1. Healthcare Performance and Measurement Tools Tom Knoebber Mission Hospitals Asheville, North Carolina

2. §POE l Pursuit of Excellence §DMAIC l Define l Measure l Analyze l Improve l Control §FOCUS PDCA l Find l Organize l Clarify l Understand l Select l PDCA §PDCA -Plan Do Check Act 12 Step 6 Step Quality Circles 6 Sigma

3. “If you don’t know where your going… How will you know when you get there” “If you don’t know where you are… How will you know when you’ve left “ “If you don’t measure it... You can’t improve it “

4. Patients / Community Departments / Employees Vision / Strategic Plan Translation & Prioritization Measures Voice of the Customer Communication Board / Leadership Implementation Evaluation

5. What Are The Issues Driving Strategic Planning & Direction ? Financial Impact 3Costs, Utilization Patient/ Consumer Satisfaction 3Leap Frog, CMS Safety 3IOM Labor 3Shortages

6. Defining Quality and Efficiency ? 37 Types of Waste Overproduction, Inventory, Transportation Waiting, Excess Processing, Wasted Motion,Defects 3IHI - Overuse, Underuse, Misuse 3The 5 S’s (Toyota Model - Lean) Sort, Straighten, Shine, Standardize, Sustain

7. Project Based Workload Opportunities Teams ~ Re-Engineering ~ Process Improvement ~ Focused Reviews ~ Education and Facilitation etc... Data & Information Measurement

8. * Prioritizing System Initiatives and Focus * Reporting and Monitoring *Charter, Scope and Plan * Review and Verify (GOYA) * Focused Data Collection and Analysis * Theories and Testing * Identification and Facilitation * Implementation Find & Organize Clarify & Understand Select PDCA

9. Measurement and Analysis 1. Individual Experience 2. Group Experience 3. Graphical Presentation of Observed 4. Statistical Interpretation of Observed 5. Graphical Interpretation of Experiments 6. Statistical Interpretation of Experiments

10. Cool Tools !!! “ Finding” & “Organizing” Opportunity §Surveys - Voice of the Customer §Control Charts - Variation l Special & Common Cause §Benchmarking §Charter / Scope §Gantt Charts

11. Cool Tools !!! “Clarifying” & “Understanding” §Brainstorming §Cause & Effect §Flow Diagrams §Data Collection l Discreet & Continuous §Pareto & Histograms & Scatter Plots §Statistical Analysis l ANOVA,Correlation / Regression, Chi Square

12. Cool Tools !!! “ Implementation” §Flow Diagrams (Process Design) §FMEA (Prevention) §Control Charts

13. Readmission Reduction An example

15. Strategic Performance Panel - Dashboard Unplanned Readmission's within 31 Days Data source changed to reflect Premier actual vs expected rate

16. Find & Organize - Charter §Problem Statement: Our readmission rate for the MSJ system is 8.01% for the quarter ending 6/00 this represents a quarterly volume of 737 readmission's on 9,198 Discharges (-deaths). This rate is above the 75th percentile of our benchmark peer group. Our current average cost per case for patients being readmitted to the hospital is $5,507. Business Case: For each readmitted patient, reimbursement is reduced or non-existent. Patients who are readmitted occupy bed space that could otherwise be used for patients with a more acute need, Patient who are readmitted due to a failure on our part will have reduced satisfaction that could lead to reduced market share in the region. Prevention of readmission's will improve utilization and reduce costs. Tips: Defined Business Case, Scope & Boundaries, Champion & Owner, Quantifiable

17. Clarifying and Understanding - Readmission Rate by Service Line (% of DCs)

18. Clarifying and Understanding - Readmission Volume by Service Line

19. Clarifying and Understanding - Analysis of Cause Pareto

20. Quick Improvements l Outpatient CHF clinic (see Pareto) l Detailed Narrative of each readmission reviewed by each service line for commonalties in practice l Review of Pain Mgmt protocol l Increased DC planning screening for post DC needs l Pilot Implementation of Case Mgmt model post discharge l Education and promotion of Medication and Assistance program through the Eblen Foundation l Readmission Sepsis team within Infection control to track for cause Selection & Implementation -

21. Monitoring (PDCA)

23. Data

25. Medical Records Attribution Audit Summary

26. Data & Quality Premier Affiliations Current Outcomes Initiatives 1.Core Measures (JCAHO required) 2. 7 th Scope of Work (voluntary) 3. AHA Quality Initiative (voluntary) 4. Premier / CMS Quality Initiative (voluntary)

27. Data & Benchmarking

28. MSJ Structure

32. Questions ? Tom Knoebber Mission Hospitals 828-213-9194