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McKesson helps improve health care quality and patient safety while reducing health care costs.Task ActionsTask Not Started ( 00:00:00 ) * * * * * * * *
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Deborah Bulger, CPHQVice President, Product ManagementPerformance Management
Patient Care and Quality Outcomes
Paul GartmanVice President, Product ManagementEnterprise Visibility
2
Learning Objectives
Determine how IT can support an organization’s quality performance goals Understand the difference between departmental capacity management and patient flow issues that affect the entire organization Learn how advanced care planning tools can help address an initiative of the IHI: Transforming Care at the Bedside
3
“Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process
measures.”
Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007
4
Crossing the Evidence Bridge
Effective care planning
Visible communication to all stakeholders
Constituent based analysis
Strategic direction
Safety technology and culture
Tactical implementation
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Perfect Care Assessment Identifying the Opportunity
December 2007IHI National Forum92 responsesMD, RN, QA, Board
63%
41%
64%55%
Mistake ProofYour
Processes
OptimizePatient Flow
Adopt WholeSystem
Measures
TransformCare at the
Bedside
The higher the bar…the greater the opportunity!
% of “No” ResponsesThe higher the bar, the greater the opportunity
6
Perfect Care Assessment Identifying the Opportunity
63%
41%
64%55%
Mistake ProofYour
Processes
OptimizePatient Flow
Adopt WholeSystem
Measures
TransformCare at the
Bedside
% of “No” ResponsesThe higher the bar, the greater the opportunity
“No single tool can solve every problem; often, the answer will lie in the discovery, implementation, and execution of several tools.”Grout J. Mistake-proofing the design of health care processes. AHRQ Publication No. 07-0020. May 2007.
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Mistake Proofing Your Processes Recognition and Prevention of Failure Points
73%
51%
54%
74%
Barcodescanning
Patient safetyattributes
Visiblility tochanges in pt
status
Automated medreconciliation
% of “No” ResponsesThe higher the bar, the greater the opportunity
Online allergies and med history for each patient Rapid reporting of critical lab values“Five rights” barcoding
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Removing a Failure PointBarcode Scanning Technology
Quantifiable results─ 99.7% compliance with bar-code
scanning─ 39% increase in reporting of
medication errors and near misses─ 33% decrease in percentage of errors
causing harm─ 48% decrease in missed doses ─ 73% decrease in extra doses─ 63% decrease in wrong doses─ Enhanced charge capture─ Increased clinician satisfaction and
retention─ Increased productivity and efficiency─ $300,000 savings in transcription fees─ And on… and on…
Bedside barcode scanning of meds
Rapid adoption of technology
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“Dockside to Bedside”100% Barcoded Medication Management
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Perfect Care Assessment Identifying the Opportunity
63%
41%
64%55%
Mistake ProofYour
Processes
OptimizePatient Flow
Adopt WholeSystem
Measures
TransformCare at the
Bedside
% of “No” ResponsesThe higher the bar, the greater the opportunity
“A hospital is a great example of a complex adaptive system. You have a number of people who are making day-to-day, even minute-to-minute, decisions in their own microsystem … that impact hospital-wide patient flow, and they are making these decisions without access to information about the macro view, or what is going on in the rest of the hospital.”Kirk Jensen, MD, MBA, FACEP, IHI faculty member and co-author, Leadership for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved Bottom Line
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Optimize Patient Flow System-wide Visibility to Patient Status
One-to-one paper, verbal communications create delaysDepartmental “micro-delays”affect system-wide throughputLack of capacity impacts organizational success
38%
29%
61%
35%
Average EDhold time <4 hrs
ObservationALOS <24 hrs
Real timedischarge
orders
Real timecensus
% of “No” ResponsesThe higher the bar, the greater the opportunity
12
Visual Controls in Everyday Life
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Visual Controls in Healthcare
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Beds are full – supply & demand misaligned ─ ED diversions ─ Medical cases crowd out more profitable surgical cases
New Joint Commission standards around patient flow─ Patient bed space─ Efficiency and safety─ Support service processes
Mid-day bed crunch due to misalignment of admissions, discharges.
Late rounding, late test results, charts incomplete, poor discharge planning etc.
Peak Admission Period Peak Discharge Period
6a 7a 8a 9a 10a 11a 12a 1p 2p 3p 4p 5p 6p 7p 12a
Source: Advisory Board interviews and analysis, 2006.
Addressing the Challenge of Capacity and Throughput Management
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Enterprise Visibility Platform
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Scheduled discharge
Patient location (radiology)
Cleaning in process
Transport alert
Observation patient
Case manager alert
Results notification
Orders notification
Medications ready
Hold room for maintenance
Isolation
Pending discharge
Bed reserve communication
Patient safety alert
Reading the Display Board
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One Hospital’s Success$5.5M revenue increase within 6 months
Return on Investment analysis conducted by the Advisory Board - published June 2006
─ Improves bed turns by 19% ─ Expands overall acute care capacity by
12% ─ Reduce ED diversions by up to 60% ─ Reduce EVS staff by up to 20%
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Perfect Care Assessment Identifying the Opportunity
63%
41%
64%55%
Mistake ProofYour
Processes
OptimizePatient Flow
Adopt WholeSystem
Measures
TransformCare at the
Bedside
% of “No” ResponsesThe higher the bar, the greater the opportunity
“By looking at macrosystem and microsystem measures frequently—daily, weekly, or monthly—the organization can better monitor its performance, find improvement opportunities, and prevent quality levels from eroding without anyone noticing.”Whole System Measures, IHI, 2007
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Adopt Whole System Measures Meaningful Information to Sustain Improvement
Data rich, information poorIT investment should decrease manual collection – but doesn’tIncreasing regulatory requirements
72%
74%
46%
65%
Single "sourceof truth"
Constituentbased metrics
"Are we gettingbetter?"
Automated datacollection
% of “No” ResponsesThe higher the bar, the greater the opportunity
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Removing Data Silos
Medication safety analysis
Surgical cost & quality
Productivity and profitability
Patient safety
Grouping and reimbursement
Departmental initiatives
Hospital-wide initiatives
Source data integration
Data warehouse & healthcare applications
Publication & analysis of results
Scorecards
Graphs
Document links
Action Triggers
Control charts
Work lists
Information transparency
Actionable insight
Dashboards
Radar Charts
Financial DSS
HIS
Med administration
Surgery IS
Laboratory IS
Patient experience
Payroll
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Constituent-based Metrics
Highest level, composite metrics Month-over-month trendsLinks to accountable staff
C Suite, Board
Nursing Executive
Drill by unit, caregiver, drug, date, time, etc., so manager can take immediate actionMetrics updated after each shiftPrincipled action triggers
Quality Manager
Criteria-based review lists Streamlined case review
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Perfect Care Assessment Identifying the Opportunity
63%
41%
64%55%
Mistake ProofYour
Processes
OptimizePatient Flow
Adopt WholeSystem
Measures
TransformCare at the
Bedside
% of “No” ResponsesThe higher the bar, the greater the opportunity
“Patients say ‘They give me exactly what I want (need) exactly when I want (need it).”Rutherford, et al, Transforming Care at the Bedside, IHI, 2004
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Transform Care at the Bedside Evidence-based, Interdisciplinary Care Delivery
Automated plans that drive care deliveryIntegrated orders, documentation, assessments, etc.Prioritize activities based on patient progress
54%
46%
64%
55%
> 70% of time indirect pt care
Care plans integral to ptmanagement
Access toevidence at
bedside
Visible careplan
% of “No” ResponsesThe higher the bar, the greater the opportunity
24
PneumoniaPatient
Antibiotic 22 min. Overdue
Care Process AlertsCore Measure - Patient Monitoring
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“Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process
measures.”
Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007
26
Thank you!
How does your organization measure up?─ Take the Quality Care Assessment in McKesson booth #3035
Feb. 25-28 at HIMSS
Deborah Bulger [email protected]
Paul Gartman [email protected]