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Lessons Learned for Creating a Process Improvement Performance Management System. Jay Ford, Ph.D. Director of Research, NIATx March 2010. Reduce Waiting & No-Shows Increase Admissions & Continuation. Some is not a number, soon is not a time. -- Don Berwick, MD. - PowerPoint PPT Presentation
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Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Reduce Waiting & No-Shows Increase Admissions & Continuation
Lessons Learned for Creating a Process Improvement Performance
Management System
Jay Ford, Ph.D.Director of Research, NIATx
March 2010
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Some is not a number, soon is not a time.
-- Don Berwick, MD
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Institute of Medicine Report• Promote patient centered care
• Foster the adoption of evidence based practices
• Develop and using process and outcome measures to enhance quality of care, and
• Mandate the use of quality improvement measures
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Improving the quality of care requires
• Identifying problem areas accurately
• Implementing creative interventions
• Understanding customer data needs
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Design Data Systems that
• Capture and track essential measures of performance and quality
• Teach staff how to collect, analyze and learn from data and
• Develop systems to support organizational data needs
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Is This Your Data System?
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Inquiring minds want to know• What factors were related to successful
adoption of process-focused data?
• What barriers were encountered developing data expertise and focus?
• What attributes do we need to think about when developing a data system?
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
PIPM Hierarchy of Needs
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
How Much Data to Collect?
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Key Lessons Learned: Data Collection
• Key process improvement variables are often not available (Date of first contact) or may not be adequately captured (e.g., no-shows) within existing systems.
• Conduct a data walk-through of your system to assess capabilities.– Identify currently available PI Data Elements– Flowchart of the provider submission process.– Evaluate the data submission instructions– Pilot test the process with a small sample of
records
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Data Walk-through Questions
• Could the data easily be pulled from the state system?
• What barriers were encountered?• How complete and accurate was the data?• Were there significant missing gaps in the
data?• Did you notice any errors in the data?• Write-up and share the lessons learned
with key stakeholders.
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Is this Data Quality?
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Key Lessons Learned: Data Quality
• Establish a process for verifying and checking data accuracy.
• Failure to verify data entry for accuracy will limit the validity of performance management feedback reports related to process improvement.
• Approaches toward ensuring data integrity include – Automatic linkages (e.g., Washington)– Built-in quality checks (e.g., Ohio and Maine)– Feedback mechanisms (e.g., New York, South
Carolina and Oklahoma and – Ongoing training and technical assistance
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Examples of Ongoing Training and Technical Assistance
• Oklahoma created a Data Integrity Review Team (DIRT) to provide on site review and technical assistance on all data issues for any provider.
• Maine created a change team to monitor data and performance of the contracted agencies and developed FAQs.
• New York developed a series of data entry and report analysis training modules for the STAR-QI system.
• Ohio offers technical assistance and follow-up through site visits, telephone calls, or conferences.
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
What type of Feedback?
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Comparative Feedback
• Organizational Performance versus – a target (internal) or – a benchmark (external)
• Types of comparisons– Internal comparisons over time– External performance comparisons to other
similar organizations– External performance comparisons to other
agencies within a state
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Comparative Feedback
• Measurement Comparisons– Performance vs. Outcomes– Business Process vs. Treatment
Performance/Outcomes Importance of comparisons
• Types of Feedback Reports– Data Quality– Performance Reports– Pay for Performance
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Comparative Feedback
• Understand the whole picture
• Select a few key outcome measures
• Use of reports to guide questions
• Benchmarks vs. Targets
• Focus on the comparison (internal vs. external)
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Key Lessons Learned: Performance Management
• Do not skimp on data quality efforts.• Ensure access to all persons who need the
reports. • Create performance feedback loops that
include, not isolate, the provider data coordinators.
• Provide only reports that help providers effectively use data to make decisions.
• Use pictures or graphs, but remember: one graph, one message.
• Update reports over time as data is corrected.
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
State Examples• New York generates data warehouse reports by
provider or in the aggregate.• Ohio links STAR-SI performance measures to
departmental Performance Target Outline (PTO).• South Carolina facilitates provider comparisons by
preparing & disseminating monthly comparative reports.• Maine provides public access to the TDS reports and
allows agencies to access the secure system and to request specialized reports.
• Oklahoma provides feedback through the Integrated Client Information System (ICIS), allowing monthly access to feedback reports.
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
Key Lessons Learned: Pay for Performance
• Building the system
• Pilot testing
• Offering the right type of incentive
• Overcoming potential obstacles
• Implementing strategies for long-term success and sustainability
Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net
For further information, please visit
www.niatx.net
www.odmhsas.org/data
Contact Information
Jay Ford, [email protected]
Mark [email protected]