Barbara Rebold attended the 2018 National Association for Healthcare Quality Next (NAHQ Next) conference in Minneapolis from November 4 to 7, 2018. The articles below summarize the lessons learned at the conference.
Patient Safety
Managing the Patient Safety “Other” Event Category:
Phyllis Ragland, RN, CPHQ, CPPS, a Clinical Patient Safety Adviser from American Data Network PSO presented on what they are seeing in the 13,000 events reported to their PSO in the Other Event Category. Phyllis shared that there are nine event types called Common Formats created by the Agency for Healthcare Quality to be used by patient safety organizations (PSOs). Eight are specific and the ninth category is Other. PSOs are finding the highest volume to be in the Other event type. ADNPSO did an analysis of 500 other events, created subcategories and then reanalyzed over 1200 additional events that had used the new subcategories. Using the preventability question in the common formats, the analysis revealed that 62% of the other events almost certainly or likely could have been prevented. Notably, Other events that resulted in death was 2.9% higher than all events together. The majority of these were codes or unexpected deaths that occurred in medical-surgical units. They found that specimens was now a top category. They also found events miscategorized that should have been reported in the Falls, Surgery, or Medication cateogries. Some specific subcategories they used were Against Medical Advice (AMA) and Leaving without Being Seen (LWBS) which they defined respectively as as already in or admitted and being cared for but left and checked in to clinic or ER but not there when you call them.
Quality
Once Upon an A3- Problem Storytelling and Root-Cause for Maximum Impact:
Sara Butz, MBOE,RHIA,CCDS,LSSBB,CPHQ, Director of Performance Improvement for Knox Community Hospital presented on how she uses A-3 to keep her PI program organized and effective. A-3 is an 8 step PDCA that should fit on an A-3 piece of paper. It was used by Toyota to structure their problem solving and continuous improvement efforts. It is called A-3 because it is a one-page tool which is the code for that size of paper. Sara shared that she believes the beauty of the tool is that it forces the user to be succinct. In her description of how she uses the A-3, she shared how she combines methods from PDSA, Lean, Root Cause Analysis and estimations of cost savings. She advised that it is important to look at the size of the problem and she shared a crosswalk of PDSA to DMAIC to A-3 to 8D/PSP.
801 (VC) Stay on Track: Using Dashboards and Scorecards in Healthcare Analytics:
Nidia Williams, Vice President, Operational Excellence presented on their journey to Dashboards and Scorecards at Lifespan. They changed from a chief quality officer model with no direct staff and all hospitals decentralized. They convinced IT that they needed software developers and informatics staff in their department due to the need to be out of the total IT development queue so that they could respond to data needs more timely, be flexible, able to change and able to update metrics frequently. This required improvement of relations with IT and development of new processes. They used the NAHQ competencies to have improvement staff do self-assessments and created new job descriptions. Then, they sent staff for training. She explained that Scorecards are for high-level information that they established first. Dashboards are for operational decisions. In their Operational Excellence department, one of the analysts is assigned for each dashboard and another analyst is assigned to be their back up to cover for when the lead analyst is not available. Currently they do all dashboards using Microsoft Excel with macros. She emphasized that the priority is to create the infrastructure for dashboards before moving to a dashboard software package. In their dashboards, they have found it to be very important to provide an indication of which direction is better and provide comparable data. Most of the data does not come from the medical record but from operational information such as pharmacy systems, laboratory systems and cost accounting systems. They have found the dashboards to be useful to their steering committee to prioritize projects.
Note on 306 Quality Reporting 2019: What Lies Ahead:
Zahid Butt, MD from Medisolv and Deborah Krauss from CMS presented an update on 2019 quality reporting requirements. Dr. Butt reminded the audience of Dr. Avedis Donabedian’s framework for quality measurement, structure + process = outcomes. CMS is moving rapidly to outcomes measurement to support value-based purchasing. He advised that you need structure and process to get to outcomes. The CMS quality reporting programs include the hospital inpatient quality reporting program (HIQR), the hospital readmissions reduction program (HRRP), the hospital value based purchasing program (HVBP) and the hospital acquired conditions reduction program (HACRP). CMS has begun a “patients over paperwork” initiative. There are major changes in the inpatient quality reporting process. CMS is removing measures. Three factors were emphasized by Dr. Butt, Factor 1-which he calls is everyone doing well?, Factor 5-he related to reshuffling the deck, is a more effective measure available and Factor 8-is the juice worth the squeeze? Or is the burden of collecting this measure justified by the results or reporting it?