While measuring is a requirement for process improvement, it’s not the end goal.
Identifying the necessary reports, in and of itself, does not automatically translate to an improved patient experience as revealed in February 2015 by two JAMA articles. Both failed to find significant difference between hospitals who had implemented the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) and those who had not. As it turns out, the act of adopting frameworks to measure and report does not change the rate of improvement.
Donald M. Berwick, MD, MPP writes in an accompanying JAMA editorial:
“The authors of both reports in this issue of JAMA struggle to explain their findings, troubled as any sensible person must be by the suggestion that knowing results would not help caring, committed clinicians and organizations improve their results.”
In order to improve, individual behavior needs to change. Here are three essential report “qualities” to better connect measurement with behavior change, and thus improve the patient experience.
While hospitals and surgery centers may have access to “reports”, not all reports are equal. Timing is everything, and receiving monthly reports is less than ideal when trying to improve process. When available any time, however, analytics provide a mechanism for immediate accountability and drive more intelligent behavior change. At the end of every day, we need to easily evaluate our performance and, where necessary, make changes for the next day.
With real-time analytics, the managers and directors are informed with objective data allowing them to intervene before emotions and incorrect perceptions create division or erode culture within the team. What was today’s on time start rate? Why were cases late? How many patients waited over an hour past their scheduled start time? What was the average turn over time in the OR 6 today? With real-time analytics, managers are able to approach surgeons before there’s an opportunity to complain. This type of information, delivered in an easily consumable format, empowers the directors to have confidence their data-driven decisions are supported in real-time. And that’s a big deal for tomorrow’s patient. There’s no waiting for improvement.
2. Granular, Interactive, and Individually Comparative.
Hospitals and surgery centers may understand how they perform as a group, but improving that performance is traditionally limited to revising policy and communicating new goals to large groups. This leaves improvement opportunities hidden and the patient experience stagnant.
Two anecdotal examples highlight the limitations of traditional reports. First, consider a group’s on-time antibiotic performance is 99.64 percent – a typical result. It’s worthy of accolades and difficult to improve….until one compares the individuals. By comparing individual performance within this “99.64 percent”, the narrative changes and exposes new opportunities to reduce complications and cost. Comparing providers reveals everyone was 100 percent, except for 2 providers who were at 72 percent and 83 percent respectively. It is these providers who are putting their patients at increased risk for infection – raising costs and lowering patient satisfaction. It is these 2 providers who need to change their behavior in order to improve the overall performance from 99.64 percent to 100 percent. Traditional reports lack this level of granularity, and thus hide the opportunity for improvement and prolong the status quo.
In a second example, consider the overall incidence of complications for a given practice is 12 per 3,200 cases, or 0.38 percent. Again, this result may be cause for inaction as this is “acceptably low”. However, comparing individuals reveals that 7 of those 12 complications involve the same provider. Is there cause for concern? Is there a need to intervene so that tomorrow’s patients are safer? There are many more such examples. Individually comparative reports simply open new opportunities for process improvement and improved patient experience.
Fundamental to successful use of informatics is getting the right information, at the right time, to the right person. Analytics need to go further than senior leadership or department director levels and arrive in the hands of the people who are providing the care. Too often individuals are identified by managers only when either “something is wrong” and corrective action is warranted or when “exemplary behavior” has been documented. Outside of these two extremes, the vast majority of providers remain idle in a world of “average mediocrity”, defensive towards a suggestion they need to change.
For transformational change, “mediocrity” needs to improve to “excellence” because there’s real value for patient outcomes and the hospital’s bottom line when improving a “78 percent” to “96 percent”. For such change though, individuals need to be empowered with tools to measure themselves, compare themselves, and improve themselves – without fear of being negatively labeled by superiors. Truth is, we all have opportunity for improvement, and such opportunity must not be equated with a state of individual failure. Instead, measurements must be made available down to the individual level so that every provider can better reach their own full potential.
For transformational improvement, we need more than just reports. The collected information must be convenient, accessible, and meaningful – designed to help individuals change their own behavior. Real-time, individualized, and distributed analytics are key report qualities that will enable measurements to impact the patient experience through decreased complications, decreased costs, and an overall improved experience.