Transcript Slide 1

Quality Improvement and Performance
Indicators
Thalassemia Center
Prepared by : Samah Darwazeh
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 .
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Information : Data which have been processed and
analyzed in a formal, intelligent way to make the data
useful
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Data are numbers; information is what
numbers mean
Example
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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 .
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But, today , health care procedures are complex,
and performance is not easy to measure
Quality Performance Indicators
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Well defined

Variable

Measurable
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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
Rate Based Indicator
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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 .
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 .
Sentinel Based Indicator
In sentinel events ,we aim at zero defect
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
Indicator Types

Structure indicator ( input )

Process indicator ( System )

Outcome ( out put )
Any Activity or function has the following
Input
( Resources )
( Structure )
Process
(System )
(policy & procedures)
output
( 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
Process Indicator ( system )

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
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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?
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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
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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.
Performance Measurement according
to the JCIA
Monitoring
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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



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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
..but make the DATA
A dvers e P atient O utc om es Data
U N IT
JAN
F EB
M AR
AP R
M AY
JUN
Un it 1
F a lls/P D
9
5
14
6
8
5
M e d E/P D
8
5
9
4
7
5
Re str/P D
2
1
3
3
2
3
HA De c /P D
2
3
2
4
1
2
Un it 2
F a lls
M e d Er
Re str
Indicator / Monitor
Falls/Patient Days
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEP
AUG
5
4
3
2
1
0
Medication Errors per 1000 Patient
Days
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEP
AUG
15
10
5
0
Preventable Adverse Drug Events
How they occur
Administratio
n
34%
Prescribing
56%
Dispensing
4%
Transcription
6%
Adm inis tration
Dis pens ing
Trans cription
Pres cribing
OCT
NOV
DEC
APR
MAY
JUN
JUL
AUG
SEP
JAN
FEB
MAR
Overtime Hours
100
50
0
Staff HPPD* and Number of Falls
A Mulitple Line Graph
10
*HPPD=Hours per patient day
8
6
4
Falls/100 Patient Days
HPPD
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEP
0
AUG
2
Budgeted HPPD
Control Chart
Number of Medication Dispensing Errors per 1000 Doses
2.5 Doses
2
UCL
1.5
Mean
1
0.5
DEC
NOV
OCT
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
0
LCL
Matrix Example
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
4.2
4.3
3.6
3.6
3.4
4.3
4.1
4.1
4
4.3
4.2
4.5
2
2
6
6
7
3
2
2
3
4
3
2
Patient
Satisfaction
Pain
Managemen
t
Falls per
1000 Pt
Days
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 !