Dashboards: Hospitals’ Quality Control Panel

Quality of care is a major focus of healthcare reform and dashboards are emerging as valuable tools for tracking performance measures, clinical and operational performance and facilitate transparency. The federal government, medical societies and providers are proponents of dashboard systems, and while experts say they can be utilized by any specialty and are not difficult to implement, challenges related to data collection and cost remain.

Cincinnati Children’s Heart Institute’s set of dashboards lets users evaluate quality measures as well as growth and development metrics. Interested parties can track, for example, hospital-acquired infections and 30-day postoperative mortality and can switch screens to view cost data and patient satisfaction scores. The data are tied to the facility’s EMR system.

The tool lets users transparently monitor performance “which would allow us to determine priorities and overall strategies for growth and development,” says Catherine Krawczeski, MD, former director of quality improvement and clinical effectiveness at Cincinnati Children’s Heart Institute.Krawczeski, now a professor at Stanford University School of Medicine, helped establish the dashboard at Cincinnati Children’s starting in 2008.

An “executive dashboard” facilitates communication of institute indicators to hospital leaders and allows all employees access to data. This dashboard includes data on quality and safety, clinical outcomes, business development, programmatic growth and academic output.

A care delivery system dashboard includes metrics on patient and employee safety, readmissions, how patients navigate through the organization and others. The dashboard tracks progress in cardiology subspecialties as well, such as heart failure/cardiomyopathy, adult congenital heart disease and heart transplantation.

The dashboard allowed the hospital to demonstrate a high quality of care as well as low infection rates and overall quality performance measures. They also saw a 111 percent increase in total revenue between 2008 and 2012.

Key elements

“Dashboards offer transparency and data that drive practice performance,” says Daniel Virnich, MD, chief medical officer of TeamHealth Hospital Medicine, a Knoxville, Tenn., group that provides clinician staffing services to hospitals. “Before they evolved, a lot of physicians weren’t aware of their own performance issues.”

“If you have a live dashboard, staff and consumers know how well you’re doing, and it shows you’re willing to show your results in an honest and accurate fashion,” Krawczeski says.

Dashboards generally collect several key pieces of data about a practice, Virnich adds. These include operational data related to staffing, scheduling, hours worked; coding and documentation data, including procedures performed; patient throughput metrics, such as length of stay and readmission; and quality indicators, such as patient satisfaction and medical documentation completion. They also include financial data. The goal is to aggregate all that data in one spot and generate reports on a regular basis for the key stakeholders.

TeamHealth practice groups meet monthly and regularly meet with client partners to review the dashboard data and evaluate trends and outliers.

Setting goals key to success

To successfully implement dashboards, identify the key stakeholders and their priorities, Virnich says.

“You have to understand the operational quality and performance metrics for whatever specialty you’re in and understand the key drivers for your own practice,” he adds.

Stakeholders should agree on the goals, Krawczeski explains. “Make sure the goals are aligned to the hospital or organization as a whole.”

Once goals are set, facilities should develop key performance indicators related to structure, process and outcomes, says Kathie Viers, a regulatory compliance specialist for the Hematopoeitic Cell Transplantation (HCT) Program at City of Hope National Medical Center in Duarte, Calif.

The HCT program uses transplant volume, length of stay, 30-day readmissions, mortality and patient satisfaction as some of its performance indicators.

Another important step is choosing best practice benchmarks for each performance metric. External benchmarks are great, she says, but organizations also can monitor their progress with internal benchmarks.

Stakeholders should agree how to address performance shortcomings, particularly those concerning high-volume and high-risk diagnoses, procedures and processes. Because these often impact length of stay, organizations typically monitor so they can proactively intervene.

No complex tools required

While the building and implementation processes may seem daunting, the required tools can be remarkably simple.

If the amount of data to be tracked is small—for example, in small practices—an Excel spreadsheet may meet the need. Larger groups and major medical centers, however, may require software that can handle millions of pieces of data per year.

The software cost, says Virnich, ranges from $100 to several thousand dollars per year. Storing data on a server or cloud-based system may add additional cost.

There also may be a need for additional personnel to help manage data. “There’s more personnel cost than a cost for any system, and it’s really an investment of time, but that’s way overshadowed by the benefits,” Krawczeski says.

Persisting challenges

Despite the push for quality and performance measures, many physicians have not yet bought into the concept of dashboards, Virnich says, because they still see themselves as separate entities from larger systems. Medical staff must support the dashboard initiative in order to accomplish goals, he says.

Another major challenge is disparate databases, Viers says. For example, hospital management databases may focus on admission data and reasons for admission, while clinical databases focus on quality and safety, and other databases focus on research. If these different databases aren’t interconnected tracking dashboard metrics becomes more difficult.

“Databases were developed to meet a specific need and not provide an overall view,” she says. “There needs to be a correlation or a system between the data.”

Next stop, nationwide

Dashboards are starting to move from belonging to individual hospitals to becoming shared initiatives, says Krawczeski.

The National Pediatric Cardiology Quality Improvement Collaborative, for example, tracks data related to children at high-risk for doing poorly after very high-risk heart surgeries. The goal is to learn how to improve survival, growth and outcomes.

“Collaborative improvement is crucial, particularly learning from others’ experiences,” she says. “Instead of everybody doing things in a silo, shared improvement is the best way to achieve optimal outcomes.”