1. WHA Improvement Forum For May    “Strategies for ‘in-process’ Measurement”   Travis Dollak Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation.

2. 2 Today’s Webinar Agenda o Measurement as part of daily work o Finding existing data vs. gathering data o Improvement project data vs. continual monitoring data o “When can I stop measuring”

3. Disclaimer information here… 3 Measurement Outcome Measures **Process Measures** Balancing Measures Monitoring Measures

4. The Process and Outcome Measure Relationship 4 Process improvement leads to outcome improvement, but it can take time to see outcome results.

5. Why Measure Processes? Insuring that the evidence based processes are being done is what drives positive outcomes Assuming key processes are completing leads to regression and slippage Anecdotally declaring processes work can cause waste, frustration and confusion Measuring processes help you uncover obstacles in our system that block progress 5

6. Two Sides of Process Measuring 6 Improvement Measurement Maintenance and Sustaining Measurement

7. Measuring in Time Measuring Quarterly or Yearly will not lead to “rapid cycle improvement”. Measuring in short timeframes will lead to More changes in a short period Quicker implementation Achieve results more rapidly Disclaimer information here…7

8. Measuring Effectively Seek usefulness, not perfection Use sampling Plot data over time Don’t wait for the information system Disclaimer information here… 8

9. Characteristics of Process Improvement Measurement Used during small tests of change Can be very informal or highly formal Focuses on the ability to complete the needed process Should be easy to accomplish 9

10. Improvement Measurement Examples: High-Tec RFID on Badges that identify hand washing hygiene In door – wash hands – Before leave wash again – out door Completion of a Risk Assessment: Falls/PUP/VTE in medical records Completion of required prophylaxis through EMR Med Rec on Discharge Recorded on EMR 10

11. Improvement Measurement Examples: Lo-Tec A short checklist that improvement testers use to determine prevalence of hourly rounding Having a HUC walk by rooms 3 times a day to record if patients are positioned on the designated side and keeping a tab Auditing 5 High Risk Falls patient rooms a week and completing a checklist that records if falls protocol is in place 11

12. Improvement Data Collection Tools Many times you will need to invent a data collection tool. OR use an existing tool (such as those provided at the kick-off for time at the bedside, etc) Here are a couple of inventions based on this example: Disclaimer information here…12

13. Data Collection Tools 13 Date:Unit Census:10 am to 11 am1 pm to 2 pm Mon 10/1014 patients 1911 Tue 10/119 patients 1417 * Create the tool for your staff – no matter how simple it is

14. Focus on good process measurement Ask: – How does the work get done? – How would I know? – What is important to know? – What is the easiest way to know? – What is already collected? Is it good enough?

15. At first, keep measurement simple Use Simple Visuals Use Tic and Tally Sheets Make your measures easy to track on a daily or weekly basis

16. Characteristics of Sustaining and Maintenance Measurement Focuses on the key processes that drive desired outcomes Auditing is calendared throughout the year Sampling is used to get snap-shot of the system Generally speaking, the process auditing plan is not widely communicated 16

17. Examples of Process Maintenance and Sustaining Measuring 17 Quarter 1Quarter 2Quarter 3Quarter 4 Review Readmissions Outcomes – post discharge call prevalence Fall high risk bundle in place audits VTE-Prophylaxis in required time Pressure Ulcer Bundle Prevalence Review SSI – Use of Prophylaxis Antibiotics Audit – Pre admission skin cleansing prevalence 6 mos. review of: CAUTI insertion compliance Measure hourly rounding prevalence Review Readmissions Outcomes – post discharge call prevalence Fall high risk bundle in place audits VTE-Prophylaxis in required time Pressure Ulcer Bundle Prevalence Review SSI – Use of Prophylaxis Antibiotics Audit – Pre admission skin cleansing prevalence 6 mos. review of: CAUTI insertion compliance Measure hourly rounding prevalence

18. Use Sampling Benefits: Lower cost Saves time (receive information faster) With smaller data set, its easier to improve the accuracy/quality of the data Example: Sample 20 pts/month to identify ADEs yields the same results as sampling entire population http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/T4I%20%284%29%20How%20to%20use%20Trigger%20Tools%2 0%28Feb%202011%29%20Web.pdf 18

19. Seek Usefulness, Not Perfection Usefulness means measuring just enough to tell you what direction you are headed Perfection can lead to paralysis by analysis Reporting requirements can cause us to focus efforts on perfect data and less on improvement 19

20. Next Month: 20 Front-line Staff as Improvement Leaders June 27 Noon  Front-line staff perspective  Levels of Involvement  Strategies for Feedback

21. References WORKBOOK SECTION The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, Langley, Moen, & Nolan WHA Quality Center Tools and Templates http://www.whaqualitycenter.org/Partnersfor Patients/PfPTools.aspx http://www.whaqualitycenter.org/Partnersfor Patients/PfPTools.aspx 21

22. Thank You! Questions Please complete 3 question survey when closing webinar window. 22