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Key Performance Indicators

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Objectives
Improve the understanding of KPIs and what they indicate. Identify the Key Performance Indicators at SKMC PDCA, RCA

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"If you can't measure it you can't manage it

Quality measurement reflects the compassion, safety and effectiveness of nursing care.

It is both a challenge and an opportunity.

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It begins with the Mission

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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.
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VALUES
Collaboration

Compassion

Integrity Patient Safety and Quality

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"If you can't measure it you can't manage it

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,

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History of Evaluating Nursing Care Quality

Patient outcomes versus environmental conditions.

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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Definition of Quality in the 1990s:

Meeting customers expectations Doing the right thing and doing it well (JCAHO, 1994) Clinically effective, efficient, and affordable health services that are delivered satisfactorily.

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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?

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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.

VALUE = Quality of Care + Outcome

Cost

Measures Focus on:

Consistent indicators across the

organization

Comparison of indicators over time in

the organization

Comparisons with pre-determined

standard (internal)

Quality Improvement Process

Performance measures are focused on process and outcomes Reflect actual practice/ performance Leaders determine the focus Set priorities/ goals Collection of data How to use the data Detail & frequency of data collection When do you have enough data to proceed to next process Analysis ( to compare data) Act on it!
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 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?
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Key performance indicators share five important SMART " characteristics.

Specific: Measurable: Achievable: Relevant: Time-Based:
Directly supports understanding how the company is performing relative to one or more of its goals.

Is it getting better or worse.

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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Key (Critical) Success Factors

KPIs measure the health of the organization BUT about. CRITICAL SUCCESS FACTORS?

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Examples of Key (Critical) Success Factors in Health Care

Leadership Resources Relationships Patient and Family Engagement Competent Management and Finances Improvement Technique Expert and Facilitated Assistance Health IT. Capacity to Deliver Coordination Professional and Staff Roles and Training (TEAMWORK)
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KPIs track performance against established key success factors

.

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.
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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
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KPIs track performance against established key success factors

Determine

Tracked by

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How do I interpret a KPI? KPIs do NOT give answers, rather they raise questions and direct attention.
Excellence

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How do I interpret a KPI?

If Our KPI for Infections is is this indicates that the business objective,

NOT being fulfilled.

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.
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OK Now What?

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measurement without change is waste, while change without measurement is foolhardy.

AVOID

measurement for measurements sake

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THE PDCA IMPROVEMENT PROCESS

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When to Use Plan-Do-Check-Act

Model for continuous improvement. New improvement project. Developing a new or improved design of a process, product or service. Defining a repetitive work process. Planning data collection and analysis in order to verify and prioritize problems or root causes. Iplementing any change.

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Plan-Do-Check-Act Procedure

Problem: Increase in CLBSI

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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?

To decrease the number of CLABSI by 50% in 90 days

2. How will we know that a change is an improvement?

There is an increase in the quality and safety of the patients and LOS

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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

3. What changes can we make that will result in an

1. Time out check list 2. Education/ awareness

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improvement?

Ishikawa Fishbone Diagram; Continuous Process Improvement; Cause and Effect

Management Man Method
Cause Cause

Cause Cause
Cause

Cause

Cause

Select the project Understand and clarify the process

Data Flowcharting Brainstorming Fishbone Diagram
Effect (Y)

Cause

Cause

Cause

Cause

Develop a Plan of Action

Machine Material

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

analysis to determine why

4. Root cause

5. The 5 whys
6. CELEBRATE, REWARD & RECOGNITION!
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"If you can't measure it you can't manage it

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Its not always easy

BUT YOU CAN!

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Where to find the KPIs in SKMC?

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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What are Numerators and Denominators

When an object is divided into a number of equal parts then each part is called a fraction. We have a box of gingerbread men. There are 5 men in the box. Each man is of the box contents.

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

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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

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REMEMBER!

Measurement: Process and Outcome Indicators -How do Customers look at Quality?

3 types of measures

Structure:
Process:

Physical equipment and facilities

How Healthcare is provided How the system works

Outcome:

Health status Does it make a difference?

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As a Patient, suppose you wanted to measure the quality of care for a knee replacement; consider what you could measure for each.

You could consider:

Structure:
Are there OR facilities available?

Process:

How consistently does the OR Process follow the policy?

Outcome:

What is the success rate?

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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?

HMMMI wonder what we measure at SKMC?

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International Patient Safety Goals

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Unit Specific KPIs

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HA-AD Patient Safety Goals

1. 2. Improve the accuracy of patient identification Improve the effectiveness of communication among care givers and care recipients 3. Improve the safety of using medications and medical devices 4. Reducing the risk of healthcare associated infections 5. Ensuring correct site, correct procedure, correct patient for all procedures 6. Accurately and completely reconcile medications across the continuum of care 7. Encourage patients active involvement in their own care as a patient safety strategy 8. Improve recognition and response to changes in a patients condition 9. Reducing risk of patient harm resulting from falls 10. Reduce the risk of hospital fires

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Core Measure Sets (Clinical Starter Sets)

What is a core measure?

They are standardized evidencebased performance measures They are PROCESS measures (how recommended care is provided) The core measure results are reported to SEHA Results can be tied to

$$$$$$ REIMBURSEMENT $$$$$$

Clinical Starter Sets

(Core Measure Sets)

Clinical Starter Sets

Clinical Starter sets are here to stay. Quality Measures enables us to not only pinpoint and address quality-of-care issues, but also spot and correct data-collection

problems.
Core Measures are like practice standards that guide us to give the best possible care.

These standards challenge us to re-evaluate the way we

coordinate and deliver care. For example, improved teamwork and communication can lead to 100% of STEMI patients receiving PCI within 90 minutes of arrival at the hospital.

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

Patient outcomes related to quantity or quality of nursing care

A. Donabedian, The Quality of Care, JAMA 1988:260 (12):1743-1748

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NDNQI Data Collection Methodology

Patient falls - As it occurs Patient falls with injury- As above Pressure ulcers:- Snapshot, all pts on the unit at the time once per month Community acquired Hospital acquired Unit acquired Staff mix - Monthly Nursing hours per patient day Monthly Patient Days - Monthly RN Surveys: - Annually Job satisfaction Annually Practice environment scale

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.

Structure, Process and Outcomes ( think like the customer)

QUALITY IS EVERYBODYs BUISNESS

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4 key traits for outstanding nursing quality

1. Nurses must be actively involved.. 2. Quality outcomes should be visible. 3. Support 4. Promote autonomy and accountability.

Strong leadership, Teamwork, Commitment to ongoing improvement in patient care Quality, Continuous staff education, and Efficient use of resources.
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BUILDING A HOUSE OF QUALITY

CONTINUOUS IMPROVEMENT
HIGH EXPECTATIONS
The voice of the Patient

MANAGEMENT BUY-IN TRUST SHARED VALUES AND GOALS/ OBJECTIVES

ASSESSMENT & FEEDBACK

INVOLVEMENT

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