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

2. 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

3. 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?

4. 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

5. 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

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

7. 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

8. 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?

9. 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

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

11. Top Projects

12. Quality / Risk Management

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

14. Key Volumes
Drill Down into metrics

15. Productivity / Financial

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

17. Enterprise HF readmissions by quarter

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

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

20. System Core Measures for HF: ACE / ARB for LVSD

21. 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

22. 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)

23. 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?

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

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

28. 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

30. Knowledge Portal Proactively manage automated dispensing cabinets
Inventory
Controlled substances diversion

31. 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.

32. 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.

33. 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

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