Building a Quality Report Card Angie Charlet ICAHN acharlet@icahn.org
Objectives Learn to define what a measurable quality metric entails Discover how to create meaningful dashboards that drives change Learn how to use Excel as your data collection friend How to do an internal review of current measures and opportunities to improve
Tools Provided These slides in pdf Blank Quality Playbook RHC Performance Improvement Template CCM Completion Chart Eight Forms of Waste Guide to Quality..Shhhhhh
Why Are We Talking About Report Cards? National Standards Benchmarking MIPS/MACRA Most of all.consumers are Watching!
Quick Review
Driving Quality Metrics that Produce Results Think STEEEP IOM Six Domains of Health Care Quality
Safe Avoiding harm to patients from the care that is intended to help them
Timely Reducing waits and sometimes harmful delays for both those who receive and those who give care
Effective Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse)
Efficient Avoiding waste, including waste of equipment, supplies, ideas, and energy
Equitable Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Patient-centered Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuing that patient values guide all clinical decisions.
Three Types of Measures Structure Process Outcome
Structure Measure Evaluate the infrastructure of health care setting and ability to deliver care (clinics, organization and resources) Staffing Staff skill and capabilities Policy & Procedures Availability of resources
Process Measure Used to determine the extent to which providers consistently give patients specific services that are evidence-based Think: did the patient receive the recommended care or not? Focused on areas of prevention and chronic disease management
Outcome Measures Evaluate patients health as a result of the care they have received. Looks at effects the care has had on their health, health status, and function. Can be more challenging to gather the data and hard to hold patients accountable to the recommended treatment
Ongoing Climb: Always be asking, How can we do things better? Safe Timely Effective Efficient Equitable Patient-Centered Included a review for: Structure Process Outcome
Very Brief Intro to Lean
Single-Piece Flow Lean Toolbox
The Three Principles of Lean 20 1. Engage the people who work in the process to improve the process 2. Focus on creating value from the customer s perspective 3. Bring measurable and sustained improvement
Lean Principle #1: Process 21 A bad process will beat a good person every time - W. Edwards Deming
Lean Principle #2: Customer Customers judge value on: Speed How quickly do I receive it once I request it Accuracy The information is correct and responded to my request Understandable The information is easy to read and understand Convenience It is convenient for me to get it, I can get it when I want it (and not when you are willing to give it to me)
Lean Principle #3: Sustainment 23 If you don't know where you are going, you will wind up somewhere else. - Yogi Berra
Eight Areas of Waste in Healthcare As you learn to see your processes in new ways, you develop what are called eyes for waste so you can identify the waste and then eliminate them in a systematic method.
8 Types of Wastes -- DOWNTIME
How Does Waste Affect Me? Causes physical fatigue Causes emotional fatigue Increases frustrations Increases stress Causes you to blame others Steals your time
Enough About Definitions What makes a good quality metric A good measure drives change
Making a Measure Work for You Is it meaningful? Does it make sense? Is it measurable? Do you have staff buy-in? What is the area of impact? Process? Outcome?
Where to Start? Problematic Area(s) Community needs Primary population Primary disease(s) Staff engagement Meaningful Baseline data
From Managers/Staff No time Not meaningful Cannot fix it Staff won t collect Late data No analysis No plan of action Staff cannot speak to the improvement
If someone came in and asked you what you do or have done for quality improvement.could you answer them?
First Impressions Ease of appointment scheduling? Same day appointments Same day nurse phone calls Wait times in waiting rooms/exam rooms First time patient experience
Rooming Complete questions Fall screening? Depression screening? Prevention screenings? Chart inclusive and ready for provider? Full medication reconciliation review? Any labs that should be on the chart? Referral/consult reports?
Physician Support Involve providers in the process of defining and selecting quality metrics Selecting metrics on the basis of medical evidence that proves a positive correlation with quality outcomes Holding providers accountable for quality measures that are reasonably within their control Streamlining the collection of data so as not to detract from the quality of the patient experience
Data Collection Tool Making Excel a Friend
Graph Selection
Types of Graphs Area Column Bar Line Pie
Common Elements of Graphs Colors Depth Axes Labels Title Legend
Benefits and Pitfalls Benefits Visually communicate results Analyze information from multiple periods, entities, sequences, etc. Patterns Pitfalls Data overload No conclusion Spreadsheets
Deceptive Graphs Emphasize or de-emphasize changes by affecting the axis Use different scales or starting points Use percentages to show growth Avoid trend lines Avoid displaying actual values Delivery
Deceptive view
IDEA PDCA Tool IDEA Improvement Opportunity Data Collection Methodology Explain Findings Action Steps PDCA/PDSA Plan Do Check/Sustain Act
Presenting the Data: In Dept.
Second half
Let s Break it Down
Where does the data go?
Data Points
The Reporting
Summary Director s Annual Performance Summary: Describe the PI indicator you were monitoring, a summary analysis of how well you performed in meeting your goals, activities you implemented to make improvements, follow up activities you will continue to implement and the PI indicators you will be working on next year.
PERFORMANCE IMPROVEMENT Dashboard Reporting
Simple Visual Relevant
Benefits of Dashboards Organize Summarize Focus Present Quick Easy to understand Interactive
Keep it Simple
Reporting to Board/Committees: The Dashboard
Metrics and Data Build Your Dashboard
Board Report Example
Our Data Collection Tool Summary Dashboard
Another Tool For You
Employee Engagement Don t forget to share your data!
Questions