; start change iplqi 29

30 Type of Action Special Common Special Examine single event; stop change Ineffective: will miss underlying cause Type of Variation Common Ineffective: may decrease performance Examine entire process; start change iplqi 30

31 Exercise: on an index card, sign your name 5 times 31

32 Measures Center of the Data Mean Median Mode Spread of the Data Range Data Uses Data Over Time Data Before After Data Benchmarks Data Targets Interquartile Range Standard Deviation Shape of the Data Bell Shape Skewed Bi-modal Displays Dot Plots Individual Value Plots Box Plots Histograms Pareto Charts Time Charts Concepts Random Variation Common versus Special Causes Leading versus Lagging Measures Control Charts

33 Time Charts iplqi 3

34 Time Charts: Time Series 3 Data must be in time order from oldest on the left to the most recent on the right iplqi

35 Time Charts: Time Series 3 Rules of 7: 7 points increasing / decreasing iplqi

36 Time Charts: Time Series Just because you CAN doesn t mean you SHOULD 3 iplqi

37 Time Charts: Time Series

38 Time Charts: Run Charts 3 iplqi

39 Time Charts: Run Charts Run Charts displays data Time order Displays a center line or median the middle of value of the data. Because of the center line run charts not only indicate trends, but shifts in the process Run Charts also performs 2 tests for non-random behavior special causes: Test 1: number of runs about the median a sequence of one or more consecutive points on the same side of the center line. When the data points are connected by a line, a run ends when the line crosses the median. This test indicates a shift (aka a cluster) Test 2: direction of runs up or down one or more consecutive points in the same direction. A new run begins each time there is a change in direction (either ascending or descending in the sequence data. This test indicates a trend. 3 iplqi

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41 Rules of 7: 7 points increasing / decreasing iplqi

42 Time Charts: Control Charts 4 iplqi

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50 Control Charts Special Cause Variation Process Out of Control Upper Control Limit Mean Common Cause Variation Process In Control Lower Control Limit Data plotted in time order

51 The process is stable and predictable. Process is stable and predictable but NOT acceptable. The UCL is used as a goal for process improvement. Assign a team to improve process. iplqi

52 A CASE STUDY IN USING LOS DATA TO MAKE A DECISION

53 FAMILY MEDICINE: HISTOGRAM OF LOS

54 Family Medicine: Time Series of LOS

55 Family Medicine: Boxplot of LOS Outliers: 127 patients with LOS > 8 days (6.4%)

56 Family Medicine: Histogram of LOS Removing Outliers

57 Family Medicine: Bar Chart of APR-DRG-Severity

58 Family Medicine: Top 10 APR-DRG-Severities APR-DRG- Severity Count Percent APR-DRG Neonate BirthWt > 2499g Vaginal Delivery Vaginal Delivery Heart Failure Renal Failure Other Pneumonia Chronic Obstructive Pulmonary Neonate BirthWt > 2499g Heart Failure Other Pneumonia Total

59 Family Medicine: Pareto Chart of Discharge Unit

60 Should FAM Triad Focus on 3WST? What if we only looked at those patients who were discharged from 3WST? Excludes birth cases Neonate Birth Wt > 2499g; Vaginal Delivery Nurse Leader manages 3WST Is LOS of FAM patients discharged from 3 WST different from all FAM patients? Case Manager Nurse Leader Patient Care Physician Service Leader All three CCT members are equally important in delivering a high quality experience for the patient

61 Family Medicine: Comparison

62 Key Take-a-ways There is no one data display that tells the whole story Use multiple data displays in concert to begin to uncover the story Leading (process) measures may also help tell the story Be careful before making inferences from the data Random variation Statistically valid Like-for-like comparisons 62

63 Questions? Recognition: Special thanks to Ron Erickson, president Institute for Process, Leadership and Quality Improvement (iplqi.com) for material use 63