Measuring Health Care E-Book

Yosef D. Dlugacz

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 356

Veröffentlichungsjahr: 2006

Beschreibung

This invaluable guide shows students and professionals how measurements and data can be used to balance quality services and financial viability and how measures can help to evaluate and improve organizational, clinical, and financial processes. The book explains the various performance measurement methods used in health care and shows their practical impact on clinical patient outcomes.

Leseprobe

Contents

Figures and Tables

Preface

Acknowledgments

The Author

Introduction

Chapter One: Overview

Measures and the Medical Staff

Measures and Patients

Measures and Health Care Leaders

Measures and Money

Measures and Evaluating Care

Summary

Chapter Two: Fundamentals of Data

Quality and Finance: A Perfect Fit

Quality and Accountability

Let the Walls Come Tumbling Down

Finding Answers

Objectifying the Delivery of Care

Case Example: Cardiac Mortality

Case Example: Intensive Care Units

Defining Goals

Nothing New Under the Sun

Case Example: Falls

Communicating Information from Quality Measures

Leadership Defines the Level of Quality

Finding Questions

Summary

Chapter Three: Using Data to Improve Organizational Processes

Satisfying the Demanding Consumer

Offering Value

Showing the Numbers

Measures Are Good Business

Managing with Measures

The Value of Measures

Measures and Organizational Processes

Case Example: Nutrition

Case Example: Housekeeping

Monitoring Performance

Measures Promote Knowledge

Lack of Measures Leads to Poor Resource Management

Measures and Evaluating Services

Summary

Chapter Four: What to Measure—and Why

Leadership Determines What to Measure

Measures Define Quality Care

Measures Inform Financial Decisions

Measures and Purchasing Decisions

Measures and Patient Safety

Quality Methodology for Performance Improvement

Developing a Performance Improvement Plan

Case Example: Plan Do Check Act for Bariatric Surgery

Monitoring Variation from the Standard

Case Example: Moving Between Levels of Care

Understanding Patient Flow

Summary

Chapter Five: Promoting Accountability Through Measurements

Measures and Organizational Goals

Justifying Expenses

Case Example: Self-Extubations

Getting the Doctors on Board

Case Example: Wrong-Site Surgery

Analyzing Errors

Changing the Culture

Asking Questions

Evaluating Information and Communicating Results

Summary

Chapter Six: The Rationale for External Drivers of Quality

The Government Takes the Lead

Monitoring Quality for Changed Practices

The Media Carry the Message

Public Pressure Forces Change

Quality and Community Relations

Truth or Consequences

Quality Data Force Change

Case Example: Coronary Artery Bypass Graft

Make the Regulations Work for You

Summary

Chapter Seven: Integrating Data for Operational Success

Different Data Tell Different Stories About Care

Working with Administrative Data

Working with Primary Data

Case Example: Stroke

Operational Decisions and Quality Data

Quality and Risk

Case Example: FMEA and Blood Transfusions

Communicating Quality Data

Case Example: Decubiti

Measures Tell the Truth

Summary

Chapter Eight: Internal Drivers of Quality

Using Guidelines to Drive Quality

Ensuring That the Standard of Care Is Met

CareMaps Promote Standardized Care

Variance Data Help Drive Quality

Dealing with Resistance to CareMaps

Implementing Guidelines to Drive Quality Care

Everyone Benefits from CareMaps

Documenting the Delivery of Care

Case Example: Detoxification Guidelines

Summary

Chapter Nine: Using Data for Performance Improvement

Aggregated Data Offer a Different Perspective

Case Example: Using Quality Methods to Ensure Consistency of Care

Case Example: Increasing Access to Care

Case Example: Improving Sterilization Across the System

Collaboration Works

Summary

Conclusion

Bibliography

Index

Copyright © 2006 by John Wiley & Sons, Inc. All rights reserved.

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Library of Congress Cataloging-in-Publication Data

Dlugacz, Yosef D., 1947–

Measuring health care : using data for operational, financial, and clinical improvement / Yosef D. Dlugacz.

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-7879-8383-3 (pbk.)

ISBN-10: 0-7879-8383-7 (pbk.)

1. Medical care. 2. Medical care—Utilization. 3. Medicine—Research—Data processing. 4. Medical care, Cost of. 5. Medical care—Quality control. I. Title.

[DNLM: 1. Data Collection—methods—United States. 2. Quality Assurance, Health Care—methods—United States. 3. Outcome Assessment (Health Care)—United States. W 84 AA1 D626m 2006]

RA395.A3D558 2006

362.1068—dc22

2006014167

To my beloved family—Doris, who has stood by my side every step of the way, and Adam, Stacey, Stefanie, and Hillel, who provide me with endless support and joy.

Figures and Tables

Figures

2.1

Quality Data Sources

2.2

Defining a Quality Measure

2.3

Calculating the Impact of Sedation on Patient Falls

2.4

Patient Falls and Staff Turnover, January–September

2.5

Patient Falls and Time of Day, Unit X, January

2.6

Patient Falls and Day of Week, Unit X

2.7

Patient Falls and Three Disease Conditions, Unit X

3.1

What Is Important to You?

3.2

Pain Assessment Scale

3.3

Measuring Room Preparation Time Variation

3.4

Quality Lowers Cost

4.1

Surgical Site Infection Rate over Time

4.2

Length of Stay and Readmissions Within Thirty Days

4.3

JCAHO’s 2006 Hospital National Patient Safety Goals

4.4

Quality Management Methodology: PDCA

4.5

Bariatric CareMap

4.6

Patient Flow

5.1

Levels of Accountability

5.2

ICU Mortality Rate for Sepsis Patients, 2004–2005

5.3

Self-Extubation Rate, 2004–2005

5.4

Medication Errors and Near Misses, 2005

6.1

Key Drivers for Quality Care

6.2

Discharge Disposition, Pneumonia Patients More Than Seventy Years Old

7.1

Four Examples of the Sets of Measures Reported in an Executive Summary, September 2005

7.2

Pressure Injuries, 1997–2004

8.1

Creating Order at the Bedside

8.2

Patient Friendly Heart Failure CareMap

Tables

2.1

The Impact of Quality on Finance

2.2

Intensive Care Unit Data Collected by System Hospitals

3.1

CMS Indicators for AMI, Heart Failure, and Pneumonia

4.1

Prioritization Matrix

4.2

Sample Bariatric Table of Measures

4.3

Sample Emergency Department Table of Measures

8.1

Heart Failure CareMap

9.1

Sample Ambulatory Services Table of Measures

Preface

I am writing this book to fill what I perceive as a critical gap in information. For health care to survive in this country, by which I mean for health care institutions to provide excellent patient care and also remain profitable, individuals who are involved with health care policy formulation and health care administration need to understand the value of data and use data as the basis for delivering quality care and achieving financial success.

My previous book, The Quality Handbook for Health Care Organizations, was a practical primer on how to integrate quality management methods into various aspects of the delivery of care. As I travel across the country introducing these quality concepts to health care professionals, I am struck with how little they know about using indicators and measurements—even though they are required to collect and analyze information from these quality tools. With this book my hope is to convince health care leaders that measures must be the basis of informed decisions and that without appropriate measures there can be no real oversight of hospital processes and operations. Most important, without measures there can be no real improvements in health care services.

Measuring Health Care is the product of my twenty years of working with quality management. I began, as most quality managers then did, as the person responsible for interpreting governmental regulatory standards for busy clinicians, who generally found compliance with the standards an annoyance. Over the years, as health care has become ever more complex, as quality management has evolved, and as the organization where I work (the North Shore–Long Island Jewish Health System) has expanded to include not only more hospitals but also nursing homes, rehabilitation facilities, a children’s hospital, and a behavioral health facility, my understanding of what managing quality means has evolved as well.

As a sociologist, I was trained to ask questions, sometimes hard questions, and to use data to discover the answers. I accompanied caregivers on the units, I sat in the emergency departments, and I spoke to the cleaning staff. My goal was to understand how the hospital functioned and also the relationship between providing excellent clinical care and an efficient operation.

I was extremely fortunate, as were our patients, that the individuals who served on the board of trustees wanted to understand that relationship as well, and they looked to me to explain it to them. When I presented quality measures to them, they were smart enough to ask what those numbers meant and why those numbers were interesting, and they were caring enough to wonder how they could use this information to make the hospital better. They were right on the money: information in a vacuum is meaningless. Information without context, without a methodology for improvement, without a vision for the organization, is just isolated bits of data.

As I struggled to answer their questions about the provision of care and its relationship to operational success, I realized that I needed more information. I needed to carefully define variables of quality to understand what I was measuring and monitoring, and I needed to standardize those definitions across the various institutions of the health system if I were going to aggregate and track and trend the data being collected and if I were to be able to answer the trustees’ questions.

The quality management department was expanded; along with more quality managers, analysts and statisticians were hired. Before long, working in quality involved far more than translating regulatory requirements and monitoring compliance for accreditation. Quality had become what it is designed to be—an objective definition of the delivery of service and a methodology that could be integrated into every aspect of the health care institution so that each aspect could be evaluated, understood, and improved.

This book, Measuring Health Care, is the result of my experience over the past twenty years. For me, it has been an incredibly rewarding personal journey. I fervently believe in the quality management philosophy, and I have a tremendous respect for its methodology, which, when applied, has produced enormous improvements in patient safety and organizational success. Because I am such a champion of quality, I am asked to teach its principles to professional and managerial staffs and to students of business and health in graduate colleges across the country. I teach from my experience, with examples from my work. My goal is to incorporate the objectivity and evaluative criteria of quality tools, techniques, and philosophy into the fabric of care. In this book I hope to teach the reader what I teach my students and to do it in the same way—with examples and with information and with commitment to the process.

It all begins with measures.

ACKNOWLEDGMENTS

This book could not have been written without the help and experience of many others. I am especially grateful to the members of the North Shore–Long Island Jewish Health System board of trustees, who believed in quality and generously contributed their wisdom and their time to ensuring that the health system continuously strives toward excellence.

I also want to express my particular gratitude to long-time trustee Abe Krasnoff, who for many years has made it clear that he believes not only in quality and in measurements but also in me. His commitment and generosity in funding the Julienne and Abraham Krasnoff Center for Advanced Studies in Quality, which I direct, underlines his confidence in the quality process. Thank you, Abe.

I want to thank the chairs of the Joint Conference Professional Affairs Committees, who worked tirelessly and often thanklessly to pursue our quality goals: Howard Stave, chair, Acute Care and Behavioral Health; Stuart Levine, chair, Ambulatory Care; Edwin Stein, chair, Long Term Care, Rehabilitation, Home Care, and Hospice; and Frank Scarangello, chair, Safety and Environment of Care. To them, to the members of the committees, and to Mark Claster, chair of the Committee on Quality, I owe a great deal.

Michael J. Dowling, president and CEO of the North Shore–Long Island Jewish Health System, promotes an organization that values quality and measurements. His leadership and support have encouraged me to develop the tools needed to express complex phenomena so that quality information can be used for daily operations. For that and for the opportunity to teach others about quality management I am grateful.

A special thank-you goes to Dr. Abdallah S. Mishrick, an extraordinary and much missed medical and surgical leader whose passion, integrity, and energy continue to inspire me personally and professionally.

The existence of this book owes a great deal to the outstanding professionals who make up the Quality Management Department: Andrea Restifo, my right hand, whose intelligence and love of quality have enabled me to do my best work; Karen Nelson, who shares my passion for the importance of data; and Marcella DeGeronimo and her analysts Karen Miller and Roshan Hussain, who produce magnificent reports.

And to the rest of the superb staff I am fortunate to work with, much thanks. Thanks to the graphic designers, Rico Rosales and Hillel Dlugacz, who work magic with computer design and art. Thanks also to Debi Baker, whose administrative skill was invaluable in producing this book, and to Joyce Guerriere, whose loyalty and support keep me going every day.

The folks at Jossey-Bass, Andy Pasternack and his team, have made this process a pleasure. Thanks for your support of this work from the beginning.

Finally, I must thank Alice Greenwood, my colleague and my friend, who translates my thoughts into words.

May 2006

Yosef D. Dlugacz

Great Neck, New York

The Author

Yosef D. Dlugacz, senior vice president of quality management for the North Shore–Long Island Jewish Health System, is responsible for oversight of that organization’s extensive quality management program, which spans a broad and diverse spectrum of services and facilities. As dean of the system’s Center for Learning and Innovation, he has educated many professionals in quality management and measurements.

Dlugacz is also the professional faculty coordinator for Hofstra University’s M.B.A. program and has lectured at Albert Einstein Hospital in Brazil and at Georgetown University. He is adjunct research professor at New York University and visiting professor at Beijing University’s M.B.A. program. He serves on the board of directors of the American Heart Association and is a consultant for the Council on Accreditation of the College of American Pathologists. He is on the faculty of the Healthcare Association of New York State (HANYS) Data Academy and is a member of the HANYS steering committee and the American Medical Association clinical measures workgroup.

In 2004, Dlugacz was named director of the Julienne and Abraham Krasnoff Center for Advanced Studies in Quality. Many of the best practices developed under his supervision have been published by the Joint Commission on Accreditation of Healthcare Organizations as setting standards for the entire health care industry. He has published widely in health care and quality management journals on a variety of clinical care and quality topics. His previous book, The Quality Handbook for Health Care Organizations: A Manager’s Guide to Tools and Programs (Jossey-Bass, 2004), is being used as a text for both clinical and financial programs in quality management and as a practical training tool for health care professionals.

Dlugacz holds a doctorate in sociology from the City University of New York.

Introduction

Health care in the United States is in crisis. No other country spends as much money as ineffectively and as inefficiently as we do. Insurance premiums are rising while coverage is shrinking. It’s estimated that over 42 million Americans are uninsured and have little access to adequate health services. Clearly, something is seriously wrong. Health care services are not meeting the needs of the people. The solutions that have been put forth by the government and policymakers have not addressed the underlying problems in what is clearly a broken system.