How many of you completed the sentence with
something like "painting by numbers!"
Show of hands? Zero. How many said "herding
cats?" Show of hands? 9 billion, 87 million,
837 thousand...you get the idea. Improving healthcare
is not easy...in fact, it is very hard work.
But like any job, the right tools can help you
be more efficient and effective. This article
will focus on the use of Statit piMD to help
make improvements based on comparisons.
How do we know when health care services are
"good"? Simply put, we must measure
those services. Performance activities are grouped
around quality assessment, assurance and improvement.
Assessment is the regular collection, analysis
and dissemination of information on the "health"
of the organization's processes and outcomes.
Assurance refers to the responsibility (external
or internal) to ensure that services necessary
to achieve agreed upon goals are provided. Quality
improvement refers to the activities around
the measurement of processes and outcomes of
healthcare and their comparisons against a standard.
Let's take, for example, an Oxygenation Assessment
measure from the Pneumonia core measure set.
Giving supplemental oxygen to pneumonia patients
within 24 hours prior to or after arrival at
the hospital has shown to decrease mortality
among patients. Our rolled up (all facilities
reporting), internal target for this measure
is 99%. An example of the Overall trend appears
below:
Although we are close, we are not quite meeting
our desired objective. And, even though the
process is in control, our overall trend shows
we have not met goal. This is a good time to
reiterate the importance of measuring data over
time. Measuring over time on a continuous basis
allows trends to be observed. Because pieces
of information are simply that - disconnected
pieces - the need to collect data over time
to observe patterns is critical to your performance
improvement initiatives. There are a number
of techniques that could be deployed. One such
technique is a simple, yet powerful one we call
the "Compare Table." Whenever we have
a Class variable defined in our data source,
Statit piMD will automate the process of "comparisons",
be they facilities as in our example, or by
unit, department, floor, physician, etc. The
compare analysis is used to ascertain differences
between the "classes." With our Oxygenation
Assessment measure in mind, let's take a look
at our Compare Table for all our facilities.
I chose to rank these by performance. Certainly,
it is easy to see that the Yachats facility
is having considerable challenges meeting the
target and therefore, bringing the score for
the entire organization down. We can see that
the Target Status indicator 
represents
an overall rate of less than our alarm (90%).
Additionally, the Quality Status column symbol
indicates
that their statistical performance is well below
all others. Given we have found the probable
cause of our less than desired results, the
next "drill-down" is to the specific
data and trend for the Yachats facility. By
clicking on the name Yachats in the Compare
table, we are presented with the following:
In our example, we have "allowed"
this process to remain stable although far below
our target or the performance of the other facilities.
As an example, let's go back retroactively and
make a comment and a plan for action for the
period, Q4-06. With our corrective action plan
in place, we will measure, statistically, whether
our plan for action is having the desired result.
We identified a "new phase" in the
following quarter: Q1-07. With these changes,
the output now looks like this:
Our new protocol/action plan has objectively
been proven to improve the process at the Yachats
facility. With this confirmation, our trend
for improvement at Yachats should continue.
As each period shows higher compliance, the
aggregated and overall performance will also
improve, allowing the organization to meet its
target.
Comparison techniques are like measuring our
children's height with a pencil on our kitchen
wall. Each "reporting period" we indicate
a line on the wall and the date. Without the
ability to compare that line with the previous
line for child 1 and if possible, compare that
line with the same time frame for child 2, the
lines become meaningless. The lack of ability
to make comparisons amongst our facilities,
departments, floors, physicians, etc., is analogous
to the famous line in Alice in Wonderland: "If
you don't know where you're going, any road
will take you there!"
You can learn much more about various performance
improvement ideas for comparison techniques
by going to http://piMD.statit.com.
Next issue, I will continue on the comparison
techniques through a process of comparing all
classes to all indicators on one page of output.
The power of simplicity through Statit piMD!
