Bold Goal PI Radar Dashboard

Transcription

1 Bold Goal PI Radar Dashboard Helen Macfie, Pharm.D., FABC Chief Transformation Officer Certified Lean Leader For IHI Patient Safety Executive Development Course, September, 2016 This presenter has nothing to disclose.

2 Concept: Aiming High, Aiming Wide Aim High Islands of Excellence Transformation Low Just Good Enough Incremental Improvement Unit Level System Level Breadth of Aim

3 Creating Strategic Linkage

4 Selecting Strategic Quality Priorities Reaffirm the Work Each Year Big Dots Reduce Mortality Reduce Needless Harm Improve Patient & Family Experience Key Drivers Early Response Clinical Reliability Sepsis Care Reduced Infections Reduced Complications Improved screening Population health Endorsement and Loyalty Measures Codes Outside ICU Perfect Care Sepsis Mortality Central Line, VAP, CAUTI, SSI Hand Hygiene Hospital Acq. Pressure Ulcers Patient Falls, all VTE/DVT prevention Medication reconciliation Medical Foundation Big 5 OB care C-section Inpatient: HCAHPS Ambulatory: PAS/CGCAHPS

5 Concept: The Art of Selecting Targets You want to create stretch Getting to transformation vs. improvement Better than average or truly benchmark? Thoughts on Perfect Care at the patient level Going for Zero harm ( Zero Zone ) Having said that, start where your team can support, and evolve

6 MemorialCare s safety Bold Goals today, by June 2016 Reduce mortality Severe sepsis mortality by >50 % Code blue emergencies outside ICU by >50% Achieve perfect care to >95% Core Measure sets all diagnoses/bundles Medication Reconciliation (90% PTA, Admit, D/C) Reduce harm to Zero Zone Hospital acquired infections (HAI) Achieve 100% hand hygiene compliance HA pressure ulcers Patient falls with injury Harm Across the Board by > 70% Promote Population Health NTSV C-Section rate to < 15% Medical Foundation goals to top 10 th percentile Screening breast and colorectal; diabetes care HbA1c < 8, generic prescribing rate, childhood immunizations (combo 10)

7 Concept: PI Radar Dashboard Development What Boards and leadership should do: Understand and regularly oversee a few system-level quality measures Set specific how good, by when aims for improvement of these systemlevel measures Where are we trying to get to How will we know we got there Idea Development of our PI Radar to: Measure progress Facilitate storytelling Recognize success and opportunities for further improvement

8 Ex: PI Radar Dashboard Hospital Shows where we started, have been, are now How it works: Stretch targets (Green = hard!) Scalable Balanced Performance over time Inservice: Bold - move out, to/beyond the green line

9 Ex: PI Radar Dashboard Ambulatory Shows where we are, comparisons to percentiles

10 Ex: PI Radar Dashboard Peds Hospital Engagement Network focus

11 The PI Radar Dashboard How It Works Matches our Bold Goals Revised no more than annually (maintain focus for one year) Quarterly production, with trended drilldown data reflecting monthly or quarterly (per indicator) On other months, review committees can then focus on a drilldown area, patient story, demonstration or other quality focus Microsoft Excel use of Radar graph Disparate indicators are able to be shown using scalable segments Example Perfect Care Exceed = 100%, Target = 95%, Average = 80%, Below = 50% or less; whereas infections are reverse-ranked based on CDC/NHSN benchmarks

12 The PI Radar Dashboard How It Works The basic inservice and interpretation Can easily see movement by indicator from where we were, to where we ve been last 12 months to most recent quarter Allows both celebration and focus on opportunities If we look like Australia it s good Drilldown slides with the rest of the story Total max slides Facilitates summary review and then focus depending on audience Construction roles Excel PI Radar system office staff Drilldown data entered into Excel spreadsheet located in common shared drive by system (80%) and campus (20%) staff PowerPoint images imported/built by system staff, with the stories entered by campus staff

13 The PI Radar Dashboard How It Really Works Construction create scale for each goal 1. Identify what constitutes the TARGET at 75 th point 2. Identify what constitutes Average (yellow light) 3. Identify what is the floor or poor performance 4. Identify what exceeding target looks like 5. Make these harder each year to propel

14 The PI Radar Dashboard How It Really Works Construction create scale for each goal 6. Calculate where the dot should plot If the metric is a less is better, the lower # (e.g. zero infections) should equate to the 100 on scale, and etc. See example Excel file to see actual formulas If the dot falls between Target and Exceed, use 100 formula. If Average and Target, use 75 formula. If between Poor and Average, use 50 formula. And if below that, use 25 formula or if really poor, plot at 5. If you get stuck, Helen hmacfie@memorialcare.org 7. Create the rest of the story 1 slide per focus area graphs and story combos If you are not there, can someone else get it/tell it

15 Codes per 10,000 Discharges 3Q'05 4Q'05 1Q'06 2Q'06 3Q'06 4Q'06 1Q'07 2Q'07 3Q'07 4Q'07 1Q'08 2Q'08 3Q'08 4Q'08 1Q'09 2Q'09 3Q'09 4Q'09 1Q'10 2Q'10 3Q'10 4Q'10 1Q'11 2Q'11 3Q'11 4Q'11 1Q'12 2Q'12 3Q'12 4Q'12 1Q'13 2Q'13 3Q'13 4Q'13 1Q'14 2Q'14 3Q'14 4Q'14 1Q'15 2Q'15 3Q'15 RRT Calls per 1000 Discharges Number of Sepsis Mortalities Mortality Rate as a % The rest of the story, 1 slide/spoke ex. Mortality Drilldown data, story Severe Sepsis & Septic Shock Mortality Includes pts 18 yrs. with Dx = or , excludes deaths in ED Mortality with Exclusions: data from Crimson, with Full DNR w/in 24h Removed 50% # of In-house Mortalities x -4.6% Multiplier, rounded, then Epic Sourced Data Mortality Rate as a % without Full DNR (Rate adjusted by 4.6% for to adjust for DNR avg Multiplier for MHS FY'08 Baseline Rate Minus 4.6% Bold Goal Sepsis Mortality Without Full DNR (Less 35% for FY'14) MemorialCare Code Blue Outside of ICU and RRT Call Comparison RRTs Bold Goal Drilldown Early Warning MEWS Epic Imp. for OFIs Systems - SMMC Pilots -> Fall'13/Jun'14 RRT Calls Outside/1000 Discharges Codes Outside of ICU/10000 Discharges 40% 30% 20% 10% 0% Opportunity Sepsis Mortality Reduction Next steps (who/ when/ status) 3Q 15: rate 14.83% vs Bold Goal of 18.2% for 59% reduction (FY 08 rate 36.4%) Datamart rolled out (Exley, Corob) New Core Measure set released Sepsis BPAC evaluatied with ED & Critical Care for refinements to order sets and data. Preliminary reporting summary next slide (lower % overall, Perfect Care, at high end of US experience) RRT/MEWS Created new Epic workflows adults (CNOs, MC*21). Lean A3 held, pilots started Sep 13, assessment done A3#2 Feb 14 for scoring revisions imp May 14 w/ trackboards at OCMMC and SMMC, pre-login screens for all A3#3 Dec 14 for data review, next steps and how to use MEWS, spread plan and PEWS (pediatric) Action plans and spread in progress team check-in Apr 15, Aug 15 Spread to all med/surg units at SMMC and OCMMC Oct 14, LBMMC spring 15 Linking to bed placement (last ED set) see Mortality graphs, Crimson

16 Incorporation of Five Lean Kata Coaching Questions Coaching Kata behavior or pattern 1. What is the target condition? 2. What is the actual condition now? 3. What obstacles are preventing you from reaching the target condition? Which are you addressing now? Who out there is doing it better? What toolkits already exist? What could work here?

17 Incorporation of Five Lean Kata Coaching Questions 4. What is your next step? What could work here? Who will champion this? Who should be on the team to work out the details? What tests of change can we do where, in order to test our theories next Tuesday? How to launch, educate, monitor and provide feedback? 5. When can we go and see what we have learned from taking that step?