© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 1 Welcome Effective Measurement and Respectful Reporting to Improve Quality of Care an d Joy in Practice Jim Shirley and Doug Stewart October 24, 2014

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Healthcare Performance Measures 1. IHI Model for Improvement (5) - The Aim – Measure - Change model - The Aim – Measure - Change model 2. General Principles of Measurement 2. General Principles of Measurement - Focus on something you can change. - Focus on something you can change. 3. Types of Performance Measures 3. Types of Performance Measures - Quality, Outcome and Process - Quality, Outcome and Process 4. Tools to Plot and Interpret Data 4. Tools to Plot and Interpret Data - QI Macros and Control Charts - QI Macros and Control Charts Slide 2

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 3 1. IHI Model for Improvement (5)

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 4 1. IHI Model for Improvement (5) - Improvement Worksheet 1. IHI Model for Improvement (5) - Improvement Worksheet

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 5 2. General Principles of Measurement (3) a. Measurement can be thought of a. Measurement can be thought of as a window through which we as a window through which we view a process... view a process... b. Each measure gives us a different b. Each measure gives us a different perspective for our view: perspective for our view: (1) Process times at check-in (1) Process times at check-in (2) Wait time until pt. is called back (2) Wait time until pt. is called back (3) Provider exam time (3) Provider exam time

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 6 2. General Principles of Measurement (3) (continued) c. Measures should focus on something c. Measures should focus on something you can change: you can change: (1) Process time for one step in process (1) Process time for one step in process (2) Delay time between process steps (2) Delay time between process steps (3) Percentage complete and accurate (3) Percentage complete and accurate information from previous step information from previous step

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 7 Measures for Patient Flow in a Clinic (6)

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 8 Types of Performance Measures (3) 3. Types of Performance Measures (3) Measures can be categorized in several Measures can be categorized in several ways, including: ways, including: a. Domains of Quality a. Domains of Quality b. Outcome and Process Measures b. Outcome and Process Measures Each can be helpful in improvement Each can be helpful in improvement work.... work....

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 9 a. Domains of Quality (3) 1. Safety (Pt. falls, medication errors,...) 1. Safety (Pt. falls, medication errors,...) 2. Clinical excellence or effectiveness 2. Clinical excellence or effectiveness (Did the new process achieve its goal?) (Did the new process achieve its goal?) 3. Utilization (Reducing length of stay) 3. Utilization (Reducing length of stay) 4. Timeliness (Reducing lab turnaround time) 4. Timeliness (Reducing lab turnaround time) 5. Accessibility (Reducing pt. wait time for an 5. Accessibility (Reducing pt. wait time for an appointment) appointment) 6. Patient Satisfaction (Patients likely to 6. Patient Satisfaction (Patients likely to recommend hospital or clinic?) recommend hospital or clinic?)

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 10 Outcome measures (pt. infection rate) ● Outcome measures (pt. infection rate) - Can be difficult with a negative outcome - Can be difficult with a negative outcome and procedures used were “correct.” and procedures used were “correct.” Process measures (length of intubation) ● Process measures (length of intubation) - Process measures can give early indication of outcomes. indication of outcomes. - Example: Increasing immunization to reduce community-acquired infections reduce community-acquired infections b. Outcome and Process Measures (3)

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 11 Tools to Plot and Interpret Data (1) 4. Tools to Plot and Interpret Data (1) a. QI Macros – Powerful software to add a. QI Macros – Powerful software to add to Excel to create charts/analyze data to Excel to create charts/analyze data It creates: It creates: - Run Charts - Control Charts - Run Charts - Control Charts - Histograms - Pareto Charts - Histograms - Pareto Charts And, it has templates (flowcharts and And, it has templates (flowcharts and fishbone charts), does statistical fishbone charts), does statistical analysis and can transform data. analysis and can transform data. - Cost is $229 for this powerful tool!! - Cost is $229 for this powerful tool!!

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 12

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 13 b. Control Chart – Basic Elements (3) b. Control Chart – Basic Elements (3) Center line is the “mean” statistic Center line is the “mean” statistic (arithmetic average). (arithmetic average). Control limits help identify special Control limits help identify special causes when limits are exceeded. causes when limits are exceeded. Control charts examine data in a Control charts examine data in a time-series... that is... over time. time-series... that is... over time.

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 14 Basic Elements of a Control Chart

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 15 Control Charts (2) – Help Differentiate: Common Cause Variation... Common Cause Variation... (random variation) (random variation) Special Cause Variation.... (variation caused by a specific factor) (variation caused by a specific factor) 1. Detect quickly 2. Diagnose problems 3. Eliminate problems

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 16 f. Detecting Special Causes (1) f. Detecting Special Causes (1) QI Macros will highlight in RED special QI Macros will highlight in RED special cause variation which is not random cause variation which is not random variation variation These special causes can be examined These special causes can be examined to identify improvement opportunities. to identify improvement opportunities.

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) Slide 17

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/22/14) √ Healthcare Performance Measures Slide 18 √ 1. IHI Model for Improvement - The Aim – Measure - Change model - The Aim – Measure - Change model √ 2. General Principles of Measurement - Focus on something you can change. - Focus on something you can change. √ 3. Types of Performance Measures √ 3. Types of Performance Measures - Quality, Outcome and Process - Quality, Outcome and Process √ 4. Tools to Plot and Interpret Data √ 4. Tools to Plot and Interpret Data - QI Macros and Control Charts - QI Macros and Control Charts

© Copyright 2014 James Shirley Management Consultants, Inc. All right reserved. (10/20/14) Slide 19