Quality Improvement and Performance Indicators

1. Quality Improvement and Performance Indicators Thalassemia Center Prepared by : Samah Darwazeh

2. Data Collection for Quality Monitoring The organization’s leaders identify key measures (indicators) to monitor the organization’s clinical and managerial structures, processes, and outcomes. ( QPS.3,JCIA 2005)

3. Data and Information • In health care, we are awash in a sea of data • We are data rich , but are also information poor

4. Data and Information • Data : Raw facts and figures collected as parts of the normal functioning of the organization . • Information : Data which have been processed and analyzed in a formal, intelligent way to make the data useful • Data are numbers; information is what numbers mean

5. Example • E.g. a sudden increase in the no. of patients who manifest certain symptoms of disease wont be deciphered ( difficult to understand) until this numerical increase is analyzed to determine true factors and causes .

6. Performance Indicators “What gets measured gets done” “If you measure it , you can improve it”

7. Performance Indicators • Indicators are numerical values that reveal the condition of a process –how well it is performing , or how present performance compares with past

8. Performance measurement Definition : • Is an indicator or quantitative tool that reveals an organization’s performance in relation to specific process or outcome.

9. Performance measurement ( indicators ) • In a very simple situation , you can improve performance without measuring or quantifying it . • E.g. No need for sophisticated statistical analysis to know that dim lighting in dispensary leads to medication error . • But, today , health care procedures are complex, and performance is not easy to measure

10. Quality Performance Indicators • Well defined • Variable • Measurable • Monitors quality of an important aspects of service

11. Well defined • Very clear and precise . • All staff will understand it the same way . No deviations in interpreting it . • E.g. ( Mortality rate, Morbidity rate , no. of C- sections with complications , waiting time for O.P.D

12. Variable • Cannot be fixed , but Should be a variable that changes and is affected by your performance

13. Measurable The indicator should be presented in either ways : No. e.g. ( no. of medication errors ). % e.g. (percentage of patient satisfaction ). Rate e.g. ( Morbidity rate). Ratio e.g. (Rate of nurses/patient in ICU) .

14. Monitor quality of an important aspect of a service Decide what is the important aspects of the service. Usually it should be linked to the out come or the effect on the customer whether internal or external

15. Types of quality performanceindicators • Based on the importance of activity , there are 2 types • of indicators : • Rate based indicators • Sentinel Even Indicators

16. Rate Based Indicator • Where you accept the variation • E.g. : Customer satisfaction indicator we may accept 90% and find it good • E.g. : Morbidity rate 1% may be acceptable and good .

17. Sentinel Based Indicator What is the Sentinel Event • Is an unexpected occurrence involving death or serious injury to the patients. • They need immediate investigation and response . • The terms “ sentinel event” and “medical error” are not synonymous; not all sentinel events occurs because of an error and not all errors result in sentinel events .

18. Sentinel Based Indicator In sentinel events ,we aim at zero defect i.e. the indicator should show 100% compliance otherwise we have a fault in our system process . E.g. : Blood transfusion should have 0% mistakes , we cannot accept even 1 mistake

19. Indicator Types • Structure indicator ( input ) • Process indicator ( System ) • Outcome ( out put )

20. Any Activity or function has the following Input Process output ( Outcome) (System ) ( Resources ) ( Structure ) (policy & procedures)

21. Structure ( input ) indicator • Related to the resources and facilities • e.g. the Ratio of nurses/bed; if my standard is to provide excellent patient care then the ratio of nurse/bed is an indicator • e.g. : 1/3, it is applicable everywhere or in Thalassemia could be 4/1. • choose the indicator that suits your standard to monitor it

22. Process Indicator ( system ) • Related to the system and procedures • E/g . Waiting time of patient in O.P.D • No. of lost or delayed files/clinic . • % of newborns discharged without circumcision • No. of medication errors/month • No. of incident reports/month

23. Outcome indicator Related to the outcome/results of the services that we offer • E.g. % of post operative infections. • Morbidity rate • % of patients satisfaction

24. Example : ( Surgical procedure ) Input/structure Indicator : No. of nurses /procedure. No. of operations done per room Process indicator : % of cancelled operations % of delayed operations Output Indicator : Mortality rate . % of complications Rate of post operation infection

25. Criteria for choosing performance measures ( indicators) in heath care • The organization will get lost in the endless maze of measurement opportunities. • No need to waste time and money measuring less important process while crucial procedures are ignored .

26. QPS.1.2 The leaders prioritize which processes should be monitored and which improvement and patient safety activities should be carried out.

27. How to choose ? • High risk areas • High – Volume areas • Problem –prone areas

28. High risk areas • Patients who are particularly vulnerable , fragile or unstable • Consider the risks involved in providing care to this group . • What potential results of failing to provide correct treatment .

29. High risk areas • What data will you need to gather ? How should you interpret them? • E.g. ( Trauma Care , Transplant patients , elderly population , HIV/AIDS patients .

30. High Volume areas • Comprises services that are offered frequently , or to large numbers of patients . • E.g. Admission procedures, patient education . • E.g. Demographics ( what population(s) does your organization serve ? Does your service targets particular age group or diagnostic category ?any particular treatment approach ?

31. Problem prone areas • Are those where, historically , procedures have produced unsatisfactory results . • Where are these problems located ? What are their causes?

32. Areas of overlap among these categories • Example : • Your organization may serve diabetic patients ( High- risk ) in great number ( high volume )and it maybe that outcomes for this population, while sometimes meeting expectations, are often poor ( problem prone )

33. Performance Measurement according to the JCIA • Clinical monitoring includes: • patient assessment • laboratory and radiology safety and quality control programs • surgical procedures • use of antibiotics and other medications and medication errors • use of anesthesia • use of blood and blood products.

34. Performance Measurement according to the JCIA • Monitoring includes: • availability, content, and use of patient records • infection control, surveillance, and reporting • procurement of routinely required supplies and medications essential to meet patient needs • reporting of activities as required by law and regulation

35. Performance Measurement according to the JCIA • Monitoring includes: • risk management • utilization management • patient and family expectations and satisfaction • staff expectations and satisfaction • patient demographics and diagnoses • surveillance, control, and prevention of events that jeopardize the safety of patients, families, and staff

36. Data Example

37. Keep It Simple Statistically

38. ..but make the DATA INFORMATIONAL

40. Indicator / Monitor

42. Preventable Adverse Drug Events

44. Staff HPPD* and Number of Falls *HPPD=Hours per patient day

45. Doses Control Chart

46. Surgical Care Unit JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Sick time per FTE 6.6 3.1 3.8 3.8 5.2 2.3 4.9 4.3 3.4 5.3 4.3 3.4 Vacancy % rate 14 14 23 23 20 5 12 11 8 12 10 12 Patient Satisfaction Pain Management 4.2 4.3 3.6 3.6 3.4 4.3 4.1 4.1 4 4.3 4.2 4.5 Falls per 1000 Pt Days 2 2 6 6 7 3 2 2 3 4 3 2 Matrix Example

47. Brainstorming After understanding the JCI required area of monitoring , and the priorities we discussed earlier . what do you think it should be monitored at the Thalassemia Center in each area ?

48. Thank You !