the democratisation of information

The Democratisation of Information

Dr. Gareth GoodierChief ExecutiveMelbourne Health

21 October 2015

• Serving more than 1 million Victorians

• Victoria’s first public hospital

• Provides local and tertiary/ quaternary academic health services

• Largest mental health service in Melbourne

• Services over 1.2 million Melburnians

• Opened in 2013• Joint venture with the

University of Melbourne• World-class institute in

infection and immunity

Royal Park Campus

City Campus

“The goal is to turn data into information, and information into insight.”

– Carly Fiorina (Former CEO and Chair Hewlett, Packard)

AnalyticsTools External:

Informationfor strategic

development and externaladvocacy

Internal:Insights to

inform operational and clinical decisions

• Embed analytics within decision making processes

• Drive behavioural change

• Improved outcomes for patients

• Improved resource utilisation• Faster response to challenges and opportunities

• Track Strategic Plan and Business Plan

• Benchmark with peer organisations

• Improved strength in negotiation with funding bodies

Data

DataDATA

DATAdata

Data

Data

Information is power

How do clinicians want information? Electronic Accessible Intuitive Graphical Real-time Reliable Comprehensive

“The most valuable commodity I know of is

information” – Gordon Gecko (Wall

Street)

The Business Intelligence Maturity Model

Several sources of

truth

Centralised information

Advanced Analytics

Information: • We have

consistent and accessible information across RMH

• Ongoing work with Consultant Attribution data accuracy

Insight:• We are

developing and acting on insights including:− Emergency − Length of Stay− Patient

Incidents− DNA rates

We are

here

Our journey to date

2015Engaged a new vendor in Draper & Dash

2012/13Commencement of our Qlikview journey

2012In-house reporting system and excel spreadsheets

Admission Care TypeAdmission MethodAdmission Account GroupAdmission DateAdmission TimeDischarge MethodExpected DischargeMedical DischargeDischarge DateDischarge TimeDRG Same DayGender Age BandWIES WIES Estimation##### 18,012.36

Acute Planned AdmissionPublic 14-01-2015 13:49 Home/Private residence/accommodation17/01/2015 : - 15-01-2015 14:13 Q61B-RED BLOOD CELL DISDERS -CSCCOvernightMale 90-94 0.38 0.63Acute Admission from ED (VEMD only)Private 27-12-2014 20:39 Transfer to other hospital- - 07-01-2015 14:36 B70B-STROKE & OTH CEREB DIS +SCCOvernightFemale 90-94 1.36 4.29Designated Rehabilitation UnitPlanned AdmissionPublic 20-03-2015 15:55 Home/Private residence/accommodation- - 31-03-2015 08:42 Z60Z-REHABILITATIONOvernightFemale 85-89 0.00 0.00Acute Admission from ED (VEMD only)Private 03-01-2015 18:26 Home/Private residence/accommodation- - 08-01-2015 15:52 E62A-RESPIRATRY INFECTN/INFLAMM+CCCOvernightMale 80-84 1.64 1.71Acute Admission from ED (VEMD only)Public 31-01-2015 18:59 Home/Private residence/accommodation- - 01-02-2015 08:30 F66B-CORONARY ATHEROSCLEROSIS -CSCCOvernightMale 85-89 0.46 0.52Acute Admission from ED (VEMD only)Public 25-02-2015 15:11 Transfer to other hospital- - 27-02-2015 12:52 L67B-OTH KIDNY & URNRY TRCT DX-CSCCOvernightMale 90-94 0.62 0.62Acute Admission from ED (VEMD only)Public 18-02-2015 23:36 Statistical Separation- - 27-02-2015 16:01 F12B-IMPLANT/REPLCE PM,TOT SYS -CCCOvernightFemale 85-89 2.88 2.21Geriatric Evaluation & ManagementStatistical AdmissionPublic 27-02-2015 16:02 Home/Private residence/accommodation- - 17-03-2015 10:26 F76B-ARRHY, CARD & COND DISDR -CSCCOvernightFemale 85-89 0.00 0.00Acute Admission from ED (VEMD only)Public 12-02-2015 20:01 Home/Private residence/accommodation16/02/2015 : 15/02/2015 : 15-02-2015 12:29 L63A-KDNY & UNRY TRCT INF +CSCCOvernightMale 75-79 1.22 0.74Acute Admission from ED (VEMD only)Public 09-02-2015 13:50 Home/Private residence/accommodation- - 10-02-2015 16:50 E74C-INTERSTITIAL LUNG DIS -CCOvernightMale 90-94 0.77 0.54Acute Planned AdmissionPublic 19-02-2015 06:27 Home/Private residence/accommodation- 19/02/2015 : 19-02-2015 14:00 B05Z-CARPAL TUNNEL RELEASESame DayFemale 70-74 0.39 0.46Acute Admission from ED (VEMD only)Public 01-01-2015 18:36 Home/Private residence/accommodation- - 06-01-2015 15:36 E65B-CHRNIC OBSTRCT AIRWAY DIS -CCCOvernightFemale 70-74 1.07 0.83Acute Admission from ED (VEMD only)Public 08-02-2015 20:20 Home/Private residence/accommodation- - 12-02-2015 15:16 L63A-KDNY & UNRY TRCT INF +CSCCOvernightFemale 75-79 1.22 0.95Acute Admission from ED (VEMD only)Public 28-02-2015 17:58 Home/Private residence/accommodation01/03/2015 : - 01-03-2015 13:40 T63B-VIRAL ILLNESS -CCOvernightFemale 75-79 0.55 0.54Acute Planned AdmissionPublic 19-01-2015 13:41 Home/Private residence/accommodation- - 21-01-2015 09:13 F65B-PERIPHERAL VASCULAR DSRD -CSCCOvernightMale 75-79 0.77 1.23Acute Planned AdmissionPublic 25-02-2015 07:00 Home/Private residence/accommodation- - 27-02-2015 11:46 E42B-BRONCHOSCOPY -CCCOvernightMale 80-84 1.68 1.21Acute Admission from ED (VEMD only)Public 15-01-2015 20:25 Aged care residential facility19/01/2015 : - 16-01-2015 15:24 F76A-ARRHY, CARD & COND DISDR +CSCCOvernightFemale 90-94 1.26 0.54Acute Planned AdmissionPublic 03-01-2015 06:00 Home/Private residence/accommodation- - 03-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 05-01-2015 06:00 Home/Private residence/accommodation- - 05-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 07-01-2015 06:00 Home/Private residence/accommodation- - 07-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 09-01-2015 06:00 Home/Private residence/accommodation- - 09-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 12-01-2015 06:00 Home/Private residence/accommodation- - 12-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 14-01-2015 06:00 Home/Private residence/accommodation- - 14-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 16-01-2015 06:00 Home/Private residence/accommodation- - 16-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 19-01-2015 06:00 Home/Private residence/accommodation- - 19-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 21-01-2015 06:00 Home/Private residence/accommodation- - 21-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 23-01-2015 06:00 Home/Private residence/accommodation- - 23-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 26-01-2015 06:00 Home/Private residence/accommodation- - 26-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 28-01-2015 06:00 Aged care residential facility- - 28-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 30-01-2015 06:00 Aged care residential facility- - 30-01-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 02-02-2015 06:00 Home/Private residence/accommodation- - 02-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 04-02-2015 06:00 Home/Private residence/accommodation- - 04-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 06-02-2015 06:00 Home/Private residence/accommodation- - 06-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 09-02-2015 06:00 Home/Private residence/accommodation- - 09-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 11-02-2015 06:00 Home/Private residence/accommodation- - 11-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 13-02-2015 06:00 Home/Private residence/accommodation- - 13-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 16-02-2015 06:00 Home/Private residence/accommodation- - 16-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 18-02-2015 06:00 Home/Private residence/accommodation- - 18-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 20-02-2015 06:00 Home/Private residence/accommodation- - 20-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 23-02-2015 06:00 Home/Private residence/accommodation- - 23-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11Acute Planned AdmissionPublic 25-02-2015 06:00 Home/Private residence/accommodation- - 25-02-2015 11:00 L61Z-HAEMODIALYSISSame DayMale 70-74 0.11 0.11

• Multiple data sources• Multiple sources of

truth• Static inflexible

reporting• Delayed period

reporting • Analytics was the

domain of a few with the time and skill

• Engaged the BI Unit of a generalist management consulting firm

• Improved data flexibility but very clunky, not intuitive and time consuming

• Poor user adoption - users continued with former familiar system

• Specialist in Healthcare BI and Qlikview

• Includes several pre-built and proven applications

• Best practice principles in dashboard design

• Single source of truth• Live data in meetings • Increasing end user

adoption

The Democratisation of Information

“IT IS NOT JUST ABOUT PROVIDING BETTER INFORMATION. IT IS THE DEMOCRATISATION OF INFORMATION, LEADING TO CULTURE AND BEHAVIOUR CHANGE”

A new approach to reporting

“You can have data without information, but you cannot have information without

data” - Daniel Keys Moran

“Few people will appreciate the

music if I just show them the notes.

Most of us need to hear it”

- Hans Rosling

Performance at a glanceEmergency Department Visibility

Emergency Department

Targeted audience requirementsOutpatients

Improved design principlesReflecting the operating theatre workflow

Theatres

Drill-down functionalityMortality over time & primary diagnosis

Mortality and Outcomes

Focussed on key challengesUnderstanding readmissions

Readmissions

Driving user adoption

• Measuring and monitoring usage since re-launch in April 2015

• Uptake continues to be supported by:− Launch and

promotional activities

− Education− Scorecard

reporting− Cultural change

The data is wrong

DENIAL

It does not apply to me

ANGER

I will get the correct data

But we are special

BARGAINING

There is nothing I can do about it

DEPRESSION

Acceptance and action

RESOLUTION

Adapted from Elisabeth Kübler-Ross 5 stage model

The 5 stages of data grief

Relentless focus on variation

•“IN THE LAST 30 YEARS, RESEARCH HAS DEMONSTRATED THAT:1) quality can be measured, 2) that quality varies enormously, 3) that where you go for care affects its quality far more than who

you are, and4) that improving quality of care, while possible, is difficult and

painful”.– Brook, McGlynn & Shekelle (2000)

•EVIDENCE SUGGESTS THAT THERE IS, AT BEST, A TWO TO THREE FOLD VARIANCE IN CLINICAL BEHAVIOUR/TREATMENT PRACTICE ACROSS MEDICINE

•WHERE THERE IS POOR CLINICAL EVIDENCE (E.G. ADHD) THE VARIATION CAN INCREASE TO MORE THAN A TWENTY FOLD DIFFERENCE

“If all variation were bad, solutions would be easy. The difficulty is in reducing the bad variation, which reflects the limits of professional knowledge and failures in its application, while preserving the good

variation that makes care patient centered”

- AJ Mulley (BMJ, 2010)

“The most expensive item in the hospital is the

Doctor’s pen”

Variation – at what cost?

International variation

Foreign body left in during procedure in adults,

2011

Average length of stay for acute myocardial infarction (AMI), 2011

Different rates of

mortality from

cancer in people <75yrs

Source: OECD Health Statistics 2013

The power of transparency

Case Examples

“However beautiful the strategy, one should occasionally look at the

results” -

Winston Churchill

Case Example 1: Improving patient safety - FallsIdentifying contributing factors

11am

3pm 9p

m

Understanding falls incidents by: • Ward• Outcome• Time• Patient level

details• Age• Location• Time• Activity

Case Example 1: Improving patient safety - FallsImplementing and monitoring change

Strategies, such as

focussed rounding at key times,

have facilitated a significant

reduction in falls

RMH is now applying the same methodology to target pressure injuries

Falls p

er mon

th is

decreas

ing

Pneu

moniti

s due

to foo

d

aspir

ation

Case example 2 – Understanding mortality Granular Drill-down Functionality

Case example 2 – Understanding mortality Drill down to Specialty and Consultant

Consultant outlier

Majority of cases of

mortality were

Palliative Care

Audit of 60 cases of mortality from aspiration pneumonia

More than half (32/60) were admitted from 23 different nursing homes with aspiration pneumonia

Speech Pathologist and Physician worked with nursing homes to improve management of patients with dysphagia:

– dysphagia management guidelines– e-learning package– expert advice– advance care planning for patients with chronic

dysphagia

Case example 2 – Understanding mortality Using data for improvement

RMH HAS HAD SIGNIFICANT SUCCESS WITH SHORT STAY SURGICAL MODELS OF CARE THAT BOTH REDUCE LENGTH OF STAY AND REDUCE COMPLICATIONS

OUR EMERGENCY GENERAL SURGERY MODEL HAS DELIVERED REDUCED LOS, REDUCED COMPLICATIONS, A REDUCTION IN CONVERSION TO SURGERY AND A STATISTICALLY SIGNIFICANT REDUCTION IN MORTALITY (SHAKERIAN ET AL, WJS, 2015; SHAKERIAN ET AL, BJS ACCEPTED FOR PUBLICATION AUGUST 2015)

ARE THERE OPPORTUNITIES TO MAKE SIMILAR IMPROVEMENT TO LOS AND OUTCOMES IN THE ELECTIVE PATIENT COHORT?

Benchmarking surgical LOS with

British Association of Day Surgery

(BADS)

Case Example 3: Improving resource utilisationIn-depth analysis and benchmarking


1. Filte

r data

using apps 2. E

xport for in

depth analysis


BADS

BADS Target%Day Case

RMHDC %

Cases Below BADS

Target

Net Financial Outcome Modelling

Breast SurgeryExcision/biopsy of breast tissue Â± localisation 95% 53.10% 24 58,894$ Simple Mastectomy (inc axillary node biopsy) 15% 0.00% 5 23,395-$

Breast Surgery Total 29 35,499$

CardiologyElective cardioversion 95% 66.30% 25 89,391$

Implantation of cardiac pacemaker 50% 0.00% 105 153,873$ Cardiology Total 130 243,264$

ENT/Head and NeckFESS Endoscopic uncinectomy, anterior and posterior 50% 6.70% 5 8,933$

Intranasal antrostomy inc luding endoscopic 80% 0.00% 2 3,573$ Biopsy / Sampling of cervical lymph nodes 40% 0.00% 1 5,229$

Enucleation of cyst of jaw 95% 80.00% 1 2,141$ Exc ision of submandibular gland 30% 0.00% 1 7,103$

ENT/Head and Neck Total 10 26,979$

General SurgeryExcision biopsy of lymph node for diagnosis (cervical, 40% 0.00% 2 8,299$

Inc ision and drainage of perianal abscess 90% 34.10% 9 3,318$ Laparoscopic repair of hiatus hernia with anti-reflux 40% 0.00% 1 2,101$

Pilonidal sinus surgery - laying open or suture/skin graft 45% 38.50% 20 5,514$ Primary repair of femoral hernia 90% 0.00% 1 1,611$ Primary repair of inguinal hernia 95% 29.40% 12 15,677$

Repair of other abdominal hernia 85% 0.00% 1 1,611$ General Surgery Total 46 38,131$

OphthalmologyDacryocystorhinostomy inc insertion of tube 90% 40.00% 3 5,332$

Surgical trabeculectomy or other penetraating 95% 0.00% 1 1,290$ Ophthalmology Total 4 6,622$

OralSurgical removal of impacted / buried tooth / teeth 95% 9.00% 11 19,935$

T&OArthroscopy of knee including menisectomy, meniscal 95% 0.00% 1 425$

Neurolysis and transposition of peripheral nerve e.g 95% 0.00% 3 3,509-$ Repair of hand or wrist tendon 90% 29.10% 34 66,463$

T&O Total 38 63,380$

RMH TOTAL 268 433,810$

Royal Melbourne Hospital

Indicators

COMPARING RMH SHORT STAY SURGERY EPISODES WITH BADS BENCHMARKS

IDENTIFIED COHORTS WITH LONGER LOS

FINANCIAL OUTCOME MODELLING IDENTIFIED A SAVINGS OPPORTUNITY OF $433K IF RMH ALIGNED AREAS OF LONGER LOS WITH WITH BADS TARGETS

WORK PROGRESSING IN CARDIOLOGY AND GENERAL SURGERY TO REVIEW CURRENT MODELS AND THE APPLICABILITY OF BADS MODELS OF CARE FOR LOCAL IMPLEMENTATION AT RMH

Implan

tation

of

pacemak

er.

BADS suggest

50% day

case.

RMH curre

ntly 0%

Lessons learned

CULTURE ‘DEMOCRATISATION OF INFORMATION’ LEADING TO

CULTURE AND BEHAVIOUR CHANGE

ACTIVELY PROMOTE DATA TRANSPARENCY

STAFF ENGAGEMENT IS IMPORTANT

““Opportunities multiply as they are seized” - Sun Tzu

Lessons learned

OPERATIONAL A BUSINESS INTELLIGENCE PROGRAM REQUIRES BOTH TECHNICAL

AND CLINICAL EXPERTISE TO DEVELOP AND DELIVER

INVEST IN BUSINESS INTELLIGENCE TOOL THAT IS GRAPHICAL AND INTUITIVE

TAKE PRAGMATIC APPROACH TO DATA ACCURACY – IT TENDS TO IMPROVE WITH TRANSPARENCY AND EXPOSURE

PROMOTE AND MEASURE END USER ADOPTION

A CHANGE MANAGEMENT APPROACH IS ESSENTIAL – THE EMBEDDING OF ANALYTICS INTO ORGANISATIONAL DECISION MAKING IS BOTH A TECHNICAL AND A CULTURAL JOURNEY

CONSULTANT ATTRIBUTION

PATIENT LEVEL COSTING BY SUB-CATEGORY (I.E. PHARMACY AND THEATRE MINS)

EXTERNAL BENCHMARKING

““Opportunities multiply as they are seized” - Sun Tzu

What can a data driven hospital achieve?

HIGH QUALITYRMH HAS A LOW STANDARDISED MORTALITY

RATE (HSMR 80; AUGUST 2015)

REDUCED LENGTH OF STAY• RMH has an 86% Relative Stay Index compared

with all major Australian hospitals.

REDUCED COST • RMH is $600 lower cost per funding unit (WIES)

than the closest peer hospital; • The National Health Performance Authority

(NHPA) reported the RMH is the “LOWEST” cost tertiary hospital in Australia.

“The price of light is less than the cost of darkness” - Arthur C. Nielsen

Our next steps…

MOBILE APPLICATIONS“MOBILE IS THE FUTURE OF EVERYTHING” –

FORBES

MOBILE APPLICATIONS FOR SENIOR DOCTORS EARLY 2016

GRANULAR LEVEL BENCHMARKING• Combine benchmarking data with drill down

functionality

KEY IN DEPTH ANALYTICS PROJECTS • Linking clinical costings with patient outcomes

in Orthopaedics• Understanding and monitoring readmissions

“Hiding within those mounds of data is knowledge that could change the

life of a patient, or change the world”

- Atul Butte