MHA Keystone Center forPatient Safety & Quality

Chris George, RN MSProject Manager, MHA Keystone Center

cgeorge@mha.org517-886-8404

www.mhakeystonecenter.org

Jill A. Marsteller, PhD, MPPAssistant Professor, Dept. of Health Policy and Management

Johns Hopkins Bloomberg School of Public Healthjmarstel@jhsph.edu

410-614-2602

Session Objectives

At the conclusion of the webinar, participants will:– Understand the purpose of completing the

Monthly Team Check-up Tool (MTCT) – Understand how to enter the MTCT into Care

Counts– Have an awareness of reports that are available to

them in Care Counts– Know how to access help using the system

Purpose of MTCT

Purpose• Helps to monitor progress of CUSP steps and

CLABSI reduction steps• Identifies activities of teams and elements of

team context that influence performance• Helps identify barriers in teamwork and

communication to guide corrective action

Why do we use the MTCT?

• Variability in site performance• Need for information about what’s going on onsite• Have/how have other collaboratives monitored

progress and context?• Testing the MTCT

– Good reliability (temporal stability); good responsiveness; construct validity was demonstrated; tool demonstrated convergent and divergent validity of the MTCT barriers

• Focus groups about the MTCT

TCT and Successful CQI Implementation

Five months of Keystone data, Mar-Jul 05 More frequent senior executive meeting was

associated with lower CLABSI rates (IRR=0.76, p<0.001).

Not enough leadership support from executives was associated high CLABSI rates (IRR=2.84, p=0.001)

Inability to work together was associated with higher CLABSI rates (IRR=3.11, p=0.037)

TCT and Successful CQI Implementation

Adventist data, Mar 07 - Feb 08 Educational activity “infection control visit/talk”

was associated with higher CLASBI rates (IRR=2.44, p=0.012)

Appropriate hand hygiene was associated with lower CLABSI rates (IRR=0.41, p=0.019)

TCT and Successful CQI Implementation

Adventist data, Mar 07 - Sep 08 ICU teams with a majority of TCTs reporting work

distractions were less likely to perform full-barrier precautions (coef.=-0.13, p=0.034) and remove unnecessary lines (coef.=-0.14, p=0.009)

Key Points: MTCT Completion

• The team leader completes the tool monthly ideally with input from the team at a team meeting or individual conversations with team members

• Answers to MTCT questions are based on previous month’s experience

• Use a separate MTCT for each unit participating in the hospital

Care Counts Log-In Screen

www.mhacarecounts.org

If you forget your password, click on Forgot your Password. You will

need to know your username. If you need

help, contact Nicole Smith (nsmith@mha.org) or 517-

886-8437.

Change Password and Data Entry

ICU Home Page

Select Team Check-Up National

Select Correct Unit

Verify Month and Year

Select Team Activities

Compliance with Checklist

Learning from Defect Activity

Barriers and Spread

Team Cohesiveness

Error Messages

You must answer the questions marked with an error icon

before the data will be accepted.

Click Save when you have answered the questions marked with an error icon.

Data Successfully Saved

If data is saved successfully, you will automatically be returned to the data entry screen.

Running Reports

Select Unit

Select Timeframe

Some Reports Allow Roll-up Feature

Reports Are Exportable

Exporting to excel allows you to work with the data. PDF creates a printer friendly view

Monthly Team Check-Up Tool Common Barrier and Team Activity Report Examples and Descriptions

Note: Common Barriers are included in these reports when teams answer “yes” or “to some extent” as to whether those issues were a barrier that month

Report Name: Common Barriers Description: Reports the percentage of time each category was seen as

a barrier to team progress• Use this report to:

– View barriers for a specific time period (e.g. last quarter of 2009)– View barriers by individual unit or select specific units and roll-up data

Common Barrier Report

Barriers Over Time Description

Report Name: Common Barriers to Team Progress Over TimeDescription: Reports the percentage of time each category was

seen as a barrier to team progress with comparison to the sponsor (state collaborative) or peer group

• Use this report to:– View barriers for an individual unit over several months– Compare barriers to those reported by a peer group or your sponsor (state

collaborative)

Barriers Over Time Report

Barriers to Progress One Time Period

Report Name: Common Barriers to Team Progress One Time PeriodDescription: Reports the percentage of time each category was seen as a

barrier to team progress with comparisons to a peer group or sponsor (state collaborative) data during a specified timeframe

• Use this report to:– View barriers for an individual unit for multiple months at a time (example: view one

quarter as a single data point)– Compare barriers to those reported by a peer group or your sponsor (state collaborative)

data for the same time period

Barriers One Time Period

Team Activities Report Desc.

Report Name: Team ActivitiesDescription: Reports monthly team check-up data, can be rolled up for

multiple months at a time and can be rolled-up for multiple units at a time

• Use this report to:– View several months of completed Monthly Team Check-Up Tools by individual units

at one time to see progressions in activities, how often meetings are being held, and data is being shared etc.

– View roll-up information for multiple units over several months to see a summary of activities taking place. In a roll-up of units, you will see a percentage of how many units reported each individual barrier to be an issue. Roll-up data can be useful for situations where there are multiple units participating, but should be used with caution as there can be tremendous variation between unit activities even with the same executive sponsor.

Team Activities Report

Team Activities, cont’d

Team Activities, cont’d

Team Dynamics

Viewing Multiple Units Description

Report Name: Team Activities-One Month-Multiple UnitsDescription: Shows data for multiple units for a one

month timeframe• Use this report to:

– View multiple units in a hospital or system on a monthly basis instead of viewing each individual report in Care Counts

Viewing Multiple Units Report

Questions?