DEVELOPING QUALITY MONITORING TOOLS AND METHODOLOGIES TO SUPPORT CLINICAL PROCESSLori A Hinga, ConsultantSolutions…Healthcare Redesign Experts

OBJECTIVES…▪ By the end of this presentation, participants will be able

to…▪ Explain three core principles of quality improvement▪ Develop, expand and/or initiate an effective quality improvement program

through implementation of standardized systems/processes▪ Identify specific areas for improvement using data collection, analysis and

reporting▪ Evaluate improvement using the PDSA quality improvement methodology

and tools▪ Identify three key benefits of a comprehensive quality improvement

program

QUALITY IMPROVEMENTQuality Improvement is an integrative process that links knowledge, structures, processes and outcomes to enhance quality throughout an organization

-National Committee for Quality Assurance

A CULTURE OF QUALITY IMPROVMENT

▪We understand our work as systems and processes▪We are committed to

continuous improvement of these systems and processes

CORE PRINCIPLES OF QUALITY IMPROVEMENT▪ Patient and/or Customer Focus▪ Organizational Commitment ▪ Leadership Involvement▪ Provider Engagement▪ Employee Empowerment▪ Established Measures ▪ Standardized Data Collection▪ Understood Improvement Tool ▪ Communication ▪ Continuous Effort

BENEFITS…▪ Efficient Systems and Processes▪ Improved Clinical Patient Outcomes▪ Improved Patient Experience/Satisfaction▪ Prepared for the transition to Value-Based Payment (VBP)▪ Readied to participate in upcoming QI incentive programs ▪ Equipped to apply for and complete national recognition

programs such as Patient-Centered Medical Home▪ Established culture of QI

QUALITY IMPROVEMENT BASICS

CULTURE ▪ COLLECT ▪ COMMUNICATE ▪ COMMITMENT ▪ CULTURE

DEVELOP A CULTURE OF QUALITY…▪Quality Improvement Plan (QIP)▪ A structure through which the core organization

functions (mission, vision, values) are evaluated and improved▪ QI teams ▪ QI meetings ▪ Defined policies ▪ Standardized systems

COLLECT AND ANALYZE DATA▪To understand how well systems/processes are working▪To identify potential areas for improvement▪ Organizational Goals ▪ Recognized Benchmarks▪ Initiative Requirement/Standard ▪ Funding Responsibility

COMMUNICATE RESULTS…

▪Standardized Process▪Transparency

COMMITMENT TO ONGOING EVALUATION…▪Strive to continually improve performance▪ Monitor the effectiveness of interventions/improvements▪ Solicit patient, provider and staff feedback

MODELS FOR IMPROVEMENT

PRESENT A SYSTEMATIC, FORMAL FRAMEWORK FOR ESTABLISHING QUALITY IMPROVEMENT PROCESSES

LEAN SIX SIGMA…▪ LEAN Six Sigma▪ Assesses progress and

value of QI efforts ▪ Define, Measure, Analyze,

Improve and Control (DMAIC)

▪ LEAN For Clinical Redesign (University of Michigan)▪ Medical practice specific

P-D-S-A…▪ Plan-Do-Study-Act Cycle ▪ Tests interventions on a

small scale▪ Combines two recognized

QI models▪ Total Quality Management

(TQM)▪ Rapid Cycle Improvement

(RCI)

TOOLS FOR IMPROVEMENT

INDIVIDUAL STRATEGIES AND/OR PROCESSES THAT HELP TO BETTER UNDERSTAND, ANALYZE AND/OR COMMUNICATE QI EFFORTS

TOOLS…

▪Run charts▪Process maps▪Fishbone

diagrams▪Dashboards▪PDSA Worksheet

EXAMPLES…

PRACTICALLY SPEAKINGIMPROVING QUALITY ONE STEP AT A TIME

WHERE ARE WE…TODAY?▪What data is being collected?▪How is data being collected?▪How often is data being collected?▪What is done with the data?▪What does the data show?▪ Is the data reported?

CONSIDERATIONS…

▪ Patient Populations▪Requirements▪Recognized

Benchmarks▪Operations

PATIENT POPULATIONS

▪Barriers to Care▪Gaps in Care▪Chronic Conditions▪High Risk

BENCHMARKS▪Uniform Data System▪Healthy People 2020▪Agency for Healthcare Research and Quality ▪Physician Quality Reporting System ▪Agency for Healthcare Research and Quality▪Meaningful Use

OPERATIONS…

▪Patient Flow▪Patient Experience▪Systems/Process

PRIORITIES…▪Set priorities based on:▪ Relevance to mission▪ Organizational goals▪ Clinical Importance▪ Expected impact on outcome of care

▪ Available resources and cost

WORKING BACKWARDS…▪What data is required?▪Can the data be accessed/extracted?

PDSA OPPORTUNITY▪Is the data being accessed/extracted?

PDSA OPPORTUNITY▪Is the data currently being analyzed?

PDSA OPPORTUNITY▪ What does the data tell us?

PDSA OPPORTUNITY

PDSA – THE PRACTICAL APPROACH

UDS & GRANT REQUIREMENT…▪ Percent of adults aged 50 to 75 years received a colorectal

cancer screening based on the most recent guidelines in 2008 (age adjusted to the year 2000 standard population)▪ Goal: Increase the proportion of adults who receive a colorectal cancer

screening based on the most recent guidelines▪ Benchmark/Target: 70.5%▪ Numerator: Number of persons aged 50 to 75 years who have had a

blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years

▪ Denominator: Number of persons aged 50 to 75 years

GATHERING INFORMATION…▪ What data is required?▪ Is access to this data available?▪ Is the data reviewed/analyzed in

a standardized way?▪ Is the benchmark being met?▪ Has continuous improvement

been made toward the benchmark?

▪ Have improvement attempts been made in the past using a recognized method and tools?

▪ Is this measure/benchmark included in the quality improvement dashboard?

▪ Is the data shared…with whom? ▪ Is there an opportunity for

improvement?▪ Is there funding connected to

this measure?▪ Is this an organizational priority?▪ Initiate a PDSA?

PDSA OPPORTUNITY…

▪AIM / GOAL: Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines

PDSA…▪PLAN

List the tasks needed to set up this test of change

Person(s) Responsible

When to be done Where to be done

Plan for collection of data (If/when available)

Predict what will happen when the test is carried out

Measures to determine if prediction succeeds

PDSA…▪DO

▪STUDY

Describe what actually happened when you ran the test

Record data and observations

Describe the measured results and how they compared to the predictionsDid the results match your predictions?

PDSA…▪ACT

ADAPT - Describe what modifications to the plan will be made for the next cycle from what you learnedList the tasks needed to set up this test of change

Person(s) Responsible

When to be done

Where to be done

ADOPT – Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability

ABANDON – Discard this change idea and try a different one

NEXT STEPS…▪ Review and/or revise Quality Improvement Plan (QIP)▪ Ensure the program reflects organizational strategies, goals,

systems and needs▪ Current methodologies and tools▪ Platforms and frequency for information sharing

▪ Train/re-train all team members → QIP, organizational goals and expectations

▪ Develop an organizational dashboard▪Ensure all data requirements are included▪Ensure responsibility is assigned for data collection/analysis and reporting

QUESTIONS…

THANK-YOU!