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

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

Shewart and Deming

Systems thinking- process driven

Variation exists

Starts with a concept of improvement

Testing and learning cycles

Data and feedback driven

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.

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

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%

• 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)

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

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

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

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%

Achieving Excellence in Performance

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

Performance- Infection Prevention & Control

Performance Excellence Nov 2014

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

Engage staff and physicians with knowledge and data

Data relevance + frequency + visual display Simple Actions and Improvement resources Manage to learn- PDCA Celebrate success!!!

morehousep@cbdha.nshealth.ca