Building The Ideal Quality & Safety Department

Technical Expertise Required for Your Quality Specialist

I have received many questions lately about how to staff a quality and safety department. The most common questions are:

  1. How many staff do I need? Are there any benchmarks for effective staffing levels?
  2. What type of skills do they need?
  3. Do they need a clinical background? If not, what other type of education is ideal?
  4. My organization never approves my FTE requests and we can barely keep up. What can I do?

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.