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

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

20

Lean Principle #1: Process

“A bad process

will beat

a good person

every time”

- W. Edwards Deming

21

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

“If you don't know where you are going, you will

wind up somewhere else.”

- Yogi Berra

23

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

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