1. Diagnostic Accreditation Program Using Tracer Methodology to Conduct Internal Assessments Brenda Watson, RTR RTMR Accreditation & Research Development Officer, DAP

2. Objectives  Understanding Tracer Methodology  Its Origins  Tracer Methodology and the DAP Survey Process  Tracer Methodology and its Role in Continuous Systems Improvement  Planning, Implementing and Evaluating Results

3. Understanding Tracer Methodology  A systems approach to evaluation - Outcome  Observe and follow systems and processes of care  Focus on real issues, actual patients  Follow the path of a system, specific care process, patient/sample, high risk area (focus area), look for risk points  Allows for flexibility and follow-up on identified issues

4. Understanding Tracer Methodology  Tracer Methodology intends to do more than just verify that an organization has documented its plans for how the delivery of care should take place  It functions to test those plans by looking at how patients move through the system and how those systems and processes relate to patients on a day-to-day basis

5. Objectives  Understanding Tracer Methodology  Its Origins  Tracer Methodology and the DAP Survey Process  Tracer Methodology and its Role in Continuous Systems Improvement  Planning, Implementing and Evaluating Results

6. Origins of Tracer Methodology  Roots in science- emerged in the early twentieth century  Used by scientific researchers: Trace a substance Study a sequence Has led to scientific breakthroughs

7. Healthcare  The tracer methodology or tracer approach in Healthcare was introduced in the early 1970’s by Kessener and Kalk (1973)  The aims of the approach were twofold. Firstly, to evaluate the quality of care and secondly, to identify areas that need improvement through the use of tracers which are “representative” of those areas of patient care  Tracers most commonly used were individual patients, tracked through their patient record and systems, such as radiology

8. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  In January 2004, JCAHO redesigned their accreditation process by implementing Tracer Methodology Shared Visions –New Pathways ®  “Tracing” the patient stay- from point of entry to post discharge and all points in between  Providing a real assessment of the organization

9. Objectives  Understanding Tracer Methodology  Its Origins  Tracer Methodology and the DAP Survey Process  Tracer Methodology and its Role in Continuous Systems Improvement  Planning, Implementing and Evaluating Results

10. DAP Quality Categories Pre-ExamExamPost-Exam Leadership and Management, Human Resources, Safety, Patient and Client Focus, Suppliers and Partners, Quality Improvement, Informatics Inputs Process Patient Outcome Pre-examExamPost-exam

11. Why the DAP Uses Tracer Methodology to Conduct Accreditation Surveys  Observe systems and processes -Provides a more realistic “moving picture” of how well things are operating  More time talking directly to healthcare providers and observing direct care  Is a much more interactive and unscripted process

12. How the DAP Uses Tracer Methodology to Conduct Accreditation Surveys  Two tracers:  System Tracer: Observes system-wide process  Patient/Sample Tracer: Allows the process to be observed by following the patient/sample  Detailed protocols:  Scenarios to observe and prompting questions- “Look and listen”

13. Tracer Methodology and DAP Accreditation Surveys  Ensures surveyor observations are directly connected to standards  Improves consistency in survey conduct  Shifts the accreditation-related focus from survey preparation, scores and a simple standards compliance exercise at a point-in-time to continuous improvement

14. Example of System Tracer  Human Resources  Planning phase  Skills competencies required  Organizational chart indicating reporting relationships  Individual human resources records  Job descriptions- Match and updated  Recruitment- selection of individuals and training/orientation  Interactive- Let’s trace a new hire

15. Objectives  Understanding Tracer Methodology  Its Origins  Tracer Methodology and the DAP Survey Process  Tracer Methodology and its Role in Continuous Systems Improvement  Planning, Implementing and Evaluating Results

16. Why use Tracer Methodology to Conduct Internal Assessments  Tracer methodology is a flexible, need-specific evaluation method that can be used in a variety of ways  Assist an organization in discovering any problematic practices, such as communication failures, documentation deficiencies, fragmented care and so on  Evolve as the needs and concerns of the organization change

17. Why use Tracer Methodology to Conduct Internal Assessments  Compares practice as to how it was designed  Tracers distinguish between documentation and action  Tracers to understand variation  Mitigate unwanted trends in systems and processes  Use tracer data to monitor for improvements

18. Objectives  Understanding Tracer Methodology  Its Origins  Tracer Methodology and the DAP Survey Process  Tracer Methodology and its Role in Continuous Systems Improvement  Planning, Implementing and Evaluating Results

19. Preparing to Use Tracers  Understanding your own organization in relation to tracers- knowing your organization, its strengths and its weaknesses is the most important factor when laying the groundwork:  Culture  Resources  Scope  Structure  Identify any current activities that can easily fit into the new approach

20. Preparing to Use Tracers  Tracers are inherently flexible in their usability- Goal same whether patient, process or system tracer, so how it is carried out and where it goes need not follow one particular style or pattern  There is no “cookie cutter” model

21. Preparing to Use Tracers: Training  Staff training is essential for optimizing the use of tracers:  Formal training  Integrated into existing programs

22. Planning The Tracer Process  Determine what, where and when to trace:  A tracer can be conducted for a patient/sample, a process, a limited system-specific or a system-wide process  Identify focus areas: Processes of care, hand-offs, documentation, system breakdowns, etc.  Look from a variety of perspectives and involve a variety of staff

23. Planning The Tracer Process  Create a system for feedback of tracer findings  Create a plan for any improvement work that comes out of tracer work- re-tracing to verify and validate improvements

24. Conducting the Tracers  Interview Tips: Follow prompts but do not use a prepared list of questions Let the interview and findings guide your next question- Tailor questions to situation Use “I” statements Ask open-ended questions Listen

25. Using and Understanding the Data From Tracers  The data should provoke useful questions:  Are we doing the right things?  Are we doing the right things well?  How can we improve the things that we are doing right and wrong?  Prioritize the improvement work

26. Conducting Tracers to Verify and Validate Improvements  The tracer process should be cyclical in nature  In this final step of the cycle, your organization can conduct tracers to track the progress of completed work, enabling you to verify that improvements are taking hold, or that additional improvements need to be made

27. Conclusion  Unique opportunity for organizations to demonstrate how they deliver care on a daily basis  Some organizations might choose to use Tracer Methodology as a new method for bolstering or even replacing current quality improvement activities

28. Conclusion Flexible and adaptive Interactive Areas for improvement will come to the surface Cyclical -Trace to verify and validate improvements Close study of how an organization delivers care on a daily basis Can you see the value in using Tracer Methodology to conduct internal assessments at your organization?

29. References and Resources 1.Kessner DM, Kalk CE, Singer J: Assessing health quality: the case for tracers. N Engl J Med 1973; 288: 189-194 2.Tracer Methodology: Tips and Strategies for Continuous Systems Improvement, 2nd Edition. As available on: http://www.jcrinc.com Thank you Brenda Watson bwatson@dap.org