A4/B4 Integrating a Seamless Measurement Plan:  Mini-Course - M. Rathgeber and H. Johns
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A4/B4 Integrating a Seamless Measurement Plan: Mini-Course - M. Rathgeber and H. Johns

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A4/B4 Integrating a Seamless Measurement Plan:  Mini-Course - M. Rathgeber and H. Johns A4/B4 Integrating a Seamless Measurement Plan: Mini-Course - M. Rathgeber and H. Johns Presentation Transcript

  • MEASUREMENT PLANS Quality Forum 2012Melanie Rathgeber Heidi JohnsMERGE Consulting BC Patient Safety & Quality Councilrathgeber.melanie@gmail.com hjohns@bcpsqc.bc.ca
  • Objectives2.Understand the link between measures for improvement projects and organizational measures4.Identify potential outcome, process and balancing measures for your work6.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)
  • Source: TheImprovementGuide View slide
  • What are we trying to accomplish? How will we know that a change is an improvement?What changes can we make that will result in improvement? Data is used to: Act Plan •set priorities •determine target Study Do •start benchmarking View slide
  • What are we trying to accomplish? How will we know that a change is an Measures: improvement?What changes can we make that will result in •Key Measures improvement? •Data over time •Family of measures Act Plan Study Do
  • Measures: What are we trying to accomplish? How will we know that a change is an •Key Measures improvement? •Regular data overWhat changes can we make that will result in improvement? time •Tells you how close you are getting to Act Plan reaching your Aim Study Do
  • What are we trying to accomplish? How will we know that a change is an improvement? Ideas based on dataWhat changes can we make that will result in improvement? e.g. Do you have a hunch that there is variation in Act Plan turnaround times? Does data verify this? Study Do Can you test a way to decrease variation?
  • Cascade of Measures – from front line to Senior Leaders/Boards
  • Family of Measures Outcome measures  Based on your Aim statement  What are we trying to accomplish?  What is ultimately better?  Voice of the patient/customer Process measures  What are you changing – is it really happening?  Voice of the system – what is being done differently?  Change more quickly than outcomes Balancing measures  What unintended consequences might occur?
  • Examples Outcome Process Balancing
  • Family of Measures in Action – AnImprovement Project - What were the outcome/process/balancing measures? - How were they chosen? - How was the data useful in driving improvement? - What was the data showing us?
  • Where do I start?• I have a hunch• I need to determine a target• How am I going to get the informationWhat actually do I want toaccomplish?
  • I really needed to develop my AIM• What was I going to DO• by WHEN• by HOW MUCH• Had a hunch that wait times to receive service were very long• Had listened to physicians that they were not happy with the process• How do I tell everyone what we were going to do
  • Suggestion• Don’t tell,• Don’t have the idea, let the group you gather come up with the what• Gather the group, determine who is the right group by asking,• Who is going to be affected by the change?
  • Back to the AIM• By September 2011 the completion of referrals from GP’s and NP’s to the Unit will be 80% by using the correct process and forms.• I needed to gather the data to see what the completion rate was• What was the actual wait time to be seen at the Unit
  • Sidebar conversations• “I don’t think this will be that bad, wait times are not bad”• “I complete the referrals it gets stalled at their office”• “ I am not clear on what needs to be done, so we go with what the patient tells us and what we can glean from the referral”
  • Gathering the data• Here is what I did………………….
  • Baseline Data
  • Baseline Data
  • Tracking Key Process Measure over Time Percent of referral forms fully complete100 9090 80 808070605040 35 29 32 2630 242010 0 April 11 May June July August Jan 12 Feb April* Calculations to be confirmed
  • Starting to Track Time Between Receipt of Referraland Date First Seen 45 40 35 29 30 30 25Days 18 20 15 15 15 15 10 5 0 Patient1 Patient2 Patient3 Patient4 Patient5 Patient6* Calculations to be confirmed
  • Family of Measures in Action – AnImprovement Project - What were the outcome/process/balancing measures? - How were they chosen? - How was the data useful in driving improvement? - What was the data showing us?
  • Some tips for getting started “Measurement should be used to speed things up, not to slow them down” - IHI Breakthrough Series Guide
  • Some tips for getting started 1. Seek usefulness not perfection 2. Don’t wait for the information system - IHI Breakthrough Series Guide
  • 1. Seek usefulness notperfection Key here is to understand the purpose of measures.
  • 2. Don’t wait for the information system.How “real time data” drives improvement.Examples?This can involve new ways of doing things.
  • New ways of doing things:stretch yourself to……. 3. find ways of capturing data in a computer- less world.
  • New ways of doing things:stretch yourself to……. 4. find ways to embed data collection into work- flow.
  • Taking data to your audience  Use a balanced set of measures  Display data over time
  • Essential when taking data toyour audience – data over time. pre-post test, p<.01 *hypothetical data – illustrative purposes only
  • Spreading change throughout yourorganization How does this affect measurement?
  • Why we are not good at using data:we don’t have a plan of actionWhat is the plan if data is not at target? • Does it depend on patterns in data? • Does it depend on how much you are off? • What is the “signal” to trigger an action plan? • How was your target set in the first place?
  • Why we are not good at using data:we don’t have a plan of action• How do leaders provide support for an area that isn’t meeting a target?• How is the action plan followed up? What is the accountability? Are people aware of plans and expectations• What is the plan when data does meet target?
  • Data Display Principles
  • Starting to Track Time Between Receipt of Referraland Date First Seen 45 40 35 29 30 30 25Days 18 20 15 15 15 15 10 5 0 Patient1 Patient2 Patient3 Patient4 Patient5 Patient6* Calculations to be confirmed
  • Percent of Patients w ith Appropriate VTE Prophylaxis MTU100 4 East80 Shuswap604020 0 v n ne Au y c ch ril pt b st ct ay No Ja l De Fe Ju Ap Se gu O Ju ar M M *hypothetical data – illustrative purposes only
  • “SMALL MULTIPLES” – all info onone page Large Teaching Medium Community Provincial 40 Hospitals 40 30 30 Hospitals Readmission Rate 20 20 40 10 10 0 0 30 20 40 Large Community Small Community 40 10 30 Hospitals 30 Hospitals 20 20 10 10 0 0 0 9 9 9 9 9 9 9 9 9 9 9 9 0 0 /0 /0 /0 /0 /0 /0 /0 /0 /0 0 / 0 / 0 / /1 /1 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 2 3 4 5 6 7 8 9 0 1 2 1 2 1 1 1 *hypothetical data – illustrative purposes only
  • Resources: BCPSQC Measurement Report http://www.bcpsqc.ca/pdf/MeasurementStrategies.pdf Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP (2009) The Improvement Guide (2nd ed). Provost L, Murray S (2011) The Health Care Data Guide.
  • Back to Objectives2.Understand the link between measures for improvement projects and organizational measures4.Identify potential outcome, process and balancing measures for your work6.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)