Driving Quality with Visual Management Scott Knoer, MS, PharmD, FASHP Chief Pharmacy Officer Cleveland Clinic

Objectives Identify various operational and clinical metrics to incorporate into your dashboards Discuss the development of an electronic pharmacy dashboard Describe the utilization of the system and improved outcomes seen by pharmacy leadership

50 Buildings on 180 acre main campus 9 Community Hospitals 18 Family Health Centers / 7 Ambulatory Surgical Centers 2,700 Physicians 11,000 Nurses 43,000 Caregivers 1,300 Residents and Fellows 65 Accredited Training Programs So what does our Pharmacy Enterprise look like physically today? Where are our Bricks and Mortar?

Cleveland Clinic Nevada Lou Ruvo Center for Brain Health (Las Vegas) Additional Locations Cleveland Clinic Florida Weston, Fl Cleveland Clinic Canada Toronto Health & Wellness Center Toronto – Health & Wellness Center Abu Dhabi, UAE Vienna China 4

Cleveland Clinic Abu Dhabi, UAE Sheikh Khalifa Medical City Abu Dhabi, UAE Additional Locations Cleveland Clinic Abu Dhabi, UAE Toronto – Health & Wellness Center Abu Dhabi, UAE Vienna China 5

Cleveland Clinic Pharmacy Enterprise (2012) 743 Pharmacy FTE’s $66 M Salary Expense $367 M Drug Expense Drug Budget $367,000,000 6

How do you keep track of it all? Business intelligence Business Review Deck Quality Dashboard Readmissions Core Measures HCAHPS MedBoard Turn-around times CoPAT dashboard Home Care Knowledge portal

Business Review Deck User defined Key Performance Metrics Benchmark Quality Financials Key Volume Indicators # of doses Just data: not necessarily benchmarked Top Projects Goals Have discussion Are we on task or not?

Business Review Deck Development Maintenance Two ½ day sessions Maintenance Monthly input Financials feed directly Manual Standard product across Cleveland Clinic (proprietary) Review Monthly review with dept. leadership Opportunity to discuss issues with the team

Pharmacy Business Review Deck Benchmark against a standard (user defined) Red, Green, Yellow

Top Projects

Quality / Risk Management

Key Volume Indicators Not necessarily benchmarkable, but volume related. Can drill down.

Key Volumes Drill Down into metrics

Productivity / Financial

Quality Dashboard System wide Core Measures HCAHPS Readmissions Drill down Core Measures SCIP HCAHPS Readmissions Also have financial dashboard

Enterprise HF readmissions by quarter

Drill down into individual hospital – Here we looked at CC South Pointe

System HCAHPS scores. Can also then drill down into individual hospitals.

System Core Measures for HF: ACE / ARB for LVSD

SCIP Click on Core Measures and drill down. Here looking at Percentage of cardiac surgeries with 6AM Blood Glucose. Can also look at Antibiotic within one hour prior to surgery

SCIP Order Set Optimization Ensuring appropriate ABX to cover for pathogens typically associated with those types of surgeries ABX available in Pyxis for 1st doses Communication between floor and pre-op. Case start timing process measures (still have opportunity here)

MedBoard® Retrospective Real Time Turn-around times Identifies areas to focus on Real Time Where is the dose right now? Where was it delivered to?

These graphs are from a medication tracking software tool called MedBoard® Drill down into TAT issues (also protection when assailed)

CoPAT Dashboard Community Parenteral Anti-Infective Therapy Quality and financial Referrals / market share Outcomes Readmissions

This product is utilized by our Home Care Pharmacy This product is utilized by our Home Care Pharmacy. It is called the Community Parenteral Anti-Infective Therapy or CoPAT Dashboard

Knowledge Portal Proactively manage automated dispensing cabinets Inventory Controlled substances diversion

Knowledge Portal Home Screen CareFusion Knowledge Portal reports Care Fusion gives us similar types of indicators for our automated dispensing cabinet data and controlled substance data on the home page of their data tool, Knowledge portal.

Knowledge Portal – Watch List The Diversion watch list is a one-click from the home page that aggregates several markers for potential diversion and ranks them via percentile. This has allowed us to quickly identify certain users to audit.

Dashboard Challenges Purchase product vs. create Data feed Direct Manual Ensuring your team understands the importance Not useful if not updated Accountability Using it What is your process to review

Opportunities Drive quality and finances HCAHPS scores Core measures By hospital By nursing unit Core measures Readmissions Ambulatory business Scripts Revenue Wait times Oversedation