McKesson helps improve health care quality and patient safety while reducing health care costs. Task Actions Task Not Started ( 00:00:00 ) * * * * * * * *

1. Patient Care and Quality Outcomes
Deborah Bulger, CPHQ Paul Gartman
Vice President, Product Management Vice President, Product Management
Performance Management Enterprise Visibility

2. Learning Objectives
Determine how IT can support an organization’s quality
performance goals
Understand the difference between departmental
capacity management and patient flow issues that
affect the entire organization
Learn how advanced care planning tools can help
address an initiative of the IHI: Transforming Care at
the Bedside
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3. “Evidence bridge: pathways that derive estimates
of clinical outcomes from changes in process
measures.”
Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges
from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007
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4. Crossing the Evidence Bridge
Strategic direction Tactical implementation
Effective care Safety
planning technology and
culture
Visible
Constituent
communication
based analysis
to all
stakeholders
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5. Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar…
The higher the bar, the greater the opportunity
the greater the opportunity!
64%
63%
55%
41%
December 2007
IHI National Forum
92 responses
MD, RN, QA, Board
Mistake Proof Optimize Adopt Whole Transform
Your Patient Flow System Care at the
Processes Measures Bedside
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6. Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity
64%
63%
55%
“No single tool can solve every
41%
problem; often, the answer will lie in
the discovery, implementation, and
execution of several tools.”
Grout J. Mistake-proofing the design of health care processes.
AHRQ Publication No. 07-0020. May 2007.
Mistake Proof Optimize Adopt Whole Transform
Your Patient Flow System Care at the
Processes Measures Bedside
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7. Mistake Proofing Your Processes
Recognition and Prevention of Failure Points
% of “No” Responses
The higher the bar, the greater the opportunity
Online allergies and med history
Automated med 74%
for each patient
reconciliation
Rapid reporting of critical lab
Visiblility to
values
54%
changes in pt
“Five rights” barcoding
status
51%
Patient safety
attributes
Barcode 73%
scanning
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8. Removing a Failure Point
Barcode Scanning Technology
Quantifiable results
Bedside barcode scanning of meds
99.7% compliance with bar-code
─
scanning
39% increase in reporting of
─
medication errors and near misses
33% decrease in percentage of errors
─
causing harm
48% decrease in missed doses
─
73% decrease in extra doses
─
Rapid adoption of technology
63% decrease in wrong doses
─
Enhanced charge capture
─
Increased clinician satisfaction and
─
retention
Increased productivity and efficiency
─
─ $300,000 savings in transcription fees
─ And on… and on…
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9. “Dockside to Bedside”
100% Barcoded Medication Management
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10. Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity
64%
63%
55%
“A hospital is a great example of a complex adaptive
system. You have a number of people who are
41%
making day-to-day, even minute-to-minute,
decisions in their own microsystem … that impact
hospital-wide patient flow, and they are making
these decisions without access to information about
the macro view, or what is going on in the rest of the
hospital.”
Kirk Jensen, MD, MBA, FACEP, IHI faculty member and co-author, Leadership
for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved
Bottom Line
Mistake Proof Optimize Adopt Whole Transform
Your Patient Flow System Care at the
Processes Measures Bedside
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11. Optimize Patient Flow
System-wide Visibility to Patient Status
% of “No” Responses
The higher the bar, the greater the opportunity
Real time 35%
One-to-one paper, verbal
census
communications create delays
Real time
Departmental “micro-delays”
61%
discharge
affect system-wide throughput
orders
Lack of capacity impacts
29%
Observation
organizational success
ALOS <24 hrs
Average ED 38%
hold time <4 hrs
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12. Visual Controls in Everyday Life
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13. Visual Controls in Healthcare
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14. Addressing the Challenge of Capacity
and Throughput Management
Beds are full – supply & demand misaligned
ED diversions
─
Medical cases crowd out more profitable surgical cases
─
New Joint Commission standards around patient flow
Patient bed space
─
Efficiency and safety
─
Support service processes
─
Late rounding, late test
Mid-day bed crunch due
results, charts
to misalignment of
incomplete, poor
admissions, discharges.
discharge planning etc.
6a 7a 8a 9a 10a 11a 12a 1p 2p 3p 4p 5p 6p 7p 12a
Peak Admission Period Peak Discharge Period
Source: Advisory Board interviews and analysis, 2006.
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15. Enterprise Visibility Platform
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16. Reading the Display Board
Transport alert
Case manager alert
Pending
discharge
Results Observation
notification patient
Isolation
Scheduled
discharge
Cleaning in
Medications
process
ready
Patient location
(radiology)
Patient safety
alert
Hold room for
Bed reserve
Orders maintenance
communication
notification
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17. One Hospital’s Success
$5.5M revenue increase within 6 months
Improves bed turns by 19%
─
Expands overall acute care capacity by
─
12%
Reduce ED diversions by up to 60%
─
Reduce EVS staff by up to 20%
─
Return on Investment analysis conducted by the Advisory Board - published June 2006
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18. Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity
64%
63%
55%
“By looking at macrosystem and
microsystem measures frequently—
41%
daily, weekly, or monthly—the
organization can better monitor its
performance, find improvement
opportunities, and prevent quality
levels from eroding without anyone
noticing.”
Whole System Measures, IHI, 2007
Mistake Proof Optimize Adopt Whole Transform
Your Patient Flow System Care at the
Processes Measures Bedside
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19. Adopt Whole System Measures
Meaningful Information to Sustain Improvement
% of “No” Responses
The higher the bar, the greater the opportunity
Data rich, information poor
Automated data 65%
IT investment should decrease
collection
manual collection – but doesn’t
46%
quot;Are we getting Increasing regulatory
better?quot;
requirements
74%
Constituent
based metrics
Single quot;source 72%
of truthquot;
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20. Removing Data Silos
Source data Data warehouse & Publication & analysis of
integration healthcare applications results
Information transparency
Medication safety
HIS
analysis
Surgical cost &
Financial DSS
quality Dashboards
Productivity and
Payroll Scorecards
profitability
Med administration Patient safety
Radar Charts
Graphs
Grouping and
Patient experience reimbursement Actionable insight
Departmental
Surgery IS initiatives
Control charts Document links
Hospital-wide
Laboratory IS initiatives
Action Triggers Work lists
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21. Constituent-based Metrics
C Suite, Board
Highest level, composite metrics
Month-over-month trends
Links to accountable staff
Nursing Executive
Drill by unit, caregiver, drug, date, time,
etc., so manager can take immediate
action
Metrics updated after each shift
Principled action triggers
Quality Manager
Criteria-based review lists
Streamlined case review
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22. Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity
64%
63%
55%
“Patients say ‘They give me exactly
41%
what I want (need) exactly when I
want (need it).”
Rutherford, et al, Transforming Care at the Bedside, IHI, 2004
Mistake Proof Optimize Adopt Whole Transform
Your Patient Flow System Care at the
Processes Measures Bedside
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23. Transform Care at the Bedside
Evidence-based, Interdisciplinary Care Delivery
% of “No” Responses
The higher the bar, the greater the opportunity
Automated plans that drive care
delivery
Visible care 55%
plan
Integrated orders, documentation,
assessments, etc.
Access to 64%
Prioritize activities based on
evidence at
patient progress
bedside
Care plans 46%
integral to pt
management
> 70% of time in 54%
direct pt care
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24. Care Process Alerts
Core Measure - Patient Monitoring
Pneumonia
Patient
Antibiotic 22 min.
Overdue
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25. “Evidence bridge: pathways that derive estimates
of clinical outcomes from changes in process
measures.”
Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges
from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007
25

26. Thank you!
How does your organization measure up?
Take the Quality Care Assessment in McKesson booth #3035
─
Feb. 25-28 at HIMSS
Deborah Bulger deborah.bulger@mckesson.com
Paul Gartman paul.gartman@mckesson.com
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