Healthcare Quality Improvement Quiz

Performance and Benchmarking & KPI

• Performance and benchmarking are integral for quality improvement in medical settings.
• Key Performance Indicators (KPIs) are metrics used to track progress and measure success.
• The Saudi Physical Therapy Association (SPA) is using performance and benchmarking to improve quality.

Concept of Performance Measurement

• Measuring performance, data collection is the foundation of quality improvement efforts.
• Measurement provides a systematic collection of quantifiable data on processes and outcomes over time.
• Performance measurement focuses on using indicators to determine performance over time or at a single point.

Measurement in Performance: Concept

• Healthcare organizations now understand the importance of data collection for quality measurement.
• Performance-based standards and guidelines are necessary for managing quality.
• Regulations enforce compliance for healthcare organizations to ensure the quality of patient care.
• Focus is on negative variations from the standard.

Standard

• Statement of expectations defines the capabilities of governance, management, and clinical support systems.
• The standard defines what is expected from the performance.
• Indicate what must be done, based on national, accreditation/regulatory standards and standards developed by the organization.
• Measurement assesses if the organization is compliant with the stated standards.

Benchmarking

• Benchmarking is a tool that uses a formal measurement process to compare an organization's performance to that of other organizations.
• Benchmarking can be used to judge the quality or level of similar things.
• Benchmarking enables comparison with other organizations that have superior practices.
• Organizations study their competitors' products to improve their own.

Potential Data Source for Benchmarking

• Similar data collection methods across different organizations must be used when comparing data.
• The data should be collected from the same population.
• Benchmark comparisons use similar criteria to allow valid comparisons.
• The data analysis must use the same adjustment factors.

Type of Benchmarking

• Internal benchmarking compares best practices within an organization regarding similar tasks involving performance, outcomes, and improvements.
• External benchmarking assesses the performance of other organizations to improve the performance of one's organization.
• Differences in data collection and case mixes can affect external benchmarking.

Clinical Practice Guidelines/Evidence-Based Practice

• Clinical practice guidelines are standards and specifications for patient care activities (in healthcare organizations).
• Guidelines are created by integrating the best research data with clinical expertise and patient values.
• Advantages to using evidence-based guidelines include standardization, reduction in treatment variation, and increased cost-effectiveness.

Measurement of Compliance with Guidelines

• The measurement process determines if guidelines were followed.
• Documentation describes instances where guidelines were not followed, why and what steps were taken to correct these variances.
• Variation in patient/client needs and human factors greatly influence care provided.

Determine Evidence-Based Practices

• Clinical proficiency and judgment are important to understand the patient care process.
• Evidence-based practices incorporate the perspectives of the practitioner and patient.
• Benchmarking is crucial in establishing best practices for evidence-based care.
• Two key components are current best practices and clinical practice.

Initial Step in Evidence-Based Practice

• Identifying the practice issue, issue, or clinical area guides the research.
• Using a PICO or PICOT question helps to guide the search for best evidence (relevant research).
• PICO/PICOT helps specify the elements of the relevant clinical and scientific research based on population, intervention, comparison, outcome, and time.

Next Steps in Evidence-Based Practice

• The strength of evidence is determined by the research type, systematic reviews, meta-analysis, and expert opinion.
• Critical questions are asked about the reliability of data, magnitude of effects, side effects, costs of applying findings, and if the results are relevant to the situation.

Clinical Pathway

• Clinical pathways are prospective patient management strategies and tools to guide care for specific diagnoses and conditions.
• They describe timing and sequence of care to produce positive patient outcomes.
• Pathways serve as management plans.

Clinical Pathway Development Teams

• Interdisciplinary teams review literature to identify best practices for patient care.
• They develop an appropriate category that focuses on nutrition, pharmacy, and physiotherapy.
• Consensus and education plan implementation and monitoring are essential parts of the process.

Clinical Practice Guidelines/Pathways

• Specific guidelines describe care to decrease treatment variation.
• Clinical practice pathways are created based on evidence and expert opinion.
• Using this approach focuses on the "typical" patient treatment.

Performance Database

• Standardized data, validated accuracy, and completeness create a statistical capability for analysis and aggregation of measures over time.
• The database provides measures and indicators to help success in specific business areas.
• The database should offer pre-designed indicators for existing needs, instead of creating new indicators.

Performance, Measures, Indicators, Metrics

• Performance measures/indicators/metrics establish standards for evaluating the degree of expected performance.
• These identify what is required for success in the process.
• Indicators are useful for predicting and achieving desired goals of the organization.

Donabedian Paradigm

• Donabedian's paradigm examines the relationship between structure (setting and equipment), process (method and procedures), and outcomes (result and patient health status).
• Care is provided based on an understanding of the relationship of all three aspects.
• The process guides care, enabling efficient and beneficial care delivery.

Types of Clinical Processes

• Patient flow describes the movement of patients through healthcare services.
• Information flow describes appropriate and timely flow of information.
• Material flow details delivery of needed supplies in a timely manner.
• Factors affecting the quality of service include disease processes, severity, compliance, and randomness.

Process Variation

• Process variation refers to changes in process conditions and the appearance of the outcomes.
• Common causes of variability are unpredictable and may affect the whole process or occur within steps of the process.
• Strategies can be adopted to reduce these variations to enhance the quality of the care and its outcomes.

Process Reliability

• Process reliability is the probability that every step in a clinical process will occur when, where, and how it's needed, based on performance measures, and free from failure.
• Reliability is enhanced when process success is measured.
• Processes can often be improved with adjustments and improvements.

Indicator Feasibility, Reliability, and Validity

• Indicators must be feasible and demonstrably relevant.
• The method of measurement must be used consistently by everyone measuring the results.
• The process' reliability is the degree to which an indicator accurately and repeatedly identifies events or situations.
• The measure's validity is the degree to which an indicator can identify all appropriate events/factors.

Improving Process Reliability

• Steps of processes can be streamlined (lean).
• Measures and changes to improve failure probabilities reduce and streamline the process.
• Process improvements improve the overall successful attainment of the outcomes.

Clinical Outcomes

• Clinical outcomes refer to short-term results such as blood sugar levels.
• Function outcomes are long-term health status outcomes (based on activities of daily living and adherence to treatment plans).
• Percieved Outcomes and satisfaction with and experience of the care, as well as their knowledge and accountability.

Key Points in Indicator Selection

• Indicators are determined by many factors including governance, standards, current organizational data, strategic plan, organizational weak areas.
• Identifying the specific indicators for evaluation, defining them clearly, and determining who is responsible to report the results.

Developing Indicators

• Developing indicators requires understanding all relevant associated organization functions, processes, and goals.
• This means a clear method of selection & the intention of the indicator/objective
• Key areas are accessibility, appropriateness, timeliness, efficiency, compliance regarding delivery & service, safety, patient and clinical outcomes.

Rate-Based Indicator

• A rate-based indicator has a numerator & denominator. The result describes either subsets or proportions of a specific event or outcome (in relation to a specific time).
• The proportion/numerator relates to the denominator.

Sentinel Event Indicators

• Sentinel events are unexpected incidents occurring in one-time circumstances or events, usually unusual, that are noteworthy events;
• These require full assessment and often an in-depth examination of the event or occurrence.

Triggers

• Triggers are stimuli that initiate action.
• Triggers can be defined statistically or through comparison of performance indicators, established standards, and baseline data.
• Triggers are used to identify areas for improvement.

Characteristics of Triggers

• Identifiable as incidence rates (numerator divided by denominator).
• Have upper/lower limits.
• Indicate a need for resource investment in-depth analysis.
• Asking questions regarding the identified problem, action, and quality improvement opportunities is pivotal to effective handling of such issues.

Creativity vs. Innovation

• Creativity is the generation of new ideas. It can't be easily quantified.
• Innovation is using creative ideas to produce new products or service offerings to meet market demand that are measurable.

Thank You!

• Presentation was delivered by Mohammed Eldeeb as a part of STEPPS master training.