by Ted Eytan, on 06 Mar 2007 05:04 pm
The Journey
Hitting the Wall, together
The organization recently launched a pretty incredible Web-based reporting system for understanding key quality metrics in the populations we serve. It brings together so much of what we are good at.
The data and presentation (which is aggregated, secure, and protects privacy by not identifying any patients specifically) is helpful, but I needed help understanding how to use it to inform strategy. Each trend chart needed an a bit of explanation of what to do next, so I asked my medical director of quality for help. Each time I asked, he said, “Come see the wall in my office.” Yesterday, he asked for my help with something and I mentioned that I would be in his neck of the woods. He wrote back: “Perfect! Then you can see my WALL”
So I went.
On his wall, he had all the relevant measures posted, trended over time, with a target, and a single point showing the medical center with the highest achievement. He then told me “the story” from the big picture perspective, and then more detailed “chapters” at the level of individual measures. He reminded me that the measures parallel high quality care - we are not working for the measures, we are working for patients.
It was such a different experience than looking at the data on a Web browser - I could tell much more quickly how all the measures related to each other, got ideas where we should focus efforts, and saw a presentation of a population who we care for, rather than a series of numbers. We could toss ideas back and forth about how we could support our system best. He told me what he was most interested in and what the opportunities were. There was a story for each situation. It was great.
My colleague is actually a seasoned clinical improvement expert, so the telling of the story is really second nature to him. I think he had the idea to present the work this way before we began our LEAN transformation. Either way, it came together nicely. One wall was better than 100 e-mail messages.
He enthusiastically blogged his thoughts on how this system is working for our team, and gave me permission to repost part of it here:
… for this grey-haired middle aged guy the data are no longer hidden. Every morning when I walk into my office I am reminded of what I am here to do; to help us improve the care we give all our members so that the quality of their lives will be improved. Please feel free to swing by my office anytime and take a look at the wall for yourself. It’s a beautiful thing.
on 08 Mar 2007 at 9:52 pm 1.Mark Graban said …
So what’s the lesson learned? Pull the plug on the web system? Encourage that leaders also use “the wall” to post metrics locally?
Another question, are you using Statistical Process Control to analyze the data and trends? Deming taught (and Donald Wheeler’s book “Understanding Variation is wonderful for this topic) that reacting to or trying to explain every up and down in a metric is actually “tampering” with the system. Certain ups and downs and “trends” are really just normal variation in the process and can’t really be explained by a “special cause” explanation.
on 09 Mar 2007 at 7:11 am 2.Ted Eytan said …
For me, the lesson learned is, make the data visible and comparable with the blink of an eye. Both at the leadership level, and the local level, as you suggest.
We have a very proficient statistical analysis shop here. At the same time, there’s a balance between getting lost in what the data means and acting on the data. The history of the medical profession has typically been steeped in the former (questioning the data and what it means) rather than the latter (intervening to improve health).
The results achieved in our nation as a whole demonstrate that.
Statistical analysis is one component. Medical judgement, and the role of physician leadership, is just as important at this stage.
We are not using the wall to establish causality. Each patient is unique and has their own story. The wall is a guide in deciding areas of emphasis, PDCA style. It’s a journey to the goal, a healthy community, rather than great measures.
on 09 Mar 2007 at 8:01 am 3.Mark Graban said …
Oh, so you were talking about patient specific data? I guess I misunderstood, I thought you were talking more about summary management metrics, such as “lab test turnaround time” daily averages and “average ED wait to see MD”.
I didn’t mean to be sticking my nose into “medical judgment”, I was thinking more about “management judgment.”
The fear of overreacting from a management standpoint comes from giving people “pats on the back” or “kicks in the butt” when things have “gotten better” or “gotten worse” when it wasn’t statistically true or valid.
on 09 Mar 2007 at 11:45 am 4.Ted Eytan said …
Sorry, Mark, for the misunderstanding.
We are in fact looking at patient de-identified, aggregate data, for well accepted health quality measures, like “immunization rates in children.”
No nose sticking is perceived - I think what you are saying is that an even-handed approach should be taken in looking at data, to do the five why’s - that it is just a map. Yes?