Worth a Thousand Words: Telling a Story with...

Worth a Thousand Words:Telling a Story with Data

Ari Robicsek, MD

Chief Medical Analytics Officer

Providence St. Joseph Health

A5/B5

Session Objectives

• Consider the challenges of representing patient safety data

• Develop an approach to designing strong data visualizations

These presenters have nothing to disclose

2

7 ‘A’s of actionable data

• Accurate

Accurate

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Effort

Bidirectionalvalidation

1. 2.

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

• Appealing (good looks draw in users)

© Jorge Gonzalezhttps://www.interaction-design.org/literature/article/bad-design-vs-good-design-5-examples-we-can-learn-frombad-design-vs-good-design-5-examples-we-can-learn-from-130706

© Nikki Syliantenghttps://www.interaction-design.org/literature/article/bad-design-vs-good-design-5-examples-we-can-learn-frombad-design-vs-good-design-5-examples-we-can-learn-from-130706

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

• Appealing (good looks draw in users)

• Aimed at the right person (no point creating a chief executive dashboard for a nursing unit leader, and vice versa)

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

• Appealing (good looks draw in users)

• Aimed at the right person (no point creating a chief executive dashboard for a nursing unit leader, and vice versa)

• Atomic (contains the deepest level of detail absolutely necessary for decision-making)

Where is my problem?What can I do about it?

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

• Appealing (good looks draw in users)

• Aimed at the right person (no point creating a chief executive dashboard for a nursing unit leader, and vice versa)

• Atomic (contains the deepest level of detail absolutely necessary for decision-making)

• Accessible (the four worst words in the English language…)

Carl Reinhold AugustWunderlich

https://en.wikipedia.org/wiki/Carl_Reinhold_August_Wunderlich#/media/File:Carl_August_Wunderlich.jpg

http://fad.northshore.org/wunderlich/

7 ‘A’s of actionable data

• Accurate

• Argumentative (i.e. Advances a hypothesis)

• Appealing (good looks draw in users)

• Aimed at the right person (no point creating a chief executive dashboard for a nursing unit leader, and vice versa)

• Atomic (contains the deepest level of detail absolutely necessary for decision-making)

• Accessible (the four worst words in the English language…)

• Arrives in time to do something about it

Big ideas for the system Inpatient Quality Dashboard

1. Employs data accuracy best practices (e.g. validation)

2. Clear visualizations with statistical discipline

3. Rapid comparison of different hospitals

4. Usable at system, market and hospital levels

5. Allows outcome and process metrics to be consumed together

6. Available ‘where users work’

Q2

A FRENCH PLOT

Current performance

A FRENCH PLOT

Trend

Q2

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g-1

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v-1

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r-1

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v-1

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7

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Statistical Process Control Chart

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v-1

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Statistical Process Control Chart

UCL

Avg

LCL

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v-1

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r-1

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Statistical Process Control Chart

7 in a row moving in the same direction

UCL

Avg

LCL

2 out of 3 on same side of centerline and 2 SD away

4 out of 5 on same side of centerline and 1 SD away

Beyond 3 SD (control limits)

8 in a row on the same side of the centerline

https://industryvisuals.w2pstore.com/product/safety-cross-mounted-on-magnetic-dry-erase-board/

Q2

Q2

Issues

• Look and feel

• Navigation hard

• Training

• Can’t see all nursing units at once

• Can’t see all metrics at once

Multiple Metrics View

• Multiple metrics, multiple hospitals

• “Stoplight”

• Current performance

• Performance over time

• Performance relative to target

Safe

C. diff 56 75 !

CAUTI 76 75

CLABSI 65 75 ●

SSI-Hyst 80 75

SSI-Colon 46 75

Falls w injury 71 75

Option 1

System Performance – Safe 4 / 5Option 2

System Performance – Safe 4 / 5

Trend

Option 3

System Performance – Safe

3 / 5target: 75

target: 66

target: 63

target: 58

target: 71

Option 4

Example: Accelerating improvement in hospital-acquired Clostridium difficile

85

After

Q4 2016 – Q3 2017

Before

Q2 2016 – Q1 2017

Locations

Vantage

Epic

A Tableau linkhttp://tableauserver.providence.org/#/views/SystemQualityScorecard/Overview?:iid=1

More Issues

• C-suites don’t go searching for data

• Data issues arise regularly

• Framing in the context of the goals of the organization

Toolbox for EveryonePay Attention to Detail (STAR, peer check)

Communicate Clearly (SBAR, repeat back, clarifying questions)

Have a Questioning Attitude (know why and comply, validate and verify)

Operate as a Team (brief, execute and debrief)

Speak Up for Safety (CUS, event reporting systems)

Tones for RespectSmile and greet others; sayhello

Introduce using preferred names and explain roles Listen with

empathy and intent to understand Communicate positive intent

of our actions Provide an opportunity for others to ask

questions

Prevent InfectionsExpect scrupulous hand hygiene

Use standard precautions and appropriate PPE for isolation

Conduct case reviews immediately when infections occur

Assist patient in maintaining personal and hand hygiene

Ensure comprehensive environmental cleaning

Eliminate CAUTIKnow the evidence-based indications for catheter use and only use when met

Insert catheter aseptically

Ensure catheter is secured

Perform appropriate catheter hygiene daily, and following fecal incontinence

Remove at earliest opportunity, no later than 48 hours unless otherwise indicated

Eliminate C. DifficileAvoid excess and inappropriate antibiotic use

Isolate and test early on suspicion of infection

Only test symptomatic patients where infection is suspected

Terminally clean room with sporicidal disinfectant at discharge

Eliminate CLABSIVerify appropriate indications for placement

At insertion, utilize maximal barrier precautions & sterile technique

Change dressing/tubing every 7 days or when integrity is breached

Flush the central line at least once every 12 hours

Verify justification for continuing central line daily

Eliminate Surgical Site InfectionsEstablish and maintain glycemic control targets (pre, peri, post)

Maintain temperature at 36 degrees C or above (pre, peri, post)

Conduct post-procedure pause to document wound class and skin closure

Ensure weight-based, appropriate dosing of antibiotics

Counsel for smoking cessation, at least for duration of wound healing

Reduce Sepsis MortalityDraw lactate level on suspicion of sepsis

Draw immediate blood cultures on suspicion of sepsis

Resuscitate with fluids 30 mL/kg over 1 hour

Administer antibiotics within 3 hours

Repeat lactate at 6 hours

Eliminate Falls with InjuryUtilize universal assessment & safety protocol for all patients

Implement interventions based on risk assessment

Share plans with patients, family and care team

Debrief with team immediately after every fall

Review medication regimen after every fall (pharmacy)

Prevent ReadmissionsComplete medication reconciliation at discharge and follow up

Ensure safe discharge with concise instructions and f/u hotline

Schedule f/u w/in 5 days (high risk) or 14 days (moderate risk)

Conduct follow-up call within 48 hours (high risk)

Provide d/c summary for transitions, warm handoff in high risk

Make Hospitals HealthierProvide goal-aligned care (focus on what matters to the patient)

Assess and support nutritional status

Minimize night-time noise, enable undisturbed sleep

Encourage exercise & staying out of bed

Ensure 24-7 family access and support for patients

Care CompassionatelyConduct hourly nurse rounding using specific compassion-based

behaviors Conduct leader rounding and immediate intervention with

patients

Make post-discharge calls with compassion-based behaviors

Implement clinician-led forums aimed at compassion-based support/burnout prevention

Use compassion and resiliency-focused interventions with clinicians at high burnout risk

Toolbox for LeadersMessage on the Mission (reflection/safety message, safety first in every

decision, stand up for those who speak up for safety)

Lead Reliable Operations (daily huddles including experience, top 10 lists)

Build Engagement, Accountability (5:1 feedback, fair and just accountability, round to influence)

Foster Teamwork (display unit-based results, learning boards, action plans)

CARING RELIABLY: IMPROVINGOUTCOMES AND MAKING IT STICK

CORE BEHAVIORS OF CARING RELIABLY

IMPATIENT HEALTH: CARE BUNDLES

INPATIENT SAFETY: CARE BUNDLES