How Much Should We Measure in Hospital Quality?

Why some of the leading pundits have it all wrong

OMW! Here we go again. Yesterday in an editorial on psqh.com, Don Berwick is quoted as stating at the IHI National Forum in December 2015, that we should “cut in half all metrics currently being used and then cut them in half again.”

I wholeheartedly disagree. And here is why.

Clinical Dashboard – Hemorrhagic Stroke

Ischemic Stroke DB Pt 1

How You Can Create Your Own Total Knee Replacement Dashboard

It's Easier Than You Think

Creating a clinical dashboard is easier than you think – and with this template and tips you’ll be on your way to having a dashboard in no time.

Quick Tips to Get You Started

First, you need the design for the Total Knee Replacement (TKR) Dashboard. Download it here in excel format.

Second, you need to remember three “truths” about quality data.

Mandatory Bundled Payment Set for Total Joint Replacements

Bundled Payment Set for 67 Geographic Areas

The Associated Press reported recently that Medicare launched mandatory bundled payment for hip and knee replacements effective April 1. 67 metropolitan areas are on the list and more will likely follow, so preparing for bundled payment ASAP is the smart play.

What’s Your First Move?

The Quality Playbook is Here!

A Step-by-Step Guide for Building Quality & Safety Programs

Wow! Today is a big day for me, and I want to share it with you. The Quality Playbook has been released!

TQPB Set

What Makes This Book So Different?

Unlike many authors, I’m not an armchair sort of guy – I’ve been on the front lines just like you.

I’ve taken everything I know about making quality & safety programs work and created a Playbook for nailing it.

It doesn’t matter if you’re in a hospital, medical group, or even the system office – the tools, tactics, and plays in The Quality Playbook can be used everywhere.

If I Can Do It, You Can Too!

Here’s what no one else is telling you about implementing a quality program like the one I’m describing…

How To Stop Medication Errors

How to Design a Medication Safety Dashboard

Medication errors continue to be the most common errors in medicine. And this is after decades of work trying to fix this problem. We’ve used bar coding, double checks, triple checks, and no interruption zones, just to name a few. And they all help. But the problem of medical errors still continues.

I taught a one day workshop on Implementing Quality Programs for the Fall Institute of the American Association of Physician Leaders, formerly the American College of Physician Executives (ACPE) this past weekend.

We spent part of the day reviewing the major components in an Annual Quality & Safety Plan. We put the redesign of the medication administration process as a priority both within the Safety section and the Process Improvement section.

We did this because of the frequency of medication errors that persists in our hospitals – on average a hospitalized patient encounters one or more medication errors per day.

We also reviewed a template for a Medication Safety Dashboard. You know my favorite line by now: The only way to manage quality is to measure and report on quality. So here is a template for doing just that. It can be used throughout any organization, from the front line to the board room, to report and manage medication related errors. It’s also a great tool for physician engagement.

I’ve used some version of this Medication Safety Dashboard in many organizations. Click here to download an excel file and of course, feel free to customize as needed.

I would love to here from you. Do you have a medication safety dashboard you would like to share? If you do, just send me an email and I’ll set up a special page for sharing.

A Dashboard for Total Knee Replacement

The Key to Managing Clinical Outcomes

Here’s the first of more than a dozen clinical dashboards that I’ll share in the coming weeks. Why? Because the pressure on physicians and hospitals to manage clinical outcomes increased exponentially when ProPublica published surgeon complication rates on the web in July.

This dashboard is for total knee replacement (click here to download an excel file). It’s one of eight surgical procedures reported on the Surgeon Scorecard and is also a high volume procedure in many hospitals. It’s also included in your hospital’s Healthgrades ratings and Truven 100 Top Hospital profiles.

I’ve used this dashboard for over 15 years. It has always been a critical part of my quality programs because it provides all of the important information needed to manage the quality of care for total knee replacement patients. Just as administrators use a monthly financial report to manage their budgets, the total knee replacement dashboard becomes the monthly report to manage quality and safety for these patients.

The Total Knee Dashboard contains several important sections:

  1. Process measures. These represent treatments recommended by evidence based medicine guidelines and order sets.
  2. Outcome measures. These are patient outcomes such as complications, readmission rates, mortality and LOS. In this example, only rates for “not present on admission” are included, because we only want to know what occurred during the hospital stay.
  3. Core measures.
  4. Comprehensive rates for Healthgrades complications and the HealthGrades star rating.
  5. Direct costs divided into the usual cost buckets. Implant costs could also be included here.
  6. Estimates for the cost of complications based on the complication rates reflected in the dashboard.

Where You Can Get The Data for The Dashboard

Most of the dashboard data comes directly out of your finance, coding, and/or cost accounting systems. This is one of the best kept secrets in healthcare. Frankly, there is enough data in these systems, (that can be converted into clinical dashboards), to keep you busy for the next 10 years. I’ve used this type of administrative data for the past 20 years and it’s been key to all of the 100 Top Hospital, 15 Top Health System, and Healthgrades designations.

I’ll post a second dashboard next week. Until then, if you have any questions about this dashboard feel free to email me at john@johnbyrnesmd.org and I’ll get back to you as quickly as possible.

PS: The data contained in the dashboard is for demonstration purposes only.

ProPublica’s Surgeon Scorecard Will Be Used for Recertification of Orthopaedic Surgeons

The American Board of Orthopaedic Surgery Announcement

In an article posted October 13, 2015, ProPublica announced that the American Board of Orthopaedic Surgery (ABOS ) will use ProPublica’s Surgeon Scorecard to help assess the competency of its surgeons.

According to ABOS Director Shepard Hurwitz, MD, “The American Board of Orthopaedic Surgery will incorporate (ProPublica) Scorecard’s ratings into its recertification process, in which surgeons are formally re-evaluated every 10 years.” He said, ‘Surgeons may also be put on a watch list based on their Scorecard rating.”

Dr. Hurwitz said the ABOS board of directors approved the decision on Oct. 5.

The ABOS is the first surgical board to formally use ProPublica’s Scorecard in it’s recertification process.

About 11,500 orthopedic surgeons are rated on the Surgeon Scorecard for complications following hip and knee replacements, two types of lumbar spinal fusion, and cervical fusion.

The Surgeon Scorecard has been controversial since it’s introduction in July, but publishing physician performance has been long overdue.  It’s a good first step in helping patients find surgeons based on the physician’s outcomes.

Dr. Hurwitz went on to say that the decision by the ABOS “… is controversial, but the fact that we’re doing it is in the spirit of transparency and holding people accountable for what’s already in the public domain.”

Like this story? Read my previous post, Surgeon Complication Rates Now Posted on the Internet where I share how I used this information when my sister underwent a knee replacement.

Surgeon Complication Rates Now Posted on the Internet

Information on Physician Performance is Here to Stay

Patient complication rates have been posted on the Internet for almost 17,000 surgeons. This landmark undertaking was achieved by ProPublica, an independent, non-profit newsroom[1].

ProPublica posted their “Surgeon Scorecard” in July. It compares the performance of surgeons for eight common elective procedures, including hip and knee replacements, spinal fusions, gallbladder removals, prostate resections, prostate removals, and cervical fusions.

The power of ProPublica’s site was demonstrated to me this morning when my brother sent me a text message that said, “Kathy (his wife) is having her knee replacement this morning.” I immediately asked for the surgeon’s name and then looked up his stats on ProPublica’s new site. In less than 5 minutes, I had information that would have previously taken hours, if not days, of phone calls to colleagues and professional acquaintances for recommendations and best guesses about who would be best for my sister-in-law to see.