Capturing Performance with an Organizational Dashboard

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Capturing Performance with an

Organizational Dashboard

Sara Z. Lin, MPH, CPH

Ashley Phelps, MPH

Arthur Ashe Student Health & Wellness Center

University of California, Los Angeles

May 30, 2012

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1. Describe the purpose and benefits of a Dashboard

2. Describe how to develop an effective Dashboard for

your organization

3. Discuss the challenges of developing and

implementing a Dashboard

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UCLA

∗ Located in Los Angeles, CA

∗ Public University founded in 1919

∗ 1 of 10 University of California campuses

∗ 12 Degree-Awarding Colleges/Schools

∗ 26,000 Undergraduates/12,000 Graduates

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• For all registered UC students

• AY 10-11: 80K Visits/26K Unique Pts

• University Health Insurance Plan

• Services Include:

•Primary Care •Urgent Care •Women’s/Men’s Health •Immunizations •Physical/Occupational Therapy •Travel Medicine

•Specialty Clinics (i.e. Derm, Diabetes, Ortho, GI) •Acupuncture and Massage

• Pharmacy/Radiology/Laboratory

About the Ashe Center

• 52 exam rooms

• 107 Employees (Clinical & Admin)

• Re-accredited by AAAHC in 2011

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About this Presentation

What this is…

∗

_{Conceptual underpinnings of an}

Organizational Dashboard

∗

Sharing the UCLA experience

with developing a Dashboard

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Sharing of your experiences

What this is not…

∗

_{Computer/Technical}

specifications of implementing a

Dashboard

∗

“You Must Create a Dashboard”

∗

An indication of my mastery of

this topic

“It's what you learn after you know it all that counts.” -- Coach John Wooden

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Purposes and Benefits

of a Dashboard

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A visual display of key performance indicators that

provides a holistic view of an organization.

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A

visual display

of key performance indicators that

provides a holistic view of an organization.

What is a Dashboard?

Converting data/information into

easy to understand visual

representations

0 100 200 300 400 500 White 33% Asian 27% Latino 17% Black 6% Other 4% Missing/De cline to State 12% American Indian/Ala skan Native 1% 0 10 20 30 Negative.1 Positive.1 PHQ-9 Screening

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A visual display of

key performance indicators

that

provides a holistic view of an organization.

What is a Dashboard?

A selection of metrics that gives

you a broad indication of how your

organization is performing.

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A visual display of key performance indicators that

provides a

holistic

view of an organization.

What is a Dashboard?

A representative view of your

organizations’ different functions.

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A visual display of key performance indicators that

provides a holistic view of an

organization

.

What is a Dashboard?

Define the “level” of organization

based on your needs.

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_{Turn Data into Information}

∗

Streamline data sources

∗

Streamline data processes

∗

Centralize data reporting

∗

_{Create an Indicator System}

∗

_{Internal and External Reporting}

∗

_{Quality Improvement Tool}

∗

_{And more…}

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…To monitor computer functions.

Dashboards Exist

All Around Us!

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…And the very complicated.

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Developing an Effective

Dashboard

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Structure • Facilities • Personnel • Patient Population • Resources • Budget • Available Clinical and Non Clinical Services Process • Service Delivery • Clinical Guidelines • Policies and Procedures • Billing/Insurance Claims • Scheduling • Culture Outcome • Morbidity and Mortality • Resources Use • Quality of Life • Cost Effectiveness • Patient Satisfaction

Linking Dashboards to QI

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S P O

1. Number of exam rooms

2. Average appointment length, in minutes 3. Clinical FTE

4. Patient satisfaction with clinician’s communication skills 5. Ratio of primary care clinicians to patients

6. Percent of patients screened for depression 7. Patient race/ethnicity

8. Number of primary care visits in the past month 9. Cost effectiveness of stress management program 10. Total payroll expense for the fall semester

11. Percent of patients that are female

12. Number of unnecessary referrals to the ER

13. Percent of patients 18+ with diabetes who had HbA1c < 8.0% 14. Number of avoidable adverse drug events

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S P O

1. Number of exam rooms

2. Average appointment length, in minutes 3. Clinical FTE

4. Patient satisfaction with clinician’s communication skills 5. Ratio of primary care clinicians to patients

6. Percent of patients screened for depression 7. Patient race/ethnicity

8. Number of primary care visits in the past month 9. Cost effectiveness of stress management program 10. Total payroll expense for the fall semester

11. Percent of patients that are female

12. Number of unnecessary referrals to the ER

13. Percent of patients 18+ with diabetes who had HbA1c < 8.0% 14. Number of avoidable adverse drug events

15. Number of secure messages sent to patients

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1. What do you need to know?

2. What do you want to know?

3. What can you get?

4. How will the information be shared?

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∗

_{Data to inform operational decisions}

∗

_{A summary of day-to-day activities}

∗

_Operations

∗

_Finance

∗

_{Human Resources}

∗

_Quality

∗

_{Patient Satisfaction}

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∗

_Use:

∗

Cues from within your organization

∗

Cues from outside of your organization

∗

_{Sample Questions}

∗

It seems like we’re seeing a lot of cases of Chlamydia. Is this true?

∗

Patients are complaining about long wait times.

∗

How do departments/units compare in regard to…?

∗

How does your facility compare to facilities in similar schools?

Regionally? Nationally?

∗

How do people compare with people…

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Remember the point of dashboard is to be

organizationally

focused.

Consider using other tools if you are interested in individual performance,

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Metrics and

Benchmarks

∗

Centers for Medicaid & Medicare

∗

Meaningful Use’s Clinical Quality

Measures

∗

Agency for Healthcare Research and

Quality (AHRQ)

∗

Healthy People/Healthy Campus

∗

Nat’l Committee for Quality Assurance

∗

Ambulatory Care Quality Alliance (AQA)

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_{Institute for Healthcare Improvement}

∗

ACHA

∗

Other Universities/Colleges

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Your Institution’s Goals

∗

Professional Groups

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More about

Metrics and

Measures

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_{Metric vs Measure}

∗

_{DON’T limit your}

brainstorming to what you

can get.

∗

_{DO keep your measures and}

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_{Data, Data, Data!}

∗

_{Data Sources}

∗

_{Data Quality}

∗

_{Data Collection}

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Data Sources

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_{Medical Records}

∗

EHR vs Paper Charts

∗

_{Your People}

∗

Talk to department heads and ask

what they are collecting

∗

Do not forget administrative staff!

∗ Human Resource, Finance, Facilities, Scheduling, IT

∗

_Insurance

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Data should be…

Data Quality

Reliable

Apples today, Apples tomorrow Ask for Apples, Get Apples

Accurate

Timely

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Data Collection

How will you populate your

dashboard: Manual vs Automatic?

How many “human interfaces” will

you need?

How much data cleaning is

required?

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∗

_Audience

∗

_{Frequency of Reporting}

∗

_{Dashboard Aesthetics}

#4-How will the information be

shared?

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Audience

Internal vs External Reporting

Clinical vs Non-Clinical Staff

Use familiar terms, when possible

Consider using “tabs” on your

Dashboard to cater the

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Frequency of

Reporting

How often do people need certain

pieces of information?

How frequent does information

need to be collected to see

useful trends?

Update information Monthly,

Quarterly, Annually, etc.

Establish a schedule for updating

your Dashboard

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Dashboard

Aesthetics

∗

Rules & Indicators

∗

What Features do you want?

∗

Drill down capabilities?

∗

Pretty colors?

∗

Pictures?

∗

Intractability?

∗

Presentation Options

∗

Commercial Dashboard Software

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Microsoft Excel

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Web-Based Interface

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Email Updates

Your information needs to “feel”

accessible to the end user!

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Challenges of Developing &

Implementation a Dashboard

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It takes a lot of Data

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_{Quality work is data driven}

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_{EMRs are tremendous enablers}

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_{EMR does not automatically equate Quality}

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It takes Time & People

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_{High initial investment}

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_{Getting staff buy-in can be difficult}

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_{Our challenges:}

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Establishing adequate QI knowledge

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Realization of Dashboard purpose and benefits

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_{Getting feedback!}

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_{Determining the right metrics & measure to include}

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_{Selecting the right frequency for reporting}

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_{Realizing what you have collected was totally wrong and}

having to redo your data

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A Dashboard tells you…

…Where your organization has been.

…Where your organization is now.

…Where your organization wants to

be tomorrow.

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Whatever stage your organization is at…

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Instructions:

1. Read the scenario

2. Refer to the currently reported M&Ms sheet

3. Select M&Ms you would include on a Dashboard

4. Reflect on the following questions:

• Which metrics and measures did you select, and why?

• What types of indicators/controls would you use, if any?

• What type of visual aids would you use to represent your metrics?

• Who will you be sharing the dashboard with?

• How frequently you update the Dashboard?

• How would you rate the quality of the data currently being collected?

• Were you able to capture everything you wanted with what was

provided to you?

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Scenario 1

Recently, your student health center has gotten a fair amount of bad press. Students have been complaining of the lack of appointment availability, long wait times during their visit and feeling like their visit was rushed when in the room with their clinician. This bad press seemed to reach a peak when the school newspaper published a letter sent in by a student that claimed she was left alone in the exam room for 45 minutes because staff had forgotten she was there. This student said the school insurance plan was a waste of money and that it was better to save the $1000 and go somewhere else for medical care.

Scenario 2

Several years ago, the university faced experienced enormous budget cuts, and the student

health center was asked to help shoulder the burden by reducing their budget. SHS responded by laying off a nurse practitioner, a medial assistant and an administrative assistant position in the Finance Department. Among many reasons, the SHS executive group justified these lay offs

stating that the clinic schedule did not appear to fill up every day, implying they were overstaffed. The clinical staff retorted that this was not the case and that if they were working in the clinic, they would see how busy it was.

Keep in mind:

• Select measures that capture your org’s performance. The scenarios only serve to provide a

context for creating your dashboard. It should not define all the measures you choose to include.

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You requested that the department heads make a list of the measures/metrics they currently collect, where they get the information from and how frequently they collect and/or report the data. The table below shows what was turned into you.

Department Measure/Metric Data Source

Reporting/Col lection Frequency

Quality Management Patient Comments_{Patient Satisfaction Scores} Emails & Comment Cards_{Survey Monkey} Monthly_Quarterly

Visit Volume (Total # of Visits, Unique Patients) EMR Report Quarterly

Information Systems Number of hits to student health web pageNumber of calls/requests to IT Help Desk Website ManagerManual count QuarterlyWeekly

# of Computer Terminals/Printers Manual count As needed

Finance

Number of insurance policies sold University Financial Ledgers Quarterly

Supply expense for each department University Financial Ledgers Quarterly

Number of Insurance claims filed EMR Billing Report Weekly

Annual registration fee allocation University Financial Ledgers Annually

Payroll expenses for SHS University Financial Ledgers Quarterly

Insurance

# of outside referrals EMR Billing Report Monthly

Insurance policies sold per quarter University Financial Ledgers Quarterly # of calls and in-person visits to Insurance Help Desk Manual tally Monthly

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Department Measure/Metric Data Source Frequency Collection

Facilities

Incident Reports filed Manual count Quarterly

Equipment inventory and inspection records Manual count As needed

Supply inventory University Equipment Management System Quarterly

Staff compliance with safety training Manual count of certificates Annually

Pharmacy

# Rx filled (new, refills) Pharmacy Software Daily

# Rx received (from SHS and outside scripts) Pharmacy Software Monthly

Reported medication errors Pharmacy Software As needed

Over the counter sales Pharmacy Software Monthly

# Rx for controlled substances Pharmacy Software Monthly

Scheduling

Number of same-day appointments EMR Scheduling Report Monthly

# of late appointments EMR Scheduling Report Weekly

# of no-shows EMR Scheduling Report Weekly

Time to 3rd available appointment EMR Scheduling Report Quarterly

Laboratory

# in-house tests vs sent-out tests Manual count Monthly

# of patients serviced Manual count Monthly

# STAT tests ordered Manual count Monthly

Laboratory incident reports Manual count As needed

Clinical Services

% of patients seen by their designated PCP EMR Clinical Report Quarterly

3rd available appointment EMR Scheduling Report Monthly

Number of available clinical hours for primary care EMR Scheduling Report Daily

Unsigned clinical notes (EMR) over 3 days EMR Clinical Report Daily

# of visits by visit type EMR Clinical Report Monthly

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