1. A Balanced Set of Clinical Measures and the discussions they have provoked Bruce George Executive Director (Operations) Quality, Improvement and Patient Safety Capital & Coast DHB

2. SITUATION (September 2013) Lots and lots of bar graphs Many providers of “data” and “charts” Multiple systems from which data is extracted Some data extracted and turned into charts without any internal oversight

3. SITUATION (September 2013) Inconsistent definitions Some very complex denominators to “enable” comparisons Multiple (connected?) committees where insight from data or charts is discussed

4. CURRENT STATE (April 2014) Standard Balanced Set of Clinical and Quality Measures Clear definitions of “counts” to drive improvement Discussion, agreement and action at Clinical Governance meetings

5. CURRENT STATE (April 2014) Balanced Set includes: Patients Discharged Deceased (monthly) SAC 1 & 2 events (monthly) Placements to Aged Residential Care (monthly) ED 6 hour target (weekly) Hospital Occupancy at 4pm (daily) All Reported Events (weekly) Readmissions (monthly) Complaints (weekly) Falls (monthly) Medication / Fluids errors (monthly) Pressure Sores / Ulcers (monthly) Peri-operative Harm (quarterly) Restraints / supportive Devices (monthly) Safe Staffing (monthly)

6. INVESTIGATIONS (April 2014) Investigations into signals Readmissions Safe Staffing Peri-operative Care

7. INVESTIGATIONS (April 2014) Investigations into signals Readmissions Safe Staffing Peri-operative Care

8. INVESTIGATIONS (April 2014) Initial analysis using existing tools Unforeseen readmission – new problem Unforeseen readmission – existing problem

9. By Specialty: Monthly Readmit Rates (Jan12 to Jan14) Three specialties highlighted as higher rates – understandable as likely to be complex cases

10. By original visit LOS Distributions of LOS resulting in a readmission are in synch with those of all admissions ReadmissionsAll Admissions

11. By Clinician: General Medicine Readmit rates largely in synch with the overall admission rates per clinician Doctors names

12. By DRG: General Medicine Readmission DRG’s in synch with total IP admission DRG’s, except X62 & G70 ReadmissionsAll Admissions

13. Outcomes of Readmissions analysis Has driven development and deployment of new charts, insight from data and discussion at Clinical Governance No clear single reason for increase but two DRGs to investigate further Progress with internal clinical audit Include Primary Care in investigations

14. Visibility of data and analysis of signals has driven Greater use of Central Dashboard Planning for Operations Centre to optimise flow & safety CURRENT STATE (April 2014)

15. Visibility of data and analysis of signals has driven Greater use of Central Dashboard Planning for Operations Centre to optimise flow & safety

16. FUTURE STATE (December 2014) Standard Balanced Set of Clinical and Quality Measures Clear definitions of “counts” to drive improvement Discussion, agreement and action at Clinical Governance meetings

17. FUTURE STATE (tbc) Charts (Statistical Process Control) accessed via intranet dashboard. Proactive not reactive - act upon early warning from signals not trends. Analysis for improvement (count) and comparison (rate). Full DHB perspective not just Hospital. Integrated Operations Centre