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A Year of Living Measurably: From Scorecard to Quality Improvement Projects Adam Helbig, MSEd. Manager, Education & Training Cincinnati Children’s Hospital Medical Center Daniel McLinden, EdD Assistant Vice President, Education & Training Cincinnati Children’s Hospital Medical Center Assistant Professor Department of Pediatrics, College of Medicine University of Cincinnati Rebecca Phillips, PhD Vice President, Education & Training Cincinnati Children’s Hospital Medical Center Associate Professor Department of Pediatrics, College of Medicine University of Cincinnati 1

Objectives •! Apply template for using scorecard results to determine improvement targets for educator practice and learner outcomes. •! Review the identification, design and implementation of quality improvement projects for measurable training outcomes. •! Obtain practical information about quality improvement methodology applied to education to positively influence stakeholder perception of the learning function

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Cincinnati Children’s at a Glance Our Vision: to be the leader in improving child health Patient Care: Admissions (includes short stay): 27,932 Emergency Department Visits: 93,456 Home Care Visits: 14,147 Outpatient Visits: 787,365 Surgical Procedures: 29,170 Patient Encounters: 925,944

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Cincinnati Children’s at a Glance Faculty and Staff: Faculty Pediatrics: 471 Surgery: 63 Radiology: 41 Anesthesia: 41 Pediatric Board Certified Subspecialists: 538 Subspecialty Fellows: 177 Active Medical Staff: 1,292 Total Employees: 10,680

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The Education Vision To be the leader in education and training in improving child health

What’s the Connection? The CCHMC Vision To be the leader in improving child health

Q3 Status

Q3 Status Nursing

Pediatric

Q3 Overall

The Education Vision To be the leader in education and training in improving child health

! Percentage of ratings at the top of the scale

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Operational – How well we implement

Environment – How we are perceived

Performance – How well we achieve our goals

The Education Strategy Map Indicators of goals Family centered Care

Title: Training required for organization readiness is complete. Rationale: Specific courses have been designated as required to ensure that all employees meet certain standards and where appropriate, the organization can comply with the requirements of external accrediting agencies.

Patient Safety

Deliver High Quality Educational programs

Preferred training site for medical residents Preferred training site for nursing

Calculation: Number of employees who have completed training and have done so within the mandated time period divided by the number that should have completed the training programs and expressed as a percent. Data Sources: ELM databases. Reporting Frequency: Quarterly Target: 97%

Preferred training site for allied health

Direction: Increasing or stable

Preferred site for continuing medical education

Responsible for managing progress: CCHMC managers

Build organizational readiness

Notes: The measure will start with July 1, 2006 new hires because accurate data sources have become available for this group. These measures will start with training required for all employees (e.g., HIPAA) will add other courses as the year progresses. Course must be in the ELM.

Responsible for managing data: Adam Helbig

The right content at the right time

Our Process Vision, Mission, Strategy Map the relationships Create the Measures Measure, Monitor, & Report Improve How we applied quality improvement approaches with data to improve educator practice and learner outcomes

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“At least 44,000 Americans die as a result of medical errors … and the number could be as high as 98,000...(p.1).”

To Err is Human: Building a Safer Health System, Institute of Medicine, 2000. http://www.nap.edu/openbook.php?isbn=0309068371

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Reframe the Future Institute of Medicine Health Process Redesign Rules •! •! •! •! •! •! •! •! •! •!

Care based on continuous healing relationships Customization based on patient needs and values The patient is the source of control Shared knowledge and the free flow of information Evidence-based decision making Safety as a system property The need for transparency to patients for informed decision-making Anticipation of needs Continuous decrease in waste Cooperation among clinicians

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Education and Training’s Response to Institute of Medicine Health Process Redesign Rules •! Design education for sustained behavior change, help beyond the learning event, how manager helps •! Education based on learner/organizational needs with ability to test out •! Learner is source of control: ease of access •! Learn from the learners experience during and post event •! Standardize evaluation so management and staff determine what’s useful not the educator •! Education delivery is a system property: safe to learn and applies in work context •! Demonstrated impact for informed decision-making •! Needs based •! Targeted content •! Team development

Vision, Mission, Strategy Map the relationships Create the Measures Measure, Monitor, & Report

The Improvement Model*

Improve

What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

*Found in Job Aid Act

Plan

Study

Do

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What are we trying to accomplish? Aim Achieve compliance rate of 97% on the Education’s Contribution to Organization Readiness measure on Education Scorecard by 6/30/09.

Specific Measurable Actionable Reasonable Time bound

What are we trying to accomplish? Key Drivers Aim Achieve compliance rate of 97% on the Education’s Contribution to Organization Readiness measure on Education Scorecard by 6/30/09.

Managers of new employees know what training is required of their direct reports New employees know the requirements based upon their positions.

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Education Contribution to Organizational Readiness by Quarter

How will we know that a change is an improvement? Overall

100.0% Goal

97%

95.0%

Compliance Rate

90.0%

85.0%

80.0%

78%

75.0%

70.0% FY07Q1

FY07Q2

FY07Q3

FY07Q4

FY08Q1

FY08Q2

FY08Q3

FY08Q4

FY09Q1

FY09Q2

FY09Q3

Fiscal Year, Quarter

What changes can we make that will result in improvement?

Aim Achieve compliance rate of 97% on the Education’s Contribution to Organization Readiness measure on Education Scorecard by 6/30/09.

Key Drivers Managers of new employees know what training is required of their direct reports New employees know the requirements based upon their positions.

Design Changes /Interventions Organization Readiness website on Learning@CCHMC tab is updated. Automatic email notification sent to noncompleters. = Intervention Complete and spread = Intervention being spread or worked on

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*Found in Job Aid

Use of PDSA Cycles* TA DA A S

Evidence Best Practice Testable Ideas

A

P

S

D

Very Small Scale Test

P D

D

S

P

A

A

P

S

D

Changes That Result in Improvement

Implementation of Change

Wide-Scale Tests of Change

Follow-up Tests Plan – Describe the Test Do – Test the Changes Study – Did the Results Match Predictions Act - Decide to Act, Adapt or Abandon

The Opportunity for Quality Improvement Science in Training and Development We are not doing research, we are making decisions with data that provides evidence. Business decisions cannot wait for unequivocal information to proceed.

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Spread of Interventions

Spreading the Methodology/Practice

Similar Classes or Projects

Other Scorecard Projects and Practices

One Class or Project

Time

Bibliography Berwick, D. “A User’s Manual for the IOM’s ‘Quality Chasm Report’,” Health Affairs, vol. 21, No.3, pp. 80-90. Britto, MT; Anderson, JT; Kent, WM; Mandel KE & et al. (2006). "Cincinnati Children's Hospital Medical Center: Transforming Care for Children and Families," Joint Commission on Accreditation of Healthcare Organizations, vol. 32, No.10 pp.541-48.. Buckingham, M. & Coffman, C. First Break All the Rules. New York: Simon & Schuster, 1999. Committee on the Quality of Healthcare in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine: 2001. Langley, GJ; Nolan, KM; Norman, CL; Provost, LP; Nolan, TW. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco:Jossey-Bass, 1996. Deming, WE. Out of the Crisis. Cambridge: MIT, 1986/2000. Deming, WE. The New Economics for Industry, Government, Education. 2nd edition. Cambridge:MIT, 1992/2000 Kotter, JP & Cohen, DS The Heart of Change: Real-Life Stories of How People Change their Organizations. Boston: HBS Press, 2002. Rogers, E. Diffusion of Innovation. 4th edition. New York Free Press, 1995 Scholtes, PR; Joiner, BL; & Streibel, BJ The Team Handbook Third Edition. Oriel, Inc., 2003 Senge, P. The Fifth Discipline. New York: Doubleday, 1990. Wheeler, DJ. Understanding Variation: the Key to Managing Chaos. 2nd edition. Knoxville: SPC Press, 1993.

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ASTD 2009 International Conference & Exposition

W202: A Year of Living Measurably: From Scorecard to Quality Improvement Projects

Learning Objectives: !

Apply template for using scorecard results to determine improvement targets for educator practice and learner outcomes.

!

Review the identification, design and implementation of quality improvement projects for measurable training outcomes.

!

Obtain practical information about quality improvement methodology applied to education to positively influence stakeholder perception of the learning function.

Adam Helbig, MSEd Manger, Education & Training Department Cincinnati Children’s Hospital Medical Center [email protected] Daniel McLinden, EdD Assistant Vice President, Education & Training Department Cincinnati Children’s Hospital Medical Center [email protected] Rebecca Phillips, PhD Vice President, Education & Training Department Cincinnati Children’s Hospital Medical Center [email protected]

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A Year of Living Measurably: From Scorecard to Quality Improvement Projects

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A Year of Living Measurably: From Scorecard to Quality Improvement Projects

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