The Evolution of STEEEP-7 Quantifying Improvement Interventions Against the IOM Quality Aims

The presenters have no conflict of interest to report related to this presentation. All presenters are employed by the University of Alabama at Birmingham Dr. Shea Polancich, PhD, RN-Joint Appointment UAB Hospital Nursing Administration and Assistant Professor UAB SON Dr. Terri Poe, DNP, RN-Chief Nursing Officer, UAB Hospital Dr. Suzie Miltner, PhD, RN-Joint Appointment-Assistant Professor UAB SON, Birmingham Veteran’s Administration Hospital

Background In 2015, the University of Alabama at Birmingham (UAB) CNO identified improvement opportunities from a system- wide perspective Improvement teams were chartered and improvement facilitator began to work with teams Projects produced multiple improvement interventions for each project Difficulty deciding between interventions (outside of the cost) No current standardized method for comparing improvement interventions No current method of developing interventions within the organization that ensured that the IOM aims for quality were being met

The Pilot Project-A Case Study Pressure transducer management was identified as a process in which variation in practice occurred within the organization Variation existed in cost and supplies, level of provider who initiated and managed the set-up, education and competency assessment, and process management Improvement team chartered that consisted of nursing managers from all of the inpatient intensive care units (ICU), anesthesia, hospital administration, data management, and an improvement facilitator

Improvement Goals for Project Decrease variation in practice Cost effectiveness and efficiency of the process Patient safety through consistent standard of care and provider competency Primarily, the aims of the improvement, were the IOM quality aims: safe, timely, effective, efficient, equitable, patient-centered care

Ensuring the IOM Aims Were Met? The improvement team reached a point in the process where there were opportunities to review and implement one of 3 different processes: RN (Registered Nurse)-only managed process for pressure transducer management Anesthesia tech only managed process for pressure transducer management Hybrid model incorporating both RN and anesthesia tech providers *Examples that follow will only provide the evaluation of the RN only and anesthesia technician models using the tools

Comparing the 3 Processes The improvement team was asked to compare the three different processes in order to select the best “practice” process for the organization that would decrease variation in practice and produce a single, standardized care delivery process for the patients around pressure transducer management

Evaluating the Processes Against the IOM Quality Aims It was determined that the best “practice” process would incorporate all aspects of the IOM Quality aims As such, the improvement facilitator developed a visual method of incorporating the aims into an evaluation process for the improvement team

Initial STEEEP Evaluation Process-Qualitative Assessment The initial STEEEP evaluation, as it was named was a qualitative assessment of each of the 3 provider management processes identified by the improvement team Members of the team were asked to evaluate each process based on each of the STEEEP elements Example provided for the RN-Only Management Model

Feedback on the STEEEP Qualitative Evaluation Tool The improvement team responded very favorably to the visual aspect of the qualitative tool The administrative team responded very favorably to the ability to use the aspects of the IOM quality aims to guide process (intervention) selection The downside of the tool, however, was still how to quantify a difference in two or more processes or interventions

Evolution of the Qualitative STEEEP Tool into the Quantitative STEEEP-7 Tool The qualitative STEEEP tool was enhanced to provide a quantitative element to the process Similar in function to the Failure Mode Effects Analysis (FMEA), the STEEEP-7 added a dimension of evaluation scales and scoring analysis An additional element was also added for “sustainability”. It was determined that sustainability was a frequently cited factor for failure of past interventions, so the ability to assess that upfront was important An example of the STEEEP-7 tool is provided

*Scoring for “Safety” begins at “1-minimal required safety to implement an intervention”

STEEEP-7 Evaluation and Analysis Process There is a total score of 32 points for the STEEEP-7 analysis For each of the 6 elements there is a 5 point likert scale for each element for a total of 30 points “Safety” Scale “1” scoring defined to begin at the “minimal safety required to implement an intervention” There is a sustainability scoring element of 0-2 points that is used to determine the sustainability component Interventions may be scored in this fashion for decision making purposes The highest scored intervention in theory should be the intervention meeting the IOM quality aims, as well as the intervention considered to be sustainable without intervention

User Friendly STEEEP-7 Tool For ease of use, the STEEEP-7 tool has been converted to an excel spreadsheet containing all the calculations for the process Those interested in using the tool may request the spreadsheet from

Demonstration of Tool Use

Next Steps The STEEEP-7 tool is in its early evolutionary stages The tool has been used in our organization for Improvement projects DNP students Other students The tool was received favorably by the improvement team and the administration team who used the process A manuscript describing the evolution of the tool has been accepted for publication by Patient Safety and Quality in Healthcare (PSQH) anticipated publication date of April/May 2016 We welcome additional testing and use by others.

Development Team Shea Polancich, PhD, RN or Terri Poe, DNP, RN Rebecca Miltner, PhD, RN