© copyright 2014 james shirley management consultants, inc. all right reserved. (10/22/14) slide 1...

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14)

Slide 1

WelcomeEffective Measurement and

Respectful Reporting to Improve Quality of Care and

Joy in Practice

Jim Shirley and Doug StewartOctober 24, 2014


Healthcare Performance Measures

1. IHI Model for Improvement (5)

- The Aim – Measure - Change model

2. General Principles of Measurement

- Focus on something you can change.

3. Types of Performance Measures

- Quality, Outcome and Process

4. Tools to Plot and Interpret Data

- QI Macros and Control Charts

Slide 2


Slide 3


Setting Aims

What are we trying to accomplish?

Establishing MeasuresHow will we know that

a change is an improvement?

Developing ChangesWhat changes can wemake that will result

in improvement?

Writing Aim Statements1. Write aims that are clear and specific.2. Start with a command such as “reduce” or “improve.3. Example: “Reduce patient waiting time by 50%.”

Establishing Measures1. Measures indicate if a change leads to improvement.2. Measures should provide information to assess if changes you make are leading to improvement.3. For example, what is the present waiting time? If we make a change, is waiting time reduced?

Developing Changes1. All improvement requires making changes.2. Not all changes result in improvement.3. We must identify changes that are most likely to result in improvement.4. You should generate several process changes.5. Then, test the changes to see if they lead to improvement.

The Model for Improvement – Institute for Healthcare Improvement

Act Plan

DoStudy

1. State cycle objective.2. Predict outcome.3. Plan to test change.4. Collect measurement data on critical processes.5. Obtain input to define problems and solutions.

1. Carry out changes.2. Document results.3. Analyze data.

1. Complete analysis.2. Compare data to predictions.3. Were goal achieved?4. Summarize what learned.5. Are changes manageable?

1. Write new std. work.2. What to change next?3. Prepare plan for next cycle.


Slide 4


- Improvement Worksheet

Improvement Project Name: __Reduce waiting time to see a urologist__ Date: __10/21/14_______

Improvement Team Members: __Jim Shirley and Doug Stewart______________________________

1. Reduce waiting time to see a urologist by 50 percent within 9 months 2. Reduce waiting time to see a physician in the office to less than 15 minutes within 4 months.

Setting Aims What are we trying

to accomplish?

Establishing Measures How will we know that a

change is an improvement?

Developing Changes What changes can we make that will result

in improvement ?

1. Waiting Time (Urologist): (1) Analyze data to determine present waiting time. (2) Track request date and time to date and time to urologist appointment. 2. Waiting Time (Physician): (1) Analyze data to determine present waiting time. (2) Create measures: Check-In to Call Back time; MA completed work to Physician in Exam Room.

1. Describe change number one. 2. Describe change number two....then the next ... and next...


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2. General Principles of Measurement (3)

a. Measurement can be thought of

as a window through which we

view a process...

b. Each measure gives us a different

perspective for our view:

(1) Process times at check-in

(2) Wait time until pt. is called back

(3) Provider exam time


Slide 6

2. General Principles of Measurement (3) (continued)

c. Measures should focus on something

you can change:

(1) Process time for one step in process

(2) Delay time between process steps

(3) Percentage complete and accurate

information from previous step


Slide 7

Measures for Patient Flow in a Clinic (6)

Current State - Value Stream Map for Clinic Patient Flow

James Shirley Management Consultants, Inc. (10/12/14)A Ci Implementation and Training/VSMs/HC Clinic

No diagnosis code written; no office visit circled; had to call to back to get both.

Some procedures and lab testslengthen pt. time.

Fee sheetnot ready.

Exam rooms full as provideris delayed withother work.

Check In

InBacklog or

queue

Work flow

MA Initial Exam

EMR EMR

ProviderExam

EMR

MAFinal Visit

EMR EMR

CheckOut

InInIn

P/T = Process Time

P/T 4 - 15 min 6 - 30 min 3 – 17 min 5-10 min

D/T

%CA

D/T = Delay Time

%CA = % Complete and Accurate (Percent that all inputs to this process box are complete and accurate from previous process box.)

0 - 5 min

90% 95%90% 95

2-13 min 12 - 60 min 0-3 min

P/T = Process Time

D/T = Delay Time

3 - 14 min

3-5 min

95

Value Stream Summary

Process Time = 21 – 86 min

Delay Time = 17 – 81 min

Lead Time = 38 – 167 min

% C&A = 69%

SupplierPatient

Some pts. do not provideaccurate information at Check-In.

Input: Name, DOB,SSN, allergies,chief complaint

Manual Information flow

CustomerPatient

Output:TreatmentPlan and

Fee Sheet

Manual Information flow


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3. Types of Performance Measures (3)

Measures can be categorized in several

ways, including:

a. Domains of Quality

b. Outcome and Process Measures

Each can be helpful in improvement

work ....


Slide 9

a. Domains of Quality (3)

1. Safety (Pt. falls, medication errors, ...)

2. Clinical excellence or effectiveness (Did the new process achieve its goal?)

3. Utilization (Reducing length of stay)

4. Timeliness (Reducing lab turnaround time)

5. Accessibility (Reducing pt. wait time for an

appointment)

6. Patient Satisfaction (Patients likely to

recommend hospital or clinic?)


Slide 10

● Outcome measures (pt. infection rate)

- Can be difficult with a negative outcome

and procedures used were “correct.”

● Process measures (length of intubation)

- Process measures can give early

indication of outcomes.

- Example: Increasing immunization to

reduce community-acquired infections

b. Outcome and Process Measures (3)


Slide 11

4. Tools to Plot and Interpret Data (1)

a. QI Macros – Powerful software to add

to Excel to create charts/analyze data

It creates:

- Run Charts - Control Charts

- Histograms - Pareto Charts

And, it has templates (flowcharts and

fishbone charts), does statistical

analysis and can transform data.

- Cost is $229 for this powerful tool!!


Slide 12


Slide 13

b. Control Chart – Basic Elements (3)

Center line is the “mean” statistic

(arithmetic average).

Control limits help identify special

causes when limits are exceeded.

Control charts examine data in a

time-series ... that is ... over time.


Slide 14

Basic Elements of a Control Chart


Slide 15

Control Charts(2) – Help Differentiate:

Common Cause Variation...

(random variation)

Special Cause Variation....

(variation caused by a specific factor)

1. Detect quickly

2. Diagnose problems

3. Eliminate problems


Slide 16

f. Detecting Special Causes (1)

QI Macros will highlight in RED special

cause variation which is not random

variation

These special causes can be examined

to identify improvement opportunities.


Slide 17


√ Healthcare Performance Measures

Slide 18

√ 1. IHI Model for Improvement - The Aim – Measure - Change model

√ 2. General Principles of Measurement

- Focus on something you can change.

√ 3. Types of Performance Measures

- Quality, Outcome and Process

√ 4. Tools to Plot and Interpret Data

- QI Macros and Control Charts

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/20/14) Slide 19

Effective Measurement and Respectful Reporting to Improve Quality of Care and Joy of Practice

Endnote References 1. Arthur, Jay, Breakthrough Improvement with QI Macros and Excel: Finding the Low- Hanging Fruit, McGraw Hill, New York, 2014 2. Balestracci, Jr., MS, Davis, data SANITY: a Quantum Leap to Unprecedented Results, MGMA, 2009 3. Carey, PhD, Raymond G., Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies, ASQ Quality Press, Milwaukee, Wisconsin, 2003 4. Hoerl, Roger W. and Snee, Ronald D., Statistical Thinking: Improving Business Performance, Duxbury Thompson Learning, 2002 5. Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138 6. Worth, Judy, Shuker, Tom and others, Perfecting Patient Journeys – Improving Patient Safety, Quality and Satisfaction While Building Problem-Solving Skills. Lean Enterprise Institute, Cambridge, MA, Version 1.0, December 2012 7. Langley, Moen, Nolan, Nolan, Norman and Provost, The Improvement Guide, A Practical Approach to Enhancing Organizational Performance, Second Addition, Jossey-Bass, A Wiley Imprint, 2009, Lean Improvement, pages 463-464.

© copyright 2014 james shirley management consultants, inc. all right reserved. (10/22/14) slide 1...

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