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Safe, Patient-Centered Healthcare: Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS

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Page 1: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Safe, Patient-Centered Healthcare:

Checklists, Data Analytics and

Standardizing Operations

Kenneth K. Boyer

Academic Director, IMS

Page 2: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Patient Safety Medical Errors are prevalent – even in top tier hospitals

•In 1998, Institute of Medicine published a seminal report estimating that:

•As many as 1,000,000 patients a year in the U.S. are harmed and

•98,000 people die as a result of preventable errors

•Set goal of reducing this number by 50% in five years

Progress?

•Pronovost, Miller and Wachter (2006, JAMA)

provide commentary that outlines the many

challenges in first measuring, then acting to

prevent medical errors and ask the question “are

patients safer now” and answer by writing “The

inability to answer this question is doubly

surprising given the increase in publicly available

quality measures over the same period” (p. 696).

Recent Newsweek Article (Oct, 2010)

•Some progress, but still substantial room to improve

•80,000 central line infections per year, with 30,000

deaths and a cost of > $2 billion

•Pronovost – Michigan Central Line Study

•Estimated to save 2,000 lives and $200M per

year

What is clear is the culture of

medicine must change ...

Undoing a culture is hard,

especially one steeped in

hierarchy and intimidation

Page 3: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Bringing Operations to the

Operating Room

•Dr. Atul Gawande – Surgeon and Public Health Researcher,

Harvard University

•Dr. Peter Pronovost – Anesthesiologist and Public Health

Researcher, Johns Hopkins University

Page 4: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Some Success Stories

• Virginia Mason Hospital (Washington)

• ThedaCare (Wisconsin)

• Beth Israel Deaconess Hospital (Boston)

• UPMC

• OSU Medical Center

• mms://streaming1.osu.edu/mediaWWW2/osu

mc10/townhall/060810townhalloitstream.wmv

• Show 9:45 – 10:30

• Show 16:15 – 18:30

Page 5: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

CMS Process of Care Measures

• Medicare mandates that hospitals collect

data on 4 common conditions (originally 3)

and ties reimbursement to performance

– Heart Attacks (AMI) – 8 measures

– Heart Failure (HF) – 4 measures

– Pneumonia Care (PN) – 7 measures

– Surgical Infection Prevention (INF) – 5

measures

Page 6: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

CMS Process of Care Measures

What do you as patients, expect these percentages to be?

What do you think OSUMC’s numbers are?

Page 7: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

CMS Core Measures: OSUMC

You can compare hospitals at:

http://www.hospitalcompare.hhs.gov

Page 8: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Improvement: 2005 to 2009

0.600

0.650

0.700

0.750

0.800

0.850

0.900

0.950

1.000

2005 2007 2009

Heart Failure (HF) Aggregate CMS Process of Care Median and Quartiles

Page 9: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Improvement: 2005 to 2009

0.600

0.650

0.700

0.750

0.800

0.850

0.900

0.950

1.000

2005 2007 2009

Pneumonia (PN) Aggregate CMS Process of Care Median and Quartiles

Page 10: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Variability in Hospital Performance

Best Hospitals

Middle Hospitals

Worst Hospitals

Page 11: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Quality Tools: Strong Impact on Patient Outcomes

Page 12: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Healthcare Research

• “Process Quality Improvement: An Examination of General vs. Outcome-Specific Climate and Practices in Hospitals”, forthcoming 2012, Journal of Operations Management, Kenneth K. Boyer, John Gardner, Sharon Schweikhart.

– Primary Findings:

• Quality Tools from private sector have strong impact on Patient Safety and Satisfaction

• Big hospitals benefit most from efforts to improve patient safety culture.

• Small hospitals benefit most from efforts to develop specialized safety tools – checklists, standard work etc.

• “Process Management Impact on Clinical and Experiential Quality: Managing Tensions between Safe and Patient-Centered Healthcare”, Aravind Chandrasekeran, Claire Senot, Kenneth K. Boyer, Manufacturing and Service Operations Management,forthcoming 2012.

Page 13: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Research Questions

Effect of CMS Process Management on Quality Outcomes

• Exploitation/Exploration dilemma (Benner & Tushman 2003, March 1991)

• Healthcare: Clinical and

Experiential quality (Donabedian 1980)

Effect of External and Internal Forces

• External (e.g. regulatory pressure):

focus on clinical quality (Westphal et

al. 1998)

• Internal (e.g. hospital leadership):

impacts outcomes (Guler et al. 2002)

RQ1: What is the effect of CMS process

management initiatives on both the clinical

and experiential quality of care in U.S

hospitals?

RQ2: How do regulatory forces influence

the effect of CMS process management

on clinical and experiential quality?

RQ3: How does hospital leadership

influence the relationship between CMS

process management and clinical and

experiential quality?

Page 14: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Research Design Overview

Sampling

Frame

284 acute care U.S. hospitals – 273 in final sample

Across 43 states

Average size: 268 beds

Method

Web Survey: Quality management practices in U.S.

hospitals

2 waves: Network hospitals (81), other (192)

Respondent Director of quality or chief nursing officer

Elements

measured

CMS Process Management

Hospital Leadership

Controls: CMS FTE, Training, Perceived Relative

Performance

Primary Data

Page 15: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Research Design Overview

Secondary Data

Construct Source Measurement

Clinical Quality CMS Process of care

measures

Experiential Quality CMS HCAHPS survey

State Legislation Timing APIC report 2009 - year of first

enacted HAI law

Controls: CMS FTE, Training, Perceived Relative Performance

P

PCQij

1ln

Q

QEQij

1ln

Evaluating State Leadership Timing

Sept 2009 March 2010

Tracking quality

performance

Administering survey

Jan 2003 Apr 2009 Dec 2008

Page 16: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Framework

Clinical

Quality

Experiential Quality

CMS Process Management

Hospital Leadership

State

Legislation Timing

Primary data

Secondary data

Data reported to CMS on patient

care processes – see Hospital

Compare for your local hospital

Patient Satisfaction survey data

reported to CMS on patient care

processes – see Hospital Compare

for your local hospital

Page 17: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Trade-off: A focus on Clinical Quality negatively impacts

Experiential Quality --- in the short run

Predictor Variables

Clinical Quality Experiential Quality

Model 1 Model 2 Model 5 Model 6

Constant 1.890** 1.962** 1.544**

1.532**

Teaching - 0.238+ - 0.292* 0.118+ 0.115+

Size 0.207** 0.188** - 0.076+ - 0.222**

Corporate Goals (for profit) 0.380* 0.364* - 0.166* - 0.168*

Ownership Structure (public) - 0.317** - 0.276** - 0.076+ - 0.078+

Training 0.024 - 0.055 0.041+ 0.069**

CMS FTE 0.014 0.022 0.010 0.012

Perceived Relative Performance 0.155** 0.120** 0.042

* 0.053*

CMS Process Management 0.231** - 0.066*

R-Square 26.34 32.87 23.79 26.17

ΔR-Square --- 6.53** ---- 2.38*

Chi-Square 77.85** 103.03** 118.91** 125.87**

Positive effect of

CMS process

management

H1a: Supported

Negative effect of

CMS process

management

H1b: Supported

Page 18: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Predictor Variables

Clinical

Quality

Experiential

Quality

Model 3 Model 7

Constant 1.903** 1.375**

Teaching - 0.343** 0.065

Size 0.187** - 0.184**

Corporate Goals (for profit) 0.462** - 0.165*

Ownership Structure (public) - 0.219* - 0.084+

Training - 0.033 0.053*

CMS FTE 0.029 0.005

Perceived Relative Performance 0.112* 0.063**

CMS Process Management 0.233** - 0.031

State Legislation Timing 0.017 - 0.034*

CMS Process Management * State Legislation Timing 0.044+ 0.023*

R-Square 34.14 28.85

ΔR-Square 1.27* 2.68*

Chi-Square 107.31** 142.66**

Positive effect of

CMS process

management *

State Legislation

Timing

H2a: Supported

Positive effect

of CMS process

management *

State Legislation

Timing

H2b: Supported

Results: Timing of State Legislation has strong impact on Quality

Page 19: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Interaction Plot: Effect of State Legislation Timing

Cli

nic

al Q

ua

lity

State Legislation Timing = Late

State Legislation Timing = Early

Low

High

CMS Process Management

Low High

Ex

perie

nti

al Q

ua

lity

State Legislation Timing = Late

State Legislation Timing = Early

Low

High

CMS Process Management

Low High

Page 20: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Conclusions

• Tradeoffs between Clinical and Patient

Experience Quality

• One Step Backward …. Two Steps

Forward

• Legislation does initiate progress on

Clinical Quality

• Leadership re Patient Experience helps

shape that outcome

Page 21: Safe, Patient-Centered Healthcare: Checklists, Data Analytics … · Checklists, Data Analytics and Standardizing Operations Kenneth K. Boyer Academic Director, IMS . Patient Safety

Conclusion

• Questions?

• For a copy of the paper or questions,

please email me:

[email protected]