WHA Improvement Forum

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• WHA Improvement Forum
• For May ? ? ?
• Strategies for in-process Measurement
• ? ?
• Travis Dollak

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Todays Webinar Todays Webinar
Agenda Measurement as part of daily work Finding existing data vs. gathering data Improvement project data vs. continual monitoring data When can I stop measuring
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Measurement
Outcome Measures Process Measures Balancing
Measures Monitoring Measures
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The Process and Outcome Measure Relationship
Process improvement leads to outcome improvement,
but it can take time to see outcome results.
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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
• Dont 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
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
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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?

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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

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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
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
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Use Sampling

• Benefits
• 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/do
  cuments/1011/T4I202842920How20to20use20Trig
  ger20Tools2028Feb2020112920Web.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
Front-line Staff as Improvement Leaders Front-line Staff as Improvement Leaders
June 27 Noon Front-line staff perspective Levels of Involvement Strategies for Feedback
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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/PartnersforPatient
  s/PfPTools.aspx

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Thank You!

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