1. CHP MEASUREMENT SUMMIT April 2011

2. AGENDA  Quick review of CHP measures  Run charts 101  Measures across borders  Sharing team measures

3. REVIEW OF CHP MEASURES  It’s now been over a year since we “revisited” measurement  Since last February, staff has worked on over 112 measures- retiring 27 measures and currently working on 85.  Currently we have nine teams working on measures: billing, dental, IBH, medical HR, front desk, pharmacy, Learning Partners and sites (clinic directors).

4. REVIEW OF MEASURES (CON’T)  CHP also has organizational measures that coincide with our strategic plan. These measures are distributed to the board monthly.  Besides the more “formal” measures, there are always brief studies that are happening:  How many vasectomies did Mark perform last year?  Which providers saw the most new patients last month?  Will the provider’s panel increase each month or stay the same?

5. REVIEW OF MEASURES (CON’T)  There is tons of data being reported all the time at CHP and most accompanied by graphs.  Next we’ll look at run charts which is the most common graph that is used currently with most teams.

6. RUN CHARTS 101  Which chart below is a run chart?

7. RUN CHARTS 101 (CON’T)  Run charts (often known as line graphs) show process performance over time.  Run charts graphically display shifts, trends, cycles over time. They can be used to identify problems (by showing a trend away from the desired results) and to track improvements that have been put into place, checking their success.

8. RUN CHARTS 101 (CON’T)  We use run charts because we want to see data over time. If we only look at the big picture (averages over a quarter or year), trends over time can often be lost. Changes could be hidden from view and problems left unresolved  For example why might the following statement be misleading? “Last year the average days in accounts receivable was 79.6 days.”

9. RUN CHARTS 101 (CON’T)  Here are two different run charts that show an average of 79.6 days in a/r.

10. ANATOMY OF A RUN CHART  A run chart is a line graph showing points over time. Days, weeks, months are usually shown on the x (horizontal) axis. In the chart below a target (or goal) is also indicated. A median line is often added to a run chart to show movement of the data away from the middle.  What is a median?

11. ANATOMY OF A RUN CHART  The median is the middle number of a series of numbers ordered from lowest to highest. It’s different than the average.  For example, the median for the numbers below is 7. The average is 20: 2, 3, 4, 7, 10, 50, 64

12. RUN CHARTS 101 (CON’T)  When we look at a run chart we look for any movement away from the middle (median).

13. RUN CHARTS 101 (CON’T) If you have 25 points or more in your data series, you can use run charts to detect special causes acting on the process - something beyond the usual that is affecting the process.

14. RUN CHARTS 101 (CON’T)  One type of special cause is called a shift  The chart below illustrates a shift--six (some authors use seven or eight) or more points below or above the median. A new median is now created.

15. RUN CHARTS 101 (CON’T)  Another special cause is called a trend.  The chart below illustrates a trend-five (some authors use six) or more points trending up or down.

16. RUN CHARTS 101 (CON’T)  One pitfall when reading run charts is that you conclude that some trend exists, when in fact you are just seeing normal process variation (and every process will show some variation).  Look at data for a long enough period of time, so that a "usual" range of variation is evident.

17. RUN CHARTS 101  Let’s look at a few run charts to see if they tell a story

18. RUN CHARTS 101

22. OTHER CHP CHARTS

23. RUN CHARTS 101  Any questions about run charts or any other graphs you’ve been receiving???