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Supercharging Change at the Front Lines of Healthcare
Phillip Morehouse, Director Performance Excellence
Cape Breton District Health Authority
CIHI 2014 Heath Data Users Day Halifax, NS
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Knowledge • Understood • Accepted • Triable • Fits the process
Data • Relate to the problem • Relevant frequencey • User friendly & visual • Who should get the data?
Action • Usually requires facilitation • Influenced by barriers to change • Learning/testing cycles
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Shewart and Deming
Systems thinking- process driven
Variation exists
Starts with a concept of improvement
Testing and learning cycles
Data and feedback driven
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Design DesignDesign Design Approve
Implement
Conference Room
Real World
Design
Conference Room
Real World
Approve(If Necessary)
Implement
Test and Modify
Test and Modify
Test and Modify
REF: HI Innovative Series- Seven Leadership Leverage Points for Organization- Level Improvement in Health Care- Second Edition.
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Initiated March 2010
MAC/CEO involvement
One test per month alternating between Lab & DI- March 2010
Behavioural Factors ◦ Pre-disposing factors: Distribution and review of test ordering guidelines “Do You Need That Scan” (Canadian Association of Radiologists)
◦ Re-enforcing factors: Identify the top 50% of physicians + peer comparison Cost of testing
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Laboratory Diagnostic Imaging
ESR PSA CEA Folate Vitamin D 25-hydroxy Vitamin D 1, 25-dihydroxy Urine C&S (No change) Lipid Profile Throat Culture Rapid Throat Screen (No change) ANA Testosterone BUN TSH & Free T4 Liver- ALT
Lumbar Spine X-Ray Chest X-Ray Portable Chest X-Ray Abdominal Ultrasound (No change) Pelvic Ultrasound CT Head Thyroid Ultrasound CT Lumbar Spine CT Chest Barium Swallow Barium Enema OBS Ultrasound-Early Rib X-Ray
0-5% No Change
5-10%
10-20%
> 20%
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• Reduced direct costs • Reduced follow up
testing/consultation • Increased capacity • Reduced wait times • Reduced radiation
exposure
Test/Exam Analysis Time= <15 hours
Since March 2010- $1,197,374
# of Tests
Test/Exam Variance
% Variance
Annualized Value
Lab Tests
17 (57,612) 16.7% $151,125
DI Exams
13 (14,280) 9.5% $215,013
Total
30 (71,892) 14.4% $366,138
Utilization Project Analysis (March 2010 – April 2013)
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10 family practices participated, MOU’s signed Over 1100 patients with Type 2 Diabetes, over the age of 18 and not
living in a nursing home Monthly data submissions and feedback reports Facilitated quarterly workshops designed by participants
Incentives: ◦ Office support; Mainpro C & M1 credits, financial compensation for data
collection and participation.
Quality Collaborative: Diabetes
•PDCA •EMR-chronic disease •Motivational interviewing
•Foot exams •Retinopathy screening process •Nutrition
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0.010.020.030.040.050.060.070.080.090.0
100.0
Perc
ent o
f T2D
M p
opul
atio
n Comparison of baseline to final clinical and process measures
for the CBDHA Quality Collaborative
Baseline, N=1119 Final, N=1065
Sept 2012
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2011 ◦ 91 C-difficile cases ◦ 15 deaths
2012 ◦ NS Auditor General/Public Health Agency of Canada/ Infection Prevention & Control NS
2013 ◦ Hand Hygiene Program & Database ◦ Pilot on 2 Medical Units Hand Hygiene auditing at the unit level Front line empowerment- individual pins and trophies
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Pre-Intervention Post-Intervention % Difference
Unit 1 86.25% 93.00% 6.75%
Unit 2 86.50% 90.75% 4.25%
DHA 82.50% 82.25% -0.25%
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Achieving Excellence in Performance
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Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Avg.
2012/13 nd nd 44 45 55 37 58 72 68 48 71 71 57
2013/14 65 42 41 51 58 53 61 59 55 65 52 68 56 2014/15 50 63 69 77 54 78 69 66
DHA 8/MAC/Infection Control - Hand Hygiene Compliance Physicians Only - District Monthly (Fiscal)[Percentage]
Key Performance Indicator System
Attachment: Hand Hygiene Fact Sheet June 2014.pdf
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Performance- Infection Prevention & Control
Performance Excellence Nov 2014
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Key Performance Indicator System ◦ Financials
Required Organizational Practices (ROPs) ◦ One day audit ◦ Unit level data
Global Trigger Tool ◦ Adverse event identification
Hand Hygiene Rates ◦ Facility entrances ◦ Pushing the data ◦ Volunteers
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Engage staff and physicians with knowledge and data
Data relevance + frequency + visual display Simple Actions and Improvement resources Manage to learn- PDCA Celebrate success!!!