Healthcare Value

John Byrnes

Many health systems suffer from having too little data to identify significant quality improvement opportunities, while others suffer from the confusion of having too much.

HFMA’s Value Project report Building Value-Driving Capabilities: Business Intelligence states, “Many hospitals and health systems ... noted the problems of “data overload” within their organizations. Too many targets and metrics are being tracked....”

Many boards and executive teams are wrestling with the issue of too much information and are looking for ways to simplify the reporting of quality measures in a meaningful, and summarized, manner.

If we treated quality reporting the same way we handle financial reporting, we would have data sets that are rolled up for board members and executive leaders while providing actionable and more detailed information to our front-line managers.

To meet this need, many health systems have developed executive-level dashboards that include composite measures, or rollups, of detailed dashboards that contain 20, 30, or sometimes 40 measures. The most well-known example is the “appropriate care score,” which is a composite measure for all of the core measures.

The Solution: The Executive Quality Dashboard

The exhibit associated with this column is an example of the evolving executive dashboard used at Spectrum Health. A one-page summary of key quality measures, it is intended for board members and executive leaders. Data in this example are for illustrative purposes only.

The composite measures are rollups of critical quality and safety dashboards used throughout the hospitals.

For all sections of the dashboard, targets are set for the current fiscal period, as well as a few years into the future. Performance through the current month is reported in the fifth column, and at the request of board members, a comment section was added as an aid to understanding.

Core measures and HCAHPS. The first section shows the performance on core measures, HCAHPS, and value-based purchasing.

Readmissions and mortality. The second section shows the overall risk-adjusted readmission and mortality rates.

Safety. The third section provides summary information on our safety initiatives. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are included in this section. Rather than a composite measure, the information reflects the number of PSIs that are above the benchmark using the AHRQ methodology. Any measures above benchmark are targeted for immediate improvement.

The Serious Safety Event Rate (SSER) was developed by the leaders at Healthcare Performance Improvement, Inc. A measure of events resulting in patient harm, the SSER is reported as a rolling 12-month rate per 10,000 adjusted patient days. National best-practice hospitals have an event rate equal to or less than 0.20.

The infection prevention and medication safety measures are a rollup of these two dashboards. For example, each measure on the infection prevention dashboard has a year-end target and is color-coded accordingly. Measures meeting target are colored green. For the executive dashboard, the percentage of green measures is reported.

Improvements and savings. The Improvements and Savings section is one of my favorites. As background, a variety of disease- and procedure-specific dashboards are used to inform and drive continuous improvement throughout our hospitals. We have more than 30 dashboards for high-volume diagnosis-related groups, identifying hundreds of complication, readmission, and mortality rates. Although these dashboards are extremely useful for front-line managers and physician leaders, they provide too much information for board meetings and executive teams.

As the chief quality officer for my system, I also do not have the time to review each dashboard and statistical process control (SPC) chart every month. However, I need a simple and straightforward tool to show if we are seeing continuous improvement. I also want a measure that would tell me if we had good improvement momentum.

As a solution, we report the number of improvements for the entire data set―the number of statistically significant process shifts in complication, mortality, and readmission rates. Historically, Spectrum Health has experienced 50 to 75 improvements in measures each year. The expectation is that in a culture of continuous improvement, the momentum of past years will be maintained or improved.

The last measure in this section is the cost savings realized from outcome improvements, highlighting the connection between cost and quality. The methodology was developed in partnership with the finance department and provides a good year-to-year comparison. As you would expect, in years where there were fewer outcome improvements, there was less savings.

Pay for performance. The next section of the dashboard provides information on the pay-for-performance programs with two large health plans as well as performance on the Incentive Compensation Plan. As you can imagine, board members and executive leadership have a keen interest in these metrics.

Other. The last section includes other measures that are needed ad hoc to keep board members and executive leaders informed of transient metrics.

Drilling Down to Details

As one might expect, when the quality and safety dashboard report was just one page, feedback indicated it did not provide enough information. Now, the dashboard includes supporting documents, such as the detailed dashboards (e.g., for infection prevention) or simply the SPC chart (e.g., for mortality and readmission rates). For the time being, the 17-page report might be the solution to “data overload,” at least for board members and executive leaders.

John Byrnes, MD, is senior vice president and chief quality officer, Spectrum Health System, Grand Rapids, Mich.; clinical associate professor, MSU College of Human Medicine, Grand Rapids; and a member of HFMA’s Western Michigan Chapter.

The author would like to thank Bruce Quada, quality improvement specialist III at Spectrum Health, for his assistance with this article.

Publication Date: Monday, October 01, 2012

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