Using Dashboards to present data to your Board: Quality and Patient Safety

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Using Dashboards to present data to your Board
Quality and Patient Safety

• Aunyika Moonan, PhD, MSPH, CPHQ
• SCHAs Director of Quality Measurement Services
• SC AHQ, May 9, 2008

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Objectives

• What is a dashboard?
• Making the case why boards need to be on board?
• How do you get your board to improve quality and
  patient safety?
• What data do you include in dashboards?
• Which performance improvement tools do you use
  with the board?
• How do you present your data to the board?

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Purpose of a dashboard?

• A dashboard is a powerful took to keep leaders
  focused on the organizations key issues and
  strategies. Well-chosen performance indicators
  displayed at a glance format help identify areas
  that are doing well and need improvement.
  Dashboard can include indicators such as
  financial viability, clinical outcomes, patient
  safety, quality of care or satisfaction rates.

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Use of a Dashboard

• Focus senior executives attention
• Link to organizations aims/goals and strategic
  plan
• Few pages
• Show Improvement

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Board Leadership is a critical ingredient to
achieving better, safer care Survey link better
outcomes are associated with hospitals where...

• 1. The board spends gt25 of time on quality
  issues(p 0.009)
• 2. The board receives a formal quality
  performance measurement report (p0.005)
• 3. There is a high level of interaction between
  the board and the medical staff on quality
  strategy (p0.021)
• 4. The senior executives compensation is based
  inpart on QI performance (p0.008)
• 5. The CEO is identified as the person with the
  greatest impact on QI (p0.01)
• Kroch et al. Hospital Boards and Quality
  Dashboards. J Patient Safety. Volume 2, Number
  1. March 2006

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SoHow do you get your Board to improve quality
and patient safety?

• Board Recruitment Choosing Board members with
  the right stuff
• Education Educate the board
• Bader and Associates Governance Consultants.
  Great Boards, Spring 2006, Volume VI, No.1

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How do you get your Board to improve quality and
patient safety?

• Measurement Use measures to focus broad work on
  what important
• 4. High Expectations Pursue perfection
• Recognition and Rewards Recognize and reward
  excellence

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How do you get your Board to improve quality and
patient safety?

• 5. Culture Promotion Pay more attention to
  culture
• 6. Board Time Exercise leaders powerful
  influence
• Recognition and Rewards Recognize and reward
  excellence

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What type of data do you include?Boards ask two
types of questions about quality and safety
Forward slides adapted from James L. Reinertsen,
M.D Boards, Dashboards and Data (IHI)
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Purpose of Measurement Research Comparison or Accountability Improvement
Key question What is the truth? Are we better or worse than? Are we getting better?
Measurement requirements and characteristics Complete, accurate, controlled, glacial pace, expensive Risk adjusted, with denominators, attributable to individuals or orgs, validity Real time, raw counts, consistent operational definitions, utility
Typical displays Comparison of control and experimental populations Performance relative to benchmarks and standards Run charts, control charts, time between events
Adapted from Solberg,Mosser, McDonald Jt Comm J Qual Improv. 1997 Mar23(3)135-47. Adapted from Solberg,Mosser, McDonald Jt Comm J Qual Improv. 1997 Mar23(3)135-47. Adapted from Solberg,Mosser, McDonald Jt Comm J Qual Improv. 1997 Mar23(3)135-47. Adapted from Solberg,Mosser, McDonald Jt Comm J Qual Improv. 1997 Mar23(3)135-47.
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Example of an answer to How good is our care?
Compared to others
Hospital could be green but still worse than
median of comparison group
Date of this report is October 24, 2006
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Another example of How do we compare? Hospital
Adverse Events per 1,000 Patient Days
Using IHI Global Trigger Tool
Our Hospital, May 2007
Current IHI Best
IHI Average
5
100
40
150
0
25
50
75
125
Number of Adverse Events per 1,000 Patient Days

• Adverse Events Include (but are not limited to)
• Allergic rash
• Excessive bleeding, unintentional trauma of a
  blood vessel
• Respiratory depression requiring intubation due
  to pain medications
• Hyperkalemia as the result of overdose of
  potassium
• Lethargy/shakiness associated with low serum
  glucose
• Drug-induced renal failure
• Surgical site infection, sepsis, infected lines,
  other hospital-acquired infections
• Internal bleeding following the first surgery
  and requiring a second surgery to stop
  
  
  
  
  the bleeding
• Atelectasis, skin breakdown, pressure sores
• DVT or pulmonary embolism during a hospital stay

Source Roger Resar, John Whittington, IHI
Collaborative
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What Boards should know about data on How good
are we and how do we compare to others?

• Upside
• Often risk adjusted
• Apples to Apples
• Source of pride
• Source of energy for improvement

• Downside
• Time lag
• Static
• the data must be wrong
• you become complacent
• How you look depends on how others perform
• Standards and Benchmarks are full of defects

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Recommendations for Board use of How do we
compare to others?

• Ask this question to help you set aims, but dont
  use these sorts of reports to oversee and guide
  improvement at each meeting.
• Compare to the best, not the 50th tile
• Always make sure you know how Green is
  determined

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Boards ask two types of questions about quality
and safety

• How good is our care?
• How do we compare to others like us?
• Is our care getting better?
• Are we on an acceptable track to achieve our key
  quality and safety objectives or do we need to
  change direction?
• If not, why not? Is the strategy wrong, or is it
  not being executed effectively?

Where dashboards and scorecards can be helpful to
boards
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What data should you include to your board?The
Board question are we going to achieve our
aims? requires management to have a strategic
theory
Big Dots (Pillars, BSC) Drivers Projects (Ops Plan)
What are your key strategic aims? How good must we be, by when? What are the system-level measures of those aims? Down deep, what really has to be changed, or put in place, in order to achieve each of these goals? What are you tracking to know whether these drivers are changing? What set of projects will move the Drivers far enough, fast enough, to achieve your aims? How will we know if the projects are being executed?
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Example Dashboard for Harm(for 5M Lives Campaign)
Board
System Level Measure Global Harm Trigger Tool
Projects High alert meds, surgical
complications, pressure ulcers, CHF, MRSA
Drivers Handwashing, culture of discipline, and
teamwork
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Performance Improvement Toolsto use with the
Board

• Run or Trend Charts
• Control Charts

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Control Chart

• Statistical Process Control-dynamic view
• Types of Variation
• Common Cause Variation-points between control
  limits in no particular pattern normally
  expected from process
• Special Cause Variation-arises form sources not
  inherent in process points outside limits,
  exhibit special patterns

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67-71
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Control Charts
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No display over time
Mix of system, project measures
Mostly comparison measures
Low standards for Green
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Is our quality and safety getting better?Are we
going to achieve our aims?

• To answer these questions for Boards
• The aims should be clearly displayed and
  understood
• A few system-level measure(s) and drivers should
  be graphically displayed over time
• The measures should be displayed monthly, at
  worst, and should be close to real time
• Measures of critical initiatives (projects that
  must be executed to achieve the aim) should be
  available if needed to answer the Boards
  questions

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Data to includeThe full Board should review the
System-level Measures (Big Dots.) The Board and
mainly the Board Quality Committee should review
both the System-level Measures and the Key
Drivers of those Measures. Occasionally, but not
often, the Board will need to see measures of Key
Projects, but these are generally the
responsibility of management to oversee and
execute.
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Common Flaws in Dashboards

• No system-level measures or aims
• Hodge-podge of system, driver, and project
  measures
• Static measures
• Too many measures
• Mixture of How do we compare to others and are
  we getting better? measures
• Low, unclear standards for green

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Summary of Best Practices for Quality and Safety
Dashboards for Boards

• Separate the two types of oversight questions
• How good is our quality? How do we compare to
  others?
• Are we getting better? Are we on track to achieve
  our aims?
• Ask the comparison question annually, when
  setting quality and safety aims. Avoid use of
  comparative data to track improvement.
• Frame your aims with reference to the theoretical
  ideal, and to the best in the world, not to
  benchmarks

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Summary of Best Practices for Quality and Safety
Dashboards for Boards

• Ask the improvement question at every meeting,
  and track with a dashboard that shows real-time
  data on system level and driver measures
  displayed on run charts
• Demand that management develop annual quality and
  safety aims
• Do not put project-level measures (often about
  one unit, disease, or department) on the Boards
  dashboard but have it prepared in case they ask

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Data Presentation to the board

• Great data presented poorly will
• not achieve your goals!
• Include
• Magnitude
• Direction
• Variability
• Rate
• Quick and easy format- callouts, annotate
• Provide conclusions with your data
• Connect data to organizational strategy

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• Aunyika Moonan
• SCHAs Director of Quality Measurement Services
• 803-796-3080
• amoonan_at_scha.org