Quality Improvement and Performance Indicators

Prepared by : Samah Darwazeh

Thalassemia Center

Data Collection for Quality Monitoring

The organization’s leaders identify key measures (indicators) to monitor the organization’s clinical

and managerial structures, processes, and outcomes. ( QPS.3,JCIA 2005)

Data and Information

In health care, we are awash in a sea of data

We are data rich , but are also information poor

Data and Information

Data : Raw facts and figures collected as parts of the normal functioning of the organization .

Information : Data which have been processed and analyzed in a formal, intelligent way to make the data useful

Data are numbers; information is what numbers mean

Example

E.g. a sudden increase in the no. of patients who manifest certain symptoms of disease wont be deciphered ( difficult to understand) until this numerical increase is analyzed to determine true factors and causes .

Performance Indicators

“What gets measured gets done”

“If you measure it , you can improve it”

Performance Indicators

Indicators are numerical values that reveal the condition of a process –how well it is performing , or how present performance compares with past

Performance measurement

Definition : Is an indicator or quantitative tool that reveals an

organization’s performance in relation to specific process or outcome.

Performance measurement ( indicators )

In a very simple situation , you can improve performance without measuring or quantifying it .

E.g. No need for sophisticated statistical analysis to know that dim lighting in dispensary leads to medication error .

But, today , health care procedures are complex, and performance is not easy to measure

Quality Performance Indicators

Well defined

Variable

Measurable

Monitors quality of an important aspects of service

Well defined

• Very clear and precise .

• All staff will understand it the same way . No deviations in interpreting it .

•E.g. ( Mortality rate, Morbidity rate , no. of C- sections with complications , waiting time for O.P.D

Variable

•Cannot be fixed , but Should be a variable that changes and is affected by your performance

Measurable

The indicator should be presented in either ways :

No. e.g. ( no. of medication errors ).

% e.g. (percentage of patient satisfaction ).

Rate e.g. ( Morbidity rate).

Ratio e.g. (Rate of nurses/patient in ICU) .

Monitor quality of an important aspect of a service

Decide what is the important aspects of the service. Usually it should be linked to the out come or the

effect on the customer whether internal or external

Types of quality performance indicators

Based on the importance of activity , there are 2 types of indicators :

• Rate based indicators

• Sentinel Even Indicators

Where you accept the variation

E.g. : Customer satisfaction indicator we may accept 90% and find it good

E.g. : Morbidity rate 1% may be acceptable and good .

Rate Based Indicator

Sentinel Based Indicator

What is the Sentinel Event Is an unexpected occurrence involving death or serious

injury to the patients.

• They need immediate investigation and response .

The terms “ sentinel event” and “medical error” are not synonymous; not all sentinel events occurs because of an error and not all errors result in sentinel events .

i.e. the indicator should show 100% compliance otherwise we have a fault in our system process .

E.g. : Blood transfusion should have 0% mistakes , we cannot accept even 1 mistake

In sentinel events ,we aim at zero defect

Sentinel Based Indicator

Indicator Types

Structure indicator ( input )

Process indicator ( System )

Outcome ( out put )

Any Activity or function has the following

Input Process output

( Resources )

( Structure )

(System )

(policy & procedures)

( Outcome)

Structure ( input ) indicator

Related to the resources and facilities

e.g. the Ratio of nurses/bed; if my standard is to provide excellent patient care then the ratio of nurse/bed is an indicator

e.g. : 1/3, it is applicable everywhere or in Thalassemia could be 4/1.

choose the indicator that suits your standard to monitor it

Related to the system and procedures

E/g . Waiting time of patient in O.P.D No. of lost or delayed files/clinic . % of newborns discharged without circumcision No. of medication errors/month No. of incident reports/month

Process Indicator ( system )

Outcome indicator

Related to the outcome/results of the services that we offer

E.g. % of post operative infections.

Morbidity rate

% of patients satisfaction

Example : ( Surgical procedure )

Input/structure Indicator :No. of nurses /procedure.No. of operations done per room

Process indicator :

% of cancelled operations

% of delayed operations

Output Indicator :Mortality rate .% of complications Rate of post operation infection

Criteria for choosing performance measures ( indicators) in heath care

The organization will get lost in the endless maze of measurement opportunities.

No need to waste time and money measuring less important process while crucial procedures are ignored .

QPS.1.2

The leaders prioritize which processes should be monitored

and which improvement and patient safety activities should be carried out.

How to choose ?

High risk areas

High – Volume areas

Problem –prone areas

High risk areas

Patients who are particularly vulnerable , fragile or unstable

Consider the risks involved in providing care to

this group .

What potential results of failing to provide correct treatment .

High risk areas

What data will you need to gather ? How should you interpret them?

E.g. ( Trauma Care , Transplant patients , elderly population , HIV/AIDS patients .

High Volume areas

Comprises services that are offered frequently , or to large numbers of patients .

E.g. Admission procedures, patient education .

E.g. Demographics ( what population(s) does your organization serve ? Does your service targets particular age group or diagnostic category ?any particular treatment approach ?

Problem prone areas

Are those where, historically , procedures have produced unsatisfactory results .

Where are these problems located ? What are their causes?

Areas of overlap among these categories

Example : Your organization may serve diabetic patients

( High- risk ) in great number ( high volume )and it maybe that outcomes for this population, while sometimes meeting expectations, are often poor ( problem prone )

Performance Measurement according to the JCIA

Clinical monitoring includes: patient assessment laboratory and radiology safety and quality control programs surgical procedures use of antibiotics and other medications and medication errors use of anesthesia use of blood and blood products.

Monitoring includes: availability, content, and use of patient records infection control, surveillance, and reporting procurement of routinely required supplies and medications essential to meet patient needs reporting of activities as required by law and regulation

Performance Measurement according to the JCIA

Monitoring includes: risk management utilization management patient and family expectations and satisfaction staff expectations and satisfaction patient demographics and diagnoses surveillance, control, and prevention of events that jeopardize the safety of patients, families, and staff

Performance Measurement according to the JCIA

..but make the

DATA

Adverse Patient Outcomes Data

UNIT JAN FEB MAR APR MAY JUNUnit 1

Falls/PD 9 5 14 6 8 5Med E/PD 8 5 9 4 7 5Restr/PD 2 1 3 3 2 3HA Dec/PD 2 3 2 4 1 2

Unit 2FallsMed ErRestr

Indicator / Monitor

Falls/Patient Days

012345

AU

G

SEP

OC

T

NO

V

DE

C

JAN

FEB

MA

R

APR

MA

Y

JUN

JUL

Medication Errors per 1000 Patient Days

05

1015

AU

G

SEP

OC

T

NO

V

DE

C

JAN

FEB

MA

R

APR

MA

Y

JUN

JUL

Preventable Adverse Drug Events

How they occur

Administration

34%

Dispensing4%

Transcription6%

Prescribing56%

Administration

Dispensing

Transcription

Prescribing

Overtime Hours

0

50

100

JAN

FEB

MA

RA

PRM

AY

JUN

JUL

AU

GSE

PO

CT

NO

VD

EC

A Mulitple Line Graph

0

2

4

6

8

10

AUG

SEP

OC

T

NO

V

DEC

JAN

FEB

MAR

APR

MAY JU

N

JUL

Falls/100 Patient Days HPPD Budgeted HPPD

Staff HPPD* and Number of Falls

*HPPD=Hours per patient day

Control Chart

Number of Medication Dispensing Errors per 1000 Doses

0

0.5

1

1.5

2

2.5

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG SE

P

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG SE

P

OCT

NOV

DEC

UCL

LCL

Mean

Doses

Surgical Care Unit JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Sick time per FTE 6.6 3.1 3.8 3.8 5.2 2.3 4.9 4.3 3.4 5.3 4.3 3.4

Vacancy % rate 14 14 23 23 20 5 12 11 8 12 10 12

Patient Satisfaction Pain Management 4.2 4.3 3.6 3.6 3.4 4.3 4.1 4.1 4 4.3 4.2 4.5

Falls per 1000 Pt Days 2 2 6 6 7 3 2 2 3 4 3 2

Matrix Example

Brainstorming

After understanding the JCI required area of monitoring , and the priorities we discussed

earlier . what do you think it should be monitored at the Thalassemia Center in each

area ?

Thank You !Thank You !