1. Healthcare Quality and Compliance R. Chris Christy, FACHE Senior Director, Global Healthcare Industry SAP Business Objects March 16, 2009

2. 1.Introduction and Overview 2.Quality in Hospitals today 3.Threats to the provision of quality 4.Strategies for quality improvement 5.Application of technology to track quality measurement 6.Q+A Agenda

3. 1.Introduction and Overview 2.Quality in Hospitals today 3.Threats to the provision of quality 4.Strategies for quality improvement 5.Application of technology to track quality measurement 6.Q+A Agenda

4. International quality trends Many countries are assessing and defining measures to increase performance of their health care systems. The reasons for the increased interests include rising costs, aging populations, medical errors, lack of accountability, and inequalities in the distribution of care Undisputed recognition that healthcare is expensive and going to continue to increase in cost What’s of interest is the relationship between cost and outcomes, defined as healthcare value

5. US Healthcare Quality Organizations Government or Government Affiliated Agency for Healthcare Research and Quality Institute of Medicine CMS Consumers American Heart Association Healthscope AARP Physicians And Clinicians Ambulatory Care Quality Alliance American Medical Association Institute for Safe Medical Practices Health Grades National Committee For Health Quality Assurance (NCQA) Institute for Healthcare Improvement (IHI) Cross Professional Alliances Bridges to Excellence American Society of Quality Performance Measurement Accreditation Employers Research and Policy Commercial Vendors Gallup Healthcare HealthLeaders Source: PwC Health Research Institute, 2007 Joint Commission On Accreditation of Healthcare Organizations Utilization Review Accreditation Commission (URAC) Healthcare Quality Certification Board National Business Group on Health Leapfrog Group Pacific Business Group on Health Kaiser Family Foundation The Commonwealth Foundation Robert Wood Johnson Foundation Hospital Compare Quality Check State by State Tracking No Shortage of Oversight Agencies

6. Quality can be determined in various ways What is our relative quality of care in the local environment? What is the absolute level of quality in our hospital? How do we compare with other organizations like us? Is our care getting better or worse – what’s the trend? What are the root causes of problems in quality of care? Are we on track to achieve key quality & safety objectives? Are patients receiving care based on internationally accepted standards of care? It is widely believed that there is an unacceptably high number of patient safety issues in provision of patient care

7. The European Commission Canada— The National Patient Safety Institute Denmark— National Danish Indicators Project The United Kingdom— The National Patient Safety Agency (NPSA) Information drawn from a range of sources. National reports on patient safety have also been produced by the National Audit Office National organizations focused on patient safety Australia— Australian Commission on Safety and Quality in Health Care A new organization is being established with a reporting function. It takes over from the Australian Council for Safety and Quality in Health Care, which commissioned a report on a sustainable SIMPATIE Project will be conducting a stock take of a range of patient safety activities including measurement studies A organization working with the Canadian Institute for Health Information (CIHI) that publishes a report based on available national level data The Danish Patient Safety Act requires reporting of patient safety and published in conjunction with the Danish Patient Safety Association Source: International Journal for Quality in Health Care; September 2006

8. Common Patient Safety Indicators Hospital-acquired infectionsVentilator pneumonia, Wound infection, Infection due to medical care, Decubitus ulcer Operative and post-operative complicationsComplications of anesthesia, Post-operative hip fracture, Post-operative pulmonary embolism or deep vein thrombosis, Post- operative sepsis Sentinel eventsTransfusion reaction, Wrong blood type, Wrong-site surgery, Foreign body left in during procedure, Medical equipment-related adverse event, Medication errors Obstetrics Birth trauma—injury to neonateObstetric trauma—vaginal delivery, Obstetric trauma—Caesarean section, Problems with childbirth, Other care-related adverse eventsIn-hospital hip fracture or patient fall Source: International Journal for Quality in Health Care; September 2006

9. 1.Introduction and Overview 2.Quality in Hospitals today 3.Threats to the provision of quality 4.Strategies for quality improvement 5.Application of technology to track quality measurement 6.Q+A Agenda

10. Threats to the provision of quality Financial resources Availability of healthcare providers No timely reporting of data Difficulty managing data quality Lack of uniformity and standardization in performance measurement Aligned reporting incentives

11. 1.Introduction and Overview 2.Quality in Hospitals today 3.Threats to the provision of quality 4.Strategies for quality improvement 5.Application of technology to track quality measurement 6.Q+A Agenda

12. Strategies for quality improvement Create a system of awareness regarding quality standards Provide recognition for areas of performance excellence where standards are being met and an environment for improvement Provide recognition for areas of performance excellence where standards are being met and an environment for improvement Create a structure of accountability for those parties contributing to patient care outcomes Create a structure of accountability for those parties contributing to patient care outcomes Create a system transparency to quality indicators internal to the hospital + externally with patients, MOH or other payers Create a system transparency to quality indicators internal to the hospital + externally with patients, MOH or other payers Utilize technology to significantly impact an indicator or group of indicators Utilize technology to significantly impact an indicator or group of indicators 1 2 3 4 5 5

13. Accreditation: Why get accredited?  Creates a culture of safety and quality  Improve public trust  Increases worker satisfaction  Negotiate payment for care based on the quality of care  Establish priorities for quality and patient safety levels  Creates a learning organization environment

14. 1.Introduction and Overview 2.Quality in Hospitals today 3.Threats to the provision of quality 4.Strategies for quality improvement 5.Application of technology to track quality measurement 6.Q+A Agenda

15. Technology Solutions to Quality  Quality Dashboards: Indicators of clinical and process outcomes reported at an institutional level with a drill down to internal organizational groups that contribute to or impact performance  Externally Reported Quality Metrics – An aggregation of the latest data reported to external regulatory agencies A mixture of data captured automatically from clinical systems and manually extracted data  Internal Process Metrics – near real time feedback

16. Health Matters

18. Balanced Scorecard  URL:

19. Thank you!

20. Questions Contact information: Chris Christy chris.christy@sap.com +1 (817) 416-8888 Q &A