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Objectives
Improve the understanding of KPIs and what they indicate. Identify the Key Performance Indicators at SKMC PDCA, RCA
Quality measurement reflects the compassion, safety and effectiveness of nursing care.
MISSION To provide compassionate, patient centered care of the highest quality in a setting of education and research VISION Sheikh Khalifa Medical City will be recognized as a preeminent medical center that strives to provide an outstanding patient experience, superior clinical outcomes and improved quality of life for the people it serves.
"If you can't measure it you can't manage it 7
VALUES
Collaboration
Compassion
An Early Challenge
In 1859, Florence Nightingale created the worlds first performance tables of hospitals. Florence Nightingale was the architect of the modern British (arguably European) hospital and, most importantly, the means of measuring its performance. It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm,
Nightingale also demonstrated that high death rates, which were invariable then in large hospitals, were preventable.
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Definitions of Quality
(as it Relates to Health Care)
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What is an Indicator?
Valid and reliable quantitative process or outcome measure related to one or more dimensions of performance, such as effectiveness or appropriateness
(The Joint Commission)
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KPI?
Measures?
Metrics?
Performance?
Indicators?
Performance Management
Management = getting work done through others Managers performance is only as good as his/her employees performance Managers job = performance management of others
Performance Improvement
Two Special Objectives in view with regards to disease, namely, To do good or to do no harm.
organization
the organization
standard (internal)
Key These are the important things that the team does to support the patient /focus on mission (directly or indirectly) Performance High, average, low what do we want as the standard for our patients?
Indicators What can we focus on regularly that tells us we are (or are not) achieving those key goals?
"If you can't measure it you can't manage it
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Within the reach of the organization. Can determine the health of the organization by focusing on a few key indicators. Performance over time.
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KPIs are directly linked to the overall goals of the organization. Business Objectives are defined at corporate level.
These goals determine critical activities (Key Success Factors) that must be done well for a particular operation to succeed.
"If you can't measure it you can't manage it
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Key Success Factors (KSFs) only change if there is a fundamental shift in business objectives. Key Performance Indicators (KPIs) change as objectives are met, or management focus shifts.
Safety
"If you can't measure it you can't manage it
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Determine
Tracked by
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"If you can't measure it you can't manage it
How do I interpret a KPI? KPIs do NOT give answers, rather they raise questions and direct attention.
Excellence
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This should direct attention to the key success factor. Problems / Issues should be identified and resolved with a view to decreasing safety KPIs and therefore achieving the business objective. If Our KPI for Infections is this indicates that the business objective,
is being fulfilled.
This indicates safety practices / education are proving successful.
"If you can't measure it you can't manage it
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OK Now What?
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AVOID
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Plan-Do-Check-Act Procedure
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PLAN
Most time consuming part of PDCA!
1. Develop aim statement What are we going to do? How will we measure it? Why?
2. Identify your stakeholders - ICD, Physicians, Nurses, QD 3. Take into account timelines, resources, and process
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Aim Statement
1. What are we trying to accomplish?
There is an increase in the quality and safety of the patients and LOS
PLAN, cont
3. What changes can we make that will result in an improvement?
Technique used in Emergency dept identified most problematic Identify causes of not-met Cause-and-Effect (Fishbone) diagram to determine root cause of why ED have problems meeting standards of CL insertion techniques )
(Use data to decide on intervention
improvement?
Cause Cause
Cause
Cause
Cause
Cause
Cause
Cause
Cause
Measurement
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Do
Provide training, education to physicians who need to improve Pilot use of time out check list Implement in next cycle
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CHECK
1. Bar chart to compare before and after 2. Was there an improvement? ( Measure it- KPI)
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ACT
1. Institutionalize the change (replicating replicating success) 2. Continue to monitor 3. If there was no change, do more data
5. The 5 whys
6. CELEBRATE, REWARD & RECOGNITION!
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Excellence
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What is Benchmarking?
. (There is no single benchmarking process that has been
universally adopted) Measures an organization's
internal processes
Helps you understand where you are in relation to a particular standard Who performs well and has process practices that are adaptable to your own unit or/and organization
Best Practices Benchmarking is the process of seeking out and studying the best internal practices that produce superior performance.
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The whole box has 5 fifth parts. We write it: 1 = Two gingerbread men are pink. Two pink men are of the box contents.
2 numerator says how many parts in the fraction = "divide by" denominator says how many equal parts in the whole
5 object Always remember: denominator can NEVER be 0. Why? Because you cannot divide by 0.
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EXAMPLE:
EXAMPLE: Total number of ? Not meeting the goal/ benchmark/ Numerator = standards Total number of files/patients audited/ checked/ monitored= Denominator = sample
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Dashboards
http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Da shboard.xls
http://ishare/QMD/default.aspx
Dashboards
Quality indicator dashboards for organizations are valuable benchmarking tools, but the interesting data analysis happens when you drill down to the unit level. You might discover that one unit has had fewer catheterassociated urinary tract infections than another unit with a similar patient population. Then it becomes a question of replicating replicating success
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Dashboards
Linking Strategy to Metrics Help you visualize and track trends on every level of your business and to align activities with key goals.
http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Da shboard.xls
http://ishare/QMD/default.aspx
REMEMBER!
Structure:
Process:
As a Patient, suppose you wanted to measure the quality of care for a knee replacement; consider what you could measure for each.
Process:
Outcome:
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Application of a PI model
Structure
Have we reduced the likelihood of harm?
Process
Are we doing what we are supposed to do?
Outcome
How do we Harm? What is Harm?
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problems.
Core Measures are like practice standards that guide us to give the best possible care.
Goals of NDNQI
Provide comparative information to hospitals for use in quality improvement activities Develop national data on the relationship between nurse staffing and patient outcomes
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Data Model
Adapted Donabedians conceptual framework
Structure
Measures of quantity and quality of nursing staff Hospital characteristics like Magnet recognition, teaching status, bed size, etc.
Process
Measure aspects of nursing care (assessment/intervention)
Outcome
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Pediatric pain assessment cycle -Snapshot, all pts on the unit at the time once per month
Pediatric IV infiltration rate-Snapshot, all pts on the unit at the time once per month Restraints prevalence-Snapshot, all pts on the unit at the time once per month Nurse turnover- Monthly RN Education & Certification - Quarterly Nosocomial infections:-Ventilator-assisted pneumonia VAP) -Central line associated blood stream infection (CLABSI) -Catheter associated urinary tract infections (CAUTI)
Monthly
Final word on PI
Every person in the organization has an influence on certain KPIs and PI KPIs do NOT give answers, rather they raise questions and direct attention.
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Strong leadership, Teamwork, Commitment to ongoing improvement in patient care Quality, Continuous staff education, and Efficient use of resources.
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INVOLVEMENT
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