Working with Data:A Toolkit for Health Care Professionals

Developed byCheryl A. Niespodziani, MBA

The Children’s Hospital, Denver

“The beautiful thing about learning is that nobody can take it away from you.”

--BB King US jazz

musician

Overview

Background Types and Uses of Tools Examples Questions/Answers

Background

Quality in health care Related factors Quality gurus

W. Edwards Deming Joseph Juran

Methods of performance improvement

Statistics vs. Tools

Inferential analysis Statistics (regression, correlation,

etc.) Descriptive analysis

Tools to display information

Tools are necessary to…

Design Measure

AssessImprove

RedesignContinuous quality

improvement

Types/Uses of Quality Tools

Planning Teams Data Collection Data Analysis Understanding Root Causes

of Performance

Tools for Planning

Hoshin Planning Critical Paths Gantt Chart Force Field

Analysis

Hoshin Planning Comes from Japanese term

hoshin kanri = policy deployment

Organization-wide process of creating a vision and taking action

Hoshin Planning Process

1. Select stakeholders2. Gather information3. Craft the vision4. Develop the elements of the vision5. Create the hoshin (strategic focus)6. Operationalize the success factors7. Develop breakthrough projects8. Conduct frequent audits

Critical Paths(also called Clinical Care Pathways/Guidelines)

Comprehensive, flexible framework Single patient-care process Details involvement of all groups Summarizes day-to-day activities “Ideal” process

Critical Path Process

1. Select the process2. Define the process3. Form a team4. Create the critical path5. Make the path a working

document

Gantt Chart

Force Field Analysis

Driving Forces(support efforts)

Restraining Forces

(conflict with efforts)

Force Field Analysis Process

1. Identify the issue2. Identify the ideal state/situation3. Brainstorm to identify positive

forces4. Brainstorm to identify negative

forces

Tools for Teams

Brainstorming Affinity Diagrams Multivoting Selection Grids Task Lists Storyboards

Brainstorming Create a non-threatening

environment Never criticize ideas (no bad or

wrong answers) Write down all ideas so team can

view Keep process short; enforce time

limit

Affinity Diagrams

Organize large volumes of information

Put into meaningful groupings Provide structure Can give new perspective to old

problems

Affinity Diagram Process

1. Choose a team2. Define the issue3. Brainstorm the issue4. Randomly display cards/notes5. Sort in silence6. Create header cards7. Draw the diagram

Multivoting

• Consider if items are same/similar

• Ask team if items can be grouped

• Combine similar items• Number items on new

list• Determine number of

points assigned to the list

• Allow group time to independently assign points

• Indicate each member’s point allocation

• Tally the votes• Note items with

greatest number of points

• Choose final selection or multivote again

Selection Grids(also called Prioritization Matrices)

1. Start with list of options2. Choose criteria & scoring system3. Draw the grid4. Judge each option against criteria &

write in scores5. Use completed grid to evaluate findings6. Determine whether new criteria are

necessary7. Select the best option

Task Lists

Most familiar quality tool Written record of what has been

done & what is left to do Can be expanded into action plans

Tips for Using Storyboards

Make it ongoing part of process Both formal and informal

presentations Include team member names Keep simple and attractive Ask for feedback and use it Be creative and have fun

Tools for Data Collection

Indicators Check Sheets Surveys

Indicators

Quantitative measures Related to one or more dimensions

of performance Help provide data that (when

analyzed) give information about quality

Direct attention to potential problems

Types of Indicators

Sentinel-event indicators

Aggregate-data indicators

Continuous-variable indicators

Rate-based indicators

Points to Remember Tailor indicators to processes that are

important (e.g., high volume, high risk, problem prone)

Use other tools to help identify appropriate processes/indicators (e.g., brainstorming, flowcharts, etc.)

Review existing data sources Make complete and objective statements;

leave no room for interpretation Consult a statistician if necessary

Check Sheets

Most basic tool Shows how often an event occurs Records data that answer objective

statements

Surveys

Tools for Data Analysis

Run Charts Control Charts

(SPC) Histograms Scatter Diagrams

Run Charts

Probably most familiar/used tool

Used to identify trends/patterns in a process over time

Helps track if target level has been attained/maintained

Run Chart Process1. Decide what the chart will measure2. Draw graph’s axes3. Plot the data points & connect them4. Evaluate the chart to identify meaningful

trends• Equal # of points will fall above/below average• A “run” of 6 or more points on 1 side of average

indicates statistically unusual event/shift• A trend of 6 or more steadily increasing/decreasing

points (with no reversals) indicates important chage• Cyclical trends should also be considered

5. Investigate the findings

Control Charts(sometimes called Statistical Process Control—SPC)

Run charts that include statistically determined “control” limits

Shows what type of variation exists Measures quantitative data (e.g.,

time or length vs. rate) Tracks performance over a

significant time period

SPC Chart Process Choose process and obtain a data set Calculate the mean Calculate the SD & set UCL/LCL Create the control chart Plot the data Analyze the chart and investigate findings Remember…terms “in control” and “out

of control” do not signify whether a process meets the desired level of performance

Histograms

Bar charts that display: Patterns of variation The way measurement data are

distributed Snapshot in time

May be more complex to establish; consult statistics textbook if needed

Histogram Process

1. Obtain data set & count number of data points

2. Determine range for entire data set3. Set the number of classes into which the

data will be divided4. Determine the class width5. Establish class boundaries6. Construct the histogram7. Count the data points in each class and

create the bars8. Analyze the findings

Scatter Diagrams

Graphs that show statistical correlation between 2 variables

Used when group wants to: Test a theory Analyze raw data Monitor an action taken

Scatter Diagram Process

1. Decide which 2 variables will be tested

2. Collect & record relevant data3. Draw horizontal/vertical axes4. Plot the variables on the graph5. Interpret the completed diagram

Tools for Understanding Root Causes of Performance

Flowcharts Cause & Effect

Diagrams Pareto Charts RCA vs. FMEA

Flowcharts

Graphic representation of process from start to finish

Can demonstrate actual process or an “ideal” process path

Can help identify problems and plan solutions

Flowchart Process

Define the process Brainstorm activities and decision

points in the process Determine the sequence of

activities and decision points Use information to create flowchart Analyze the flowchart

Cause-and-Effect Diagrams(also called Ishikawa or fishbone diagrams)

Present picture of many causal relationships between outcomes and factors of outcomes

Used to identify and display large numbers of possible causes

Fishbone Process

1. Identify outcome/problem statement2. Determine general categories for the

causes3. List major causes under general

categories4. List subclauses under major clauses5. Evaluate the diagram

Pareto Charts

Pareto principle: Few causes are responsible for majority of effects

Statistical tool used to compare events, problems, or causes according to relative frequency or magnitude

Purpose: show which causes have the greatest effects

Natural follow-up to a fishbone diagram

Pareto Chart Process

1. Decide on topic of study2. Select causes to be compared3. Set the standard for comparison4. Collect data5. Make the comparison6. Draw the chart’s vertical axis7. List factors along horizontal axis8. Draw a bar for each factor9. Include additional features if desired

Root Cause Analysis (RCA) vs. Failure Mode Effects Analysis (FMEA)

RCA Reactive Asks “why” something happened

FMEA Proactive Asks “what could happen”

FMEA Rating Scales(From VA Model)

Severity Rating Minor event Moderate event Major event Catastrophic event

Probability Rating Frequent (may happen several times in 1 year) Occasional (may happen several times in 1-2 years) Uncommon (may happen sometime in 2-5 years) Remote (may happen sometime in 5-30 years)

Detectability Rating (1=not detectable; 0=detectable)

FMEA Hazard Scoring Matrix

Catastrophic

Major Moderate Minor

Frequent 16 12 8 4

Occasional 12 9 6 3

Uncommon 8 6 4 2

Remote 4 3 2 1

Questions/Comments?

Contact:Cheryl Niespodziani

303-861-6159 (office)E-mail:

niespodziani.cheryl@tchden.org