Hm 418 harris ch12 ppt

1. Chapter Twelve
Developing Metrics
That Support Project
Plans, Interventions,
and Programs

2. Introduction
• Institute on Healthcare Improvement’s
Strategy and Model
– Framework to discipline improvement work and
foster replication of initiatives directed toward
patient safety and quality improvement
– Identify problems or opportunities for
improvement
– Select appropriate measures of these areas

3. Introduction—cont’d
• Institute on Healthcare Improvement’s
Strategy and Model—cont’d
– Obtain a baseline assessment of current practices
– Remeasure to assess the effects of improvement
efforts on measured performance as foundational
managing projects within health delivery

4. Introduction—cont’d
• IHI Triple Aim
– Developing new initiatives to communicate three
sides of the same story required to build lasting
and meaningful change:
• Patient experience of care (including quality and
satisfaction)
• Health of populations
• Cost of health care

5. Organizational Culture and
Project Management
• Barriers to successful implementation of
projects or their replication:
– Lack of leader champions
– Insufficient human and fiscal resources
– Unrealistic expectations regarding time necessary
for design and achieving desired outcomes

6. Organizational Culture and
Project Management—cont’d
• Link to organizational readiness and
assessment of this readiness including:
– Data availability
– Administrative support
– Outcome analysts support
• Provide organizational information with which
to determine how poised a team is to accept
change

7. Use of Evidence-Based Practice:
An Intertwined Element
• Levels of Evidence
– Often depicted as a pyramid
– Evidence at lowest and widest point of pyramid
includes animal research
– Higher levels of pyramid: case studies or reports,
case-control studies, cohort studies, randomized
controlled trials, systematic reviews, and meta-
analysis

8. The Cost/Quality Dance
• Outdated and detrimental to ignore costs
• Positive impact on financial landscape:
distinguishes between continuing and
eliminated work
• Key: consultation with financial analysts and
individuals with a systems lens

9. Cost Avoidance, Cost-Effectiveness,
and Cost Benefit
• Cost avoidance: costs in the future that will not
be incurred because of a change in practice or
process
• Cost-effectiveness analysis: highlights areas
where resources could be used differently to
achieve a desired effect
• Cost-benefit analysis: assigns dollar valued on
both the cost and the effectiveness of an
intervention recognizing individual and societal
benefits that often influence policy and decision-
makers

10. Selecting the Right Variables to Tell
Your Story
• Agency for Healthcare Research and Quality
defines three story genres, each with its own
matching style and measurement purpose:
– Quality improvement
– Accountability
– Research

11. Selecting the Right Variables to Tell
Your Story
• Quality Improvement
– Health outcomes
– Patient safety
– Care coordination
– Adherence to clinical guidelines
• Accountability
– Support needs of audiences other than those who
directly provide care

12. Selecting the Right Variables to Tell
Your Story—cont’d
• Research
– Generate new knowledge that is generalizable
• Setting health policy
• Evaluating programs
• Assessing effectiveness of a clinical practice or
guideline

13. Fundamental Types of Measures
• Process Measures
– Activities carried out by health care workers to
deliver services
– Specific and observable aspects of clinical practice
– Generally not adjusted based on case mix or risk
level
– Upstream measurement: measurement is taken as
the action is being completed

14. Fundamental Types of Measures
—cont’d
• Process Measures—cont’d
– Downstream measurements: information on
processes that have already been completed
• Does not clearly indicate how process was completed
• Introduces recall bias by relying on staff to record
information after task has been completed

15. Fundamental Types of Measures
—cont’d
• Outcomes Measures
– Need inclusion of both measures of process and
measures of outcomes to tell complete story of
any project or program
– Cornerstone of quality improvement
– Capture a variety of health states

16. Fundamental Types of Measures
—cont’d
• Qualitative Measures
– Commonly used based on its specificity and ease
of data gathering and analysis
– Convey deeper meaning regarding the quality, or
how well, a given process was fulfilled
– Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS): national,
standardized, publicly reported survey results of
patient perceptions of care received during a
hospitalization

17. Selecting the Right Data
• Matching populations
– Measure sets focused on patient or individual
– Use same time frame and same target population
across the entire set
– Progress made in establishing evidence-based,
validated, credible data definitions that promote
comparability within a single facility or with other
organizations

18. Selecting the Right Data—cont’d
• Common Data Sources
– CMS
– National Database of Nursing Quality Indicators
(NDNQI)
– AHRQ National Quality Measures Clearinghouse
– HEDIS
– Organizational administrative and claims data

19. Selecting the Right Data—cont’d
• Benefits of Using Established Measures
– Avoid writing or establishing individual data
definitions if established, national, or specialty
specific data definitions exist
• Requires knowledge and analysis generally not found in
healthcare organizations
– Progress in establishing evidence-based, validated,
credible data definitions

20. Selecting the Right Data—cont’d
• Eliminating Unnecessary Measures
– Lean and Project Management Body of Knowledge
(PMBOK): wasteful work: adds cost or time, or
that expands scope of the work without adding
value
– Overprocessing: requesting and processing more
information than is necessary or information that
will never be used, or reporting duplicative
information

21. Data Management Plan
• Step One: Define Data Needs
– Quantitative questions
– Qualitative questions
– Two quality-control tools:
• Process flowcharts
• Cause-and-effect diagrams

22. Data Management Plan—cont’d
• Step Two: Identify Data Sources
– Data measurement required by:
• CMS for reimbursement for services
• Joint Commission to demonstrate compliance with
accreditation standards
– Disease-specific registries
– Direct measure of nursing: National Database of
Nursing Quality Indicators
– Hospital-acquired conditions (HAC)

23. Data Management Plan—cont’d
• Step Three: Identify Performance Measures
– Structural
– Process
– Outcome
– Need to be reliable and valid

24. Data Management Plan—cont’d
• Step Four: Design the Study
– Determined by the focus of the project or
program and the specific aspects being evaluated
– Basic concepts: defining the population of interest
and determining the sample size

25. Data Management Plan—cont’d
• Step Five: Retrieve the Data
– Deciding where and how to access data that is
already being collected
– Deciding who will collect the data, how data will
be gathered, and the specific time period for the
collection
– Time period for measurement
• Retrospective and concurrent

26. Data Management Plan—cont’d
• Step Six: Analyze the Data
– To determine any necessary changes
– Frequently inadequately performed
– Statistical tools
• Run chart
• Control chart
• Pareto chart
• Scatter diagram

27. Summary
• In this era of health reform where quantifying
both cost and quality garner equal attention, it is
incumbent on the profession to develop skill and
confidence in measuring the impact of our work.
• For many healthcare professionals, the prospect
of selecting metrics instills fear because of these
measures’ importance in creating a powerful
story to share with others about contributions
nurses make with their work.

28. Summary—cont’d
• Recognizing stature of nurses, The Future of
Nursing: Leading Change, Advancing Health
identified need to partner fully with members of
healthcare team and improve information data
infrastructure to support decision making and
policy making directed to improved health
outcomes for the United States.
• Inherent in recommendation: ability to manage
projects, establish evidence, distinguish
appropriate metrics and measurement for change
outcomes.

29. Summary—cont’d
• As U.S. healthcare delivery system is reformed, an
essential lever will be measuring meaningful
elements of healthcare practice to improve
outcomes.
• Building from what has been learned about
research and evidence-based practice
implementation, the disciplines of project
management and quality improvement serve as
the guardrails for selection of meaningful metrics.