South Carolina Association for Healthcare Quality

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South Carolina Association for Healthcare Quality

• Using Data to Drive Organizational Improvement
• July 11, 2008

Bryan Bowles, Client Executive Premier Healthcare
Informatics
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Dimensions of Performance Improvement
We have identified best practices across nine
dimensions of performance improvement found in
top performing organizations.

• Staff
• Information
• Process
• Incentives
• Accountability

• Culture
• Organization
• Leadership
• Strategy

The use of data is seen throughout each dimension
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Peer-Based Dimensional Rating
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CultureValues environment for achieving
excellence team approach

• Best Practice
• Performance Improvement (PI) permeates all
  aspects of the organization operations, a part of
  daily activity
• Readily accepting of change
• Data driven mindset
• Organization participatory/team oriented
• Physicians actively engaged in change process
• Alignment in physician and hospital incentives
• Open and objective evaluation of problems leads
  to improvements that are widely felt
• Activities are performed in a collaborative and
  multidisciplinary manner
• Proactively improving patient safety

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OrganizationInfrastructure to support
information flow, decision making, and problem
resolution role of the Board and leadership
team vision for quality

• Best Practice
• Board receives comprehensive reports and is
  actively engaged in discussions about care
  delivery and quality
• Executive team devotes a substantial share of
  time to evaluating and improving care delivery
• Single organization body for driving PI
• Clinician executive responsible for oversight of
  care delivery CMO reports to the CEO and the
  Board
• Programs integral to management of care are
  centralized and aligned under physician leader
• Staff and resources that support measurement and
  management of quality and efficiency are aligned
  under single leadership
• Patient Safety integrated into PI

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Administrative LeadershipThe characteristics of
leadership team setting vision, commitment to
quality alignment across organization

• Best Practice
• Board plays an active role in PI and Care
  Management initiatives
• Leaders set clear consistent vision for quality
• Creates strategies, systems and methods and
  provides resources for achieving excellence in
  patient care
• Holds individuals/groups accountable for results
• Measurable clinical quality targets defined,
  included in strategic plan and linked with
  operational goals and incentives
• Leaders set future direction, align staff and
  establish a collaborative environment for care
  delivery management
• Leaders show patient safety is a top priority

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Physician LeadershipThe characteristics of
leadership team setting vision, commitment to
quality alignment across organization

• Best Practice
• Physician leaders aligned with Admin Leaders
  Medical Staff
• Effective communication, conflict resolution,
  negotiation, and fiscal planning
• Respected by other physicians engages other
  physicians in Care Management initiatives
• Formal physician leadership training
• Good pool of physicians for leadership
• Physician champions participate in PI/Care
  Management
• Data widely viewed as important to improving
  practice
• Initiates interventions tied to Care Management
  strategies

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StrategyCompetitive plan approach to market
priorities internal and external communications

• Best Practice
• Market positioning moves from financial to
  clinical outcomes and perception of quality sets
  the foundation for future market growth
• Strategic planning/priority setting is integrated
  effort
• Operational priorities emphasize quality and
  efficiency as key elements of organizational
  growth
• Goals and priorities are based on clinical and
  financial metrics (measurable financial and
  quality targets)
• Clinicians are involved in strategic planning
• Strong consensus around priorities and goals
• Strategic plan is communicated throughout the
  organization

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StaffOpportunities for growth staff training
and competence consistent policies and procedures

• Best Practice
• Expertise in all areas defined in scope of
  services
• Roles, responsibilities and accountabilities are
  defined and support scope of services
• Sufficient resources are allocated to care
  delivery oversight to support measurement,
  analysis, and care management
• Understands and drives Care Management and PI
  strategies and initiatives
• Data analysts are proficient in statistical
  analysis and presentation of data
• Experienced data analysts throughout organization

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Information Quality, accessibility, and
communication of data/information

• Best Practice
• Information systems in place to collect essential
  information, and to support reporting to
  stakeholders and application at point of care
• Comprehensive, risk-adjusted clinical and
  financial data available and routinely used in
  evaluating and improving performance
• Reports include statistical data for clinical
  processes and outcomes
• Data driven culture where clinical and quality
  information is used to prevent problems
• High level of confidence in the accuracy and
  completeness of clinical and financial data
• Information is systematically communicated
  throughout the organization

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ProcessTools and methods for developing
policies, procedures, protocols PI model
process for monitoring and communicating
performance analysis and actions taken to
improve processes and performance

• Best Practice
• PI model delineated and staff trained on quality
  tools and techniques
• Systematic processes for establishing and
  communicating goals, evaluating baseline
  performance, identifying improvement
  opportunities, implementing interventions,
  evaluating effectiveness
• Interventions consistently integrated into core
  processes
• Coordinated process for identifying and achieving
  best practice at the point of care, reducing
  variation, patient population based vs.
  individual case review
• Physicians provided feedback on practice patterns
• Extensive Policies/Procedures for all aspects of
  PI

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Outline the structure for priorities
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IncentivesMethods to motivate and drive
individuals/groups to achieve goals

• Best Practice
• Departments, physicians and staff incentives are
  based on overall system performance
• Use of a link/nested balanced score card at
  departmental and management levels with weighted
  priority given to satisfaction, quality,
  financial and staff development
• Alignment of physician and hospital incentives
  around organizational goals
• Financial recognition in place for staff and
  physicians who act to improve success of system

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AccountabilityHow results are achieved and
mission/vision fulfilled

• Best Practice
• Clear accountability established for achieving
  clinical and financial improvement targets
• Board reporting of progress on clinical
  improvement
• Initiatives supported by organizational
  structures with evaluation and feedback loops
  established
• PI activities consistently achieve improvement
  goals
• Clinical performance and cost reductions
  associated with decreasing variation in practice
  are factored into fiscal budgeting process
• Operational accountability centralized for all
  departments supporting care management
  (quality/outcomes management care
  management/utilization management clinical
  decision support, infection control, safety)
• Achieves best practice changes across physician
  departments

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Pathway to Performance Excellence
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Clinical Case Study Model

• Identify areas of focus to improve patient care
• Risk-adjusted and benchmark data can be used to
  accelerate clinical performance improvements by
  identifying
• Patient populations with worse than expected
  outcomes (opportunity analysis)
• The core clinical processes driving outcome
  deviations
• Improve Clinical Hypothesis Testing and Data
  Mining skills of Clinical and Data Analysts.
• Introduce new data and methods to the physician,
  clinical, and administrative leaders in the
  hospital.

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Characteristics of a SuccessfulCase Study Team

• Administrative sponsor to charter the team and
  remove barriers
• Clinical champion to drive the process and engage
  clinicians
• Analyst team (primary user who understands the
  clinical topic, key user to provide detailed data
  drills)
• Multidisciplinary clinical and operational team
  to evaluate data, generate hypotheses, plan
  improvement actions
• Dedicated time for team work within a defined
  period (e.g., 3-6 months)
• Celebrate successes and measure value

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The Role of the Analyst Team

• Prepare the opportunity analysis and work with
  clinical leaders to determine case study topic
• Refine the analysis population definition with
  the clinical leaders
• Provide preliminary data analysis for case study
  topic
• Discuss findings with clinicians to help refine
  the preliminary analysis
• Present preliminary analysis to clinical team
• Provide additional analysis as needed to support
  the clinical team

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The Role of the Clinical Team

• Review preliminary data, provide clinical insight
  and generate hypotheses to drive further data
  analysis
• Provide guidance to analysts during data
  generation sessions, if needed
• Review focused data and generate more clinical
  insight
• Review findings and recommendations and develop
  an action plan for improvement strategies patient
  care
• Implement the action plan

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Measuring Value

• As improvement needs are identified through the
  case study activities, quantify the potential
  savings (i.e., lives, days, )
• Follow-up as improvement actions are taken to
  quantify actual savings and value
• Critical to communicate success to the
  organization
• Create a value impact report to illustrate gains

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Questions to ask

• Are our activities aligned with the organizations
  goals?
• Do we have the right information to gain
  credibility?
• Do we have the right resources for project work?
• Do we have a defined process to run PI projects?
• How do we measure and communicate progress?
• Do we set defined timelines and milestones for
  projects?
• Are we spending time on non value added
  activities?

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Thank You!

• Questions?
• Contact Information
• Bryan Bowles
• Premier Healthcare Informatics
• bryan_bowles_at_premierinc.com
• 704.733.5233