South Carolina Association for Healthcare Quality

1. South Carolina Association for Healthcare Quality Using Data to Drive Organizational Improvement July 11, 2008 Bryan Bowles, Client Executive Premier Healthcare Informatics

2. Dimensions of Performance Improvement We have identified best practices across nine dimensions of performance improvement found in top performing organizations. • Staff • Information • Process • Incentives • Accountability • Culture • Organization • Leadership • Strategy The use of data is seen throughout each dimension

3. Below Average Above Average Critical Average Exemplary Competing priorities Minimal use of data/few improvements Potential conflicts Basic processes Several clear successes Some physician champions Clinical care not a focus Inadequate tools and resources Not engaged in activities Clinical care high priority Repetitive successes Incentives aligned Strategic imperative Center of Excellence Organizational integration Peer-Based Dimensional Rating

4. CultureValues; environment for achieving excellence; team approach Best Practice • Performance Improvement (PI) permeates all aspects of the organization operations, a part of daily activity • Readily accepting of change • Data driven mindset • Organization participatory/team oriented • Physicians actively engaged in change process • Alignment in physician and hospital incentives • Open and objective evaluation of problems leads to improvements that are widely felt • Activities are performed in a collaborative and multidisciplinary manner • Proactively improving patient safety

5. OrganizationInfrastructure to support information flow, decision making, and problem resolution; role of the Board and leadership team; vision for quality Best Practice • Board receives comprehensive reports and is actively engaged in discussions about care delivery and quality • Executive team devotes a substantial share of time to evaluating and improving care delivery • Single organization body for driving PI • Clinician executive responsible for oversight of care delivery; CMO reports to the CEO and the Board • Programs integral to management of care are centralized and aligned under physician leader • Staff and resources that support measurement and management of quality and efficiency are aligned under single leadership • Patient Safety integrated into PI

6. Administrative LeadershipThe characteristics of leadership team: setting vision, commitment to quality; alignment across organization Best Practice • Board plays an active role in PI and Care Management initiatives • Leaders set clear consistent vision for quality • Creates strategies, systems and methods and provides resources for achieving excellence in patient care • Holds individuals/groups accountable for results • Measurable clinical quality targets defined, included in strategic plan and linked with operational goals and incentives • Leaders set future direction, align staff and establish a collaborative environment for care delivery management • Leaders show patient safety is a top priority

7. Physician LeadershipThe characteristics of leadership team: setting vision, commitment to quality; alignment across organization Best Practice • Physician leaders aligned with Admin Leaders & Medical Staff • Effective communication, conflict resolution, negotiation, and fiscal planning • Respected by other physicians; engages other physicians in Care Management initiatives • Formal physician leadership training • Good pool of physicians for leadership • Physician champions participate in PI/Care Management • Data widely viewed as important to improving practice • Initiates interventions tied to Care Management strategies

8. StrategyCompetitive plan; approach to market; priorities; internal and external communications Best Practice • Market positioning moves from financial to clinical outcomes and perception of quality sets the foundation for future market growth • Strategic planning/priority setting is integrated effort • Operational priorities emphasize quality and efficiency as key elements of organizational growth • Goals and priorities are based on clinical and financial metrics (measurable financial and quality targets) • Clinicians are involved in strategic planning • Strong consensus around priorities and goals • Strategic plan is communicated throughout the organization

9. StaffOpportunities for growth; staff training and competence; consistent policies and procedures Best Practice • Expertise in all areas defined in scope of services • Roles, responsibilities and accountabilities are defined and support scope of services • Sufficient resources are allocated to care delivery oversight to support measurement, analysis, and care management • Understands and drives Care Management and PI strategies and initiatives • Data analysts are proficient in statistical analysis and presentation of data • Experienced data analysts throughout organization

10. InformationQuality, accessibility, and communication of data/information Best Practice • Information systems in place to collect essential information, and to support reporting to stakeholders and application at point of care • Comprehensive, risk-adjusted clinical and financial data available and routinely used in evaluating and improving performance • Reports include statistical data for clinical processes and outcomes • Data driven culture where clinical and quality information is used to prevent problems • High level of confidence in the accuracy and completeness of clinical and financial data • Information is systematically communicated throughout the organization

11. ProcessTools and methods for developing policies, procedures, protocols; PI model; process for monitoring and communicating performance; analysis and actions taken to improve processes and performance Best Practice • PI model delineated and staff trained on quality tools and techniques • Systematic processes for establishing and communicating goals, evaluating baseline performance, identifying improvement opportunities, implementing interventions, evaluating effectiveness • Interventions consistently integrated into core processes • Coordinated process for identifying and achieving best practice at the point of care, reducing variation, patient population based vs. individual case review • Physicians provided feedback on practice patterns • Extensive Policies/Procedures for all aspects of PI

12. Outline the structure for priorities

13. IncentivesMethods to motivate and drive individuals/groups to achieve goals Best Practice • Departments, physicians and staff incentives are based on overall system performance • Use of a link/nested balanced score card at departmental and management levels with weighted priority given to satisfaction, quality, financial and staff development • Alignment of physician and hospital incentives around organizational goals • Financial recognition in place for staff and physicians who act to improve success of system

14. AccountabilityHow results are achieved and mission/vision fulfilled Best Practice • Clear accountability established for achieving clinical and financial improvement targets • Board reporting of progress on clinical improvement • Initiatives supported by organizational structures with evaluation and feedback loops established • PI activities consistently achieve improvement goals • Clinical performance and cost reductions associated with decreasing variation in practice are factored into fiscal budgeting process • Operational accountability centralized for all departments supporting care management (quality/outcomes management; care management/utilization management; clinical decision support, infection control, safety) • Achieves best practice changes across physician departments

15. Pathway to Performance Excellence

16. Clinical Case Study Model • Identify areas of focus to improve patient care • Risk-adjusted and benchmark data can be used to accelerate clinical performance improvements by identifying: • Patient populations with worse than expected outcomes (opportunity analysis) • The core clinical processes driving outcome deviations • Improve Clinical Hypothesis Testing and Data Mining skills of Clinical and Data Analysts. • Introduce new data and methods to the physician, clinical, and administrative leaders in the hospital.

17. Characteristics of a SuccessfulCase Study Team • Administrative sponsor to charter the team and remove barriers • Clinical champion to drive the process and engage clinicians • Analyst team (primary user who understands the clinical topic, key user to provide detailed data drills) • Multidisciplinary clinical and operational team to evaluate data, generate hypotheses, plan improvement actions • Dedicated time for team work within a defined period (e.g., 3-6 months) • Celebrate successes and measure value

18. The Role of the Analyst Team • Prepare the opportunity analysis and work with clinical leaders to determine case study topic • Refine the analysis population definition with the clinical leaders • Provide preliminary data analysis for case study topic • Discuss findings with clinicians to help refine the preliminary analysis • Present preliminary analysis to clinical team • Provide additional analysis as needed to support the clinical team

19. The Role of the Clinical Team • Review preliminary data, provide clinical insight and generate hypotheses to drive further data analysis • Provide guidance to analysts during data generation sessions, if needed • Review focused data and generate more clinical insight • Review findings and recommendations and develop an action plan for improvement strategies patient care • Implement the action plan

20. Measuring Value • As improvement needs are identified through the case study activities, quantify the potential savings (i.e., lives, days, $$) • Follow-up as improvement actions are taken to quantify actual savings and value • Critical to communicate success to the organization • Create a value impact report to illustrate gains

21. Questions to ask • Are our activities aligned with the organizations goals? • Do we have the right information to gain credibility? • Do we have the right resources for project work? • Do we have a defined process to run PI projects? • How do we measure and communicate progress? • Do we set defined timelines and milestones for projects? • Are we spending time on non value added activities?

22. Thank You! Questions? Contact Information: Bryan Bowles Premier Healthcare Informatics bryan_bowles@premierinc.com 704.733.5233