Keeping a finger on the pulse
How fast are you going? Look at your speedometer.
How cold is it outside? Check a thermometer.
How much do you weigh? Get on a scale.
What was our agency’s response time to emergencies? Gather data over time, sift through it, sort and compare.
Or—simply glance at a Dashboard.
Delivery of vital data in an immediately accessible and visual format is something that we often take for granted—except when it comes to complex systems such as Emergency Medical Service or manufacturing processes, where evaluating data often takes the form of tedious data entry and analysis.
Montgomery County Hospital District’s (MCHD) EMS team has found a way to make critical data immediately accessible by using the Dashboard feature of CHARTrunner software from PQ Systems. And by clicking on a point on a Dashboard, team members have immediate access to the same data in a control chart that supports that point.
MCHD is a political subdivision of the state of Texas, established by legislation to provide healthcare for needy residents of the county. In addition to indigent care, it operates the county ambulance system and offers a wide variety of community and professional educational programs. Its goals include providing high quality care for Montgomery County citizens in a cost-effective manner and offering taxpayers and patients accountability in clinical, operations, and financial management.
To support its goals, MCHD relies on a system-wide quality improvement program that helps staff members learn from the decisions they make—decisions that are often made in challenging situations that require immediate responses. “Our goal is to have every employee performing their job better tomorrow than they are able today,” is the stated objective of the quality improvement effort. To this end, MCHD collects data on a variety of process measurements, including response time, the amount of time it takes to drop patients off at the hospital, hospital transports per day, and workload per ambulance. Data entered in Excel or other data sources can be immediately accessed by CHARTrunner, without re-typing or complex importing.
“MCHD has a longstanding commitment to quality. Having recently adopted Six Sigma and providing White Belt training to 100% of our staff, using CHARTrunner as the backbone of our ‘MCHD Measures’ web site was a natural fit. The simple to read and understand graphics make them ideal for everyone to look at and understand” says Allen Johnson, the MCHD CEO.
This Dashboard reflects response time—an important metric to MCHD.
The MCHD EMS team interfaces with a variety of individuals and agencies, some of whom have not been trained in quality or lack understanding of control charts. Dashboard indicators make data easy to understand to anyone, even without appropriate training. For the time it takes to turn over a patient at the hospital, for example, it is easy to see immediately whether the process is on target. ER personnel do not need to see an individuals and moving range chart with 3 sigma limits, when a simple indicator communicates the process average clearly, helping to determine immediately whether it is acceptable.
The Dashboard feature in CHARTrunner can be tailored to individual needs. A user can take those charts and reports that are most useful and place them into a dashboard with a single click, making them immediately accessible for monitoring. “Updating the dashboards is simple. It only takes a few minutes to update over one hundred different measures each week,” says Allen Sims, the MCHD EMS Director. The Dashboard functionality allows one to create an indicator image displaying a statistic value that can be calculated from a chart or entered manually. Indicator styles include speedometer, vertical bar, and horizontal bar. Many visual properties of the indicator can be user-specified such as title, fonts, colors, borders, size, and more. This can help to illustrate performance or make the information stand out. The Dashboard indicator image can be used in PowerPoint presentations, Word documents, web pages, etc.
Since the dashboard feature is totally customizable, a user may choose to utilize it to peruse charts relating to a specific process, a particular time period, or an individual part. The collection of charts that are placed into the dashboard can be modified at any time, and of course a user may elect to use the software without accessing the dashboard at all.
In other healthcare environments, the dashboard can give immediate access to data relating to length of stay, rates of infection, frequency of specific procedures, bed count, ER wait time, and a host of other key metrics that are important to hospital management. In a given department, a dashboard may be created to reflect data that relates only to that department. A clinical laboratory, for example, may want to track distribution of types of tests given, error reports, peak lab demand times, etc., while the billing office would prefer to examine data relating to length of stay, third party pay, billing errors, cost factors, accounts payable, etc.
According to Kelly Curry, the district’s deputy administrator, “When we send an ambulance to an emergency, we know that our response time can mean the difference between life and death. In a rapidly growing community such as ours, monitoring all aspects of our performance is critically important.”
Most people rarely consider the quality of their Emergency Medical Services until they call 911 or require the services of the EMS team, as the MCHD website points out. At that point, it’s too late to demand quick response or investigate the quality of care, or to consider how the service can be improved. It’s a good thing that the MCHD Board of Directors has been thinking about quality and mandating improvement even as most citizens are not aware of it until they need it.
Nonetheless, the team pursues quality improvement in order to “ensure that all citizens, rich or poor, urban or rural, receive proper and efficient care in their time of crisis.” Thanks to this commitment, and to the support of CHARTrunner, the organization has become a model for other health delivery systems throughout the country.
2008 PQ Systems.
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