Worth a Thousand Words: Telling a Story with Data

A5/B5 Worth a Thousand Words: Telling a Story with Data Ari Robicsek, MD Chief Medical Analytics Officer Providence St. Joseph Health

Session Objectives Consider the challenges of representing patient safety data Develop an approach to designing strong data visualizations These presenters have nothing to disclose 2

7 A s of actionable data Accurate

Accuracy Accurate 1. 2. Bidirectional validation Effort

7 A s of actionable data Accurate Argumentative (i.e. Advances a hypothesis)

7 A s of actionable data Accurate Argumentative (i.e. Advances a hypothesis) Appealing (good looks draw in users)

https://www.interaction-design.org/literature/article/bad-design-vs-good-design-5-examples-we-canlearn-frombad-design-vs-good-design-5-examples-we-can-learn-from-130706 Jorge Gonzalez

https://www.interaction-design.org/literature/article/bad-design-vs-good-design-5-examples-we-canlearn-frombad-design-vs-good-design-5-examples-we-can-learn-from-130706 Nikki Sylianteng

7 A s of actionable data Accurate Argumentative (i.e. Advances a hypothesis) Appealing (good looks draw in users) Aimed at the right person (no point creating a chief executive dashboard for a nursing unit leader, and vice versa) Atomic (contains the deepest level of detail absolutely necessary for decision-making)

Where is my problem? What can I do about it?

Carl Reinhold August Wunderlich https://en.wikipedia.org/wiki/carl_reinhold_august_wunderlich#/ media/file:carl_august_wunderlich.jpg

http://fad.northshore.org/wunderlich/

Big ideas for the system Inpatient Quality Dashboard 1. Employs data accuracy best practices (e.g. validation) 2. Clear visualizations with statistical discipline 3. Rapid comparison of different hospitals 4. Usable at system, market and hospital levels 5. Allows outcome and process metrics to be consumed together 6. Available where users work

A FRENCH PLOT Q2 Current performance

A FRENCH PLOT Q2 Trend

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 300 250 200 150 100 7 in a row moving in the same direction Statistical Process Control Chart Beyond 3 SD (control limits) 4 out of 5 on same side of centerline and 1 SD away UCL Avg 8 in a row on the same side of the centerline 50 2 out of 3 on same side of centerline and 2 SD away LCL 0

https://industryvisuals.w2pstore.com/product/safety-cross-mounted-on-magnetic-dry-erase-board/

Issues Look and feel Navigation hard Training Can t see all nursing units at once Can t see all metrics at once

Multiple Metrics View Multiple metrics, multiple hospitals Stoplight Current performance Performance over time Performance relative to target

Option 1 Safe C. diff 56 75! CAUTI 76 75 CLABSI 65 75 SSI-Hyst 80 75 SSI-Colon 46 75 Falls w injury 71 75

Option 2 System Performance Safe 4 / 5

Option 3 System Performance Safe 4 / 5 Trend

Option 4 System Performance Safe 3 / 5 target: 75 target: 66 target: 63 target: 58 target: 71

Example: Accelerating improvement in hospital-acquired Clostridium difficile Before Q2 2016 Q1 2017 After Q4 2016 Q3 2017 85

Locations Vantage A Tableau link http://tableauserver.providence.org/#/views/systemqualityscorecard/overview?:iid=1 Epic

More Issues C-suites don t go searching for data Data issues arise regularly Framing in the context of the goals of the organization

CARING RELIABLY: IMPROVING OUTCOMES AND MAKING IT STICK CORE BEHAVIORS OF CARING RELIABLY Toolbox for Everyone Pay Attention to Detail (STAR, peer check) Communicate Clearly (SBAR, repeat back, clarifying questions) Have a Questioning Attitude (know why and comply, validate and verify) Operate as a Team (brief, execute and debrief) Speak Up for Safety (CUS, event reporting systems) Toolbox for Leaders Message on the Mission (reflection/safety message, safety first in every decision, stand up for those who speak up forsafety) Lead Reliable Operations (daily huddles including experience, top 10 lists) Build Engagement, Accountability (5:1 feedback, fair and just accountability, round to influence) Foster Teamwork (display unit-based results, learning boards, action plans) Tones for Respect Smile and greet others; sayhello Introduce using preferred names and explain roles Listen with empathy and intent to understand Communicate positive intent of our actions Provide an opportunity for others to ask questions INPATIENT SAFETY: CARE BUNDLES Prevent Infections Expect scrupulous hand hygiene Use standard precautions and appropriate PPE for isolation Conduct case reviews immediately when infections occur Assist patient in maintaining personal and hand hygiene Ensure comprehensive environmental cleaning Eliminate CLABSI Verify appropriate indications for placement At insertion, utilize maximal barrier precautions & sterile technique Change dressing/tubing every 7 days or when integrity is breached Flush the central line at least once every 12 hours Verify justification for continuing central line daily Eliminate CAUTI Know the evidence-based indications for catheter use and only use when met Insert catheter aseptically Ensure catheter is secured Perform appropriate catheter hygiene daily, and following fecal incontinence Remove at earliest opportunity, no later than 48 hours unless otherwise indicated Eliminate Surgical Site Infections Establish and maintain glycemic control targets (pre, peri, post) Maintain temperature at 36 degrees C or above (pre, peri, post) Conduct post-procedure pause to document wound class and skin closure Ensure weight-based, appropriate dosing of antibiotics Counsel for smoking cessation, at least for duration of wound healing Eliminate C. Difficile Avoid excess and inappropriate antibioticuse Isolate and test early on suspicion of infection Only test symptomatic patients where infection is suspected Terminally clean room with sporicidal disinfectant at discharge Eliminate Falls with Injury Utilize universal assessment & safety protocol for all patients Implement interventions based on riskassessment Share plans with patients, family and care team Debrief with team immediately after every fall Review medication regimen after every fall (pharmacy) IMPATIENT HEALTH: CARE BUNDLES Make Hospitals Healthier Provide goal-aligned care (focus on what matters to the patient) Assess and support nutritional status Minimize night-time noise, enable undisturbed sleep Encourage exercise & staying out ofbed Ensure 24-7 family access and support for patients Care Compassionately Conduct hourly nurse rounding using specific compassion-based behaviors Conduct leader rounding and immediate intervention with patients Make post-discharge calls with compassion-based behaviors Implement clinician-led forums aimed at compassion-based support/burnout prevention Use compassion and resiliency-focused interventions with clinicians at high burnout risk Reduce Sepsis Mortality Draw lactate level on suspicion of sepsis Draw immediate blood cultures on suspicion of sepsis Resuscitate with fluids 30 ml/kg over 1 hour Administer antibiotics within 3 hours Repeat lactate at 6 hours Prevent Readmissions Complete medication reconciliation at discharge and follow up Ensure safe discharge with concise instructions and f/u hotline Schedule f/u w/in 5 days (high risk) or 14 days (moderate risk) Conduct follow-up call within 48 hours (high risk) Provide d/c summary for transitions, warm handoff in high risk