Deciphering Institutional Goal-Setting and Benchmarking to the Bedside: Dashboards, Clinical Service Groups and Goal Sh

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´╗┐Deciphering Institutional Goal-Setting and Benchmarking to the Bedside: Dashboards, Clinical Service Groups and Goal Sheets The Quality Colloquium on the Campus of Harvard University August, 2006

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Overview Prioritizing Organizational Goals Developing a Quality Structure to Achieve Organizational Goals Translating Organizational Goals vigorously: Utilizing Dashboards to Drive Change Integrating Performance Improvement into Daily Activities: Daily Goal Sheets

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Prioritizing Organizational Goals Patient Safety Congruent with the mission, vision, values, and vital arrangement of the establishment High-volume analyze, techniques, forms High-cost analyze, strategies, forms Problem-inclined methods, forms Input from outside sources (authorizing, administrative offices)

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Barriers To Effective Integration Hospital Diversity of patient populaces Diversity of social insurance populaces Crisis administration/Day-to-day objectives Fiscal imperatives Physician culture Academic Medical Center Lack of arrangement between School of Medicine and Hospital Clinical administration boss are scholarly division heads Hospital doctors are principally personnel

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Integration of Performance Improvement GOALS Public Reporting Data/JCAHO & CMS: Heart, Medicine, Emergency Medicine, Obstetrics, Pediatrics Internal Reporting/Hospital Dashboards for Clinical Service Groups and different Services/Departments Performance Improvement Activities & Measurements Patient Safety IHI's 100,000 Lives Saved Campaign Surviving Sepsis Campaign Heart/Cancer Services Perinatal Services Patient Satisfaction Required Measures CARE exertion PRIORITIZATION Performance Improvement Priorities Performance Standards Enhance Quality Program Implement Electronic Patient Record Implement Strategic Plan Improve Satisfaction Meet Financial Targets STRATEGY Strategic Initiatives FOUNDATION Mission, Vision, Values

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Malcolm Baldrige National Quality Award: A System Perspective

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Developing a Quality Structure to Achieve Organizational Goals What didn't work : Hospital-Within-Hospital (HWH) Structure Led by authoritative set of three (Physician, Nurse, Operations Administrator) Quality structure bolstered HWH Quality Councils drove by managerial set of three HWH Quality Councils administered by Executive Quality Council Why it didn't work: Those nearest to operational procedures not included in execution change endeavors and estimation insufficient specificity regarding marker advancement and estimation to distinguish important open doors for development Disparate databases not helpful for getting promptly accessible information for execution change (Solution: Create Decision Support Services Dept) Attempting to gauge "the universe" for every single patient populace as opposed to utilizing Pareto rule (80/20 run)

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Modalities to Overcome Barriers Structure Measurement Expression of Measurement Dissemination Consistency Feedback Response

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Developing a Quality Structure to Achieve Organizational Goals Executive Leadership Changes Led to Structural Changes Administrative Table of Organization Quality Management Structure Formation of Quality Committee of the Governing Body Formation of Quality Coordinating Group Reviews hierarchical information Identifies open doors for development Delegates duty to fitting quality board of trustees for development and change Formation of Clinical Service Groups Development of Institutional and Clinical Service Group Dashboards Evolution to distinguish pertinent pointers for key procedures through administration bunches

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Measurement: Expectations for Clinical Service Groups Ownership Derivation Iteration Feedback Response

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Clinical Service Groups (CSGs) Interdisciplinary administration aggregate comprising of doctors, attendants, chairmen, auxiliary, bolster staff, clinical teachers and extra human services experts, as fundamental Focused on quality, operations, administration, use, and money related change Performance components mirror the above territories for development

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Expression of Measurement: Dashboards Elements got from Clinical Service Groups/Regulatory prerequisites Clarity/Focus (green, yellow, red) Explicit drifting Benchmarks Data word reference Numerator definitions Denominator definitions Target sources

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Expression and Dissemination of Measurement Through Quality Dashboards JCAHO/ORYX Core Measures CMS Public Reporting Project Service Group Specific Indicators Other Indicators and Opportunities for Improvement Prioritized Using the Following Criteria Quality center Patient Safety Meets mission and vital objectives of the healing facility High-hazard Problem-Prone High Volume High-cost Intranet Access/Direct E-mail

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Expression of Measurement Through Quality Dashboards JCAHO/ORYX Core Measures Sets Acute Myocardial Infarction Pregnancy and Related Conditions Community Acquired Pneumonia CMS Public Reporting Project: Acute Myocardial Infarction Community Acquired Pneumonia Congestive Heart Failure Future Emphasis Patient Satisfaction Surgical Care Improvement Linkage to Pay for Performance (Pay for Quality)

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Translating Organizational Goals Into Action: Utilizing Dashboards to Drive Change What works: Involving those nearest to procedures that are being enhanced Multiple controls required in key marker improvement Access to various databases utilizing one source (Decision Support Services) Collecting "significant" information Demonstrating worth to enhance authoritative execution and pick up purchase in Recognize and commend victories

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Translating Organizational Goals Into Action: Utilizing Consistent Dashboards to Drive Change Roadmap to Developing Dashboards Utilized "Esteem Compass" Approach Clinical Outcomes Functional Outcomes Patient/Employee/Customer Satisfaction Administrative/Financial Outcomes Aligned key objectives with quality objectives Identified key measurements connected with vital quality objectives utilizing prioritization instrument through administration gather structure Top-down and base up approach for recognizing key measurements by administration Utilized benchmarking and confirmation based writing to recognize scratch measurements and targets

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Translating Organizational Goals Into Action: Utilizing Consistent Dashboards to Drive Change How would we populate dashboards? Information gathered: Manually Electronically Hybrid Data submitted to Quality Management Department or Decision Support Services Department as information vault Key people in charge of dashboard populace How is dashboard data shared? Clinical Service Group contacts (Quality Management delegates) convey upgraded dashboards to Clinical Service Group gatherings Participants at Clinical Service Group gatherings share and disperse dashboards at Joint Practice gatherings, staff gatherings, group gatherings and other applicable discussions Distributed electronically to clinical seats, official staff and "C" Suite Data are posted on execution change sheets on the units Shared at Quality Committee of the Governing Body gatherings and in addition with the Governing Body itself.

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Decision Support Services: "One Stop Shop" for Consistent Data and Analysis Access to all significant databases University Healthsystem Consortium (UHC) Healthshare 2 Solucient Press Ganey Patient Complaints Patient Safety Net Service-Specific - Surgery: National Surgical Quality Improvement Program - Trauma Registry Cardiology Databases Future State Data stockroom with appropriated get to

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Decision Support Services Assists to Support Quality-Driven Initiatives Performance Standards/Dashboard components Clinical Resource Management Identifying regions for potential change Focused "penetrate downs" for follow-up investigations Critical Care SICU, PICU, MICU: IHI Collaborative venture MICU: Data accumulation/examinations; information chief Physician Feedback Reports (for quality audit and recredentialing) Ad-hoc examinations for Clinical Service Groups, CQI Teams, Hospital Initiatives

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Data/Information Feedback and Communication Governing Body Quality Committee of the Governing Body Nursing Forums Physician Forums Administrative Forums Clinical Service Groups through Dashboards CQI Teams

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Consistency Measurement expression (dashboards) Overlap of estimations on independent dashboards when execution is shared Dashboard components steady after some time Data lexicon is unequivocal Ownership

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Clinical Service Group Dashboards Heart Emergency Medicine Obstetrics Pediatrics Medicine Trauma Neurosurgery Orthopedics Transplant & Urology Cancer Psychiatry Operating Room Surgery GI Medicine/Surgery ICU Departmental Dashboards Laboratories Radiology Physical Therapy/Occupational Therapy Support Services Non-Clinical Dashboards Admitting Patient Accounts Time & Attendance Cost & spending Purchasing Labor Relations Human Resources Facilities Information Technology Miscellaneous Medical Quality Assurance Nutrition Committee Pharmacy & Therapeutics Committee Surgical Review Committee Medical Record Committee Infection Control Committee Patient Satisfaction Dashboard Development

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Response: Modalities of Change Management Consensus building Dashboard expression CQI endeavors Benchmarking/synergistic undertakings Regulatory activities

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Response: CQI Activities Facilitation Clinical Service Groups Dashboard advancement/upkeep Coordinate execution change exercises CQI Teams IHI Collaborative: Reducing Complications in the SICU, PICU, MICU, and NICU Code H Team Rapid Response Team Mislabeled/Unlabeled Specimens Team Deep Vein Thrombosis Prophylaxis Team ED Patient Satisfaction Steering Committee UHC Surgical Services Initiative Sup