WHA Improvement ForumFor 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.

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Today’s Webinar

Agenda

o Measurement as part of daily worko Finding existing data vs. gathering datao Improvement project data vs. continual monitoring datao “When can I stop measuring”

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Measurement

Outcome Measures

**Process Measures**

Balancing Measures

Monitoring Measures

The Process and Outcome Measure Relationship

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Process improvement leads to outcome improvement, but it can take time to see outcome results.

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

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Two Sides of Process Measuring

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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

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Measuring Effectively

• Seek usefulness, not perfection• Use sampling• Plot data over time• Don’t wait for the information

system

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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

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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

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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

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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:

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Data Collection Tools

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Date: Unit Census: 10 am to 11 am 1 pm to 2 pm

Mon 10/10

14 patients

19 11

Tue 10/11

9 patients

14 17

* Create the tool for your staff – no matter how simple it is

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?

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

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

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Examples of Process Maintenance and Sustaining Measuring

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Quarter 1 Quarter 2 Quarter 3 Quarter 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

Use SamplingBenefits:• 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%20%28Feb%202011%29%20Web.pdf

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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

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Next Month:

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Front-line Staff as Improvement Leaders

June 27Noon

Front-line staff perspective Levels of Involvement Strategies for Feedback

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/PartnersforPatients/PfPTools.aspx

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Thank You!Questions

Please complete 3 question survey when closing webinar window.

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