How to get your data message across
Charts and graphs can bring reports to life
Three years ago, reports to the Phoenix Baptist Hospital and Medical Center (PBH) executive committee and board of directors were narratives, ran 40 to 60 pages, included several different formats, and, frankly, left the executives bored and confused. There was no clear understanding of how quality, risk management, infection control, and safety issues impacted one another, nor what the reams of statistical data told about trends and developments.
When the facilities’ board ranked its activities in 1994, among the lowest ranked items was its understanding of quality issues, measurements, and interventions. This spurred PBH’s senior vice presidents and quality personnel to analyze critically the material that was going to the board and how the information was perceived.
As a result, they developed a consolidated report that includes key quality, risk management, infection control, and safety elements in a consistent series of charts and graphs that lets readers see at a glance what is happening. The key to bringing meaning to the information was to show benchmark data against which pertinent elements could be measured.
Today, not only does the board understand and enjoy the reports, but because the graphical presentations make trends and developments obvious, the reports have helped achieve "dramatic improvements in almost every area we monitor," says Caroline Bassett Lathrop, MSN, RN, GPHQ, director of quality management at PBH.
"[The graphical reports] let us see which things actually impact patient care," she explains. As the data are gathered and analyzed, quality teams can adjust the portion of the patient care they wish to monitor. This has led to quick improvements over the past 18 months. For example, in anticoagulation therapy, the hospital’s previous time for administering thrombolytics was 90 minutes. The quality team has hit its 40-minute goal and is now working on 30 minutes, Lathrop says. Similar dramatic turnarounds were achieved in ambulatory times and pre-admission education for open-heart surgery patients.
New reports grew from basic research
Bringing all the right elements together in these reports did not prove easy, and Lathrop says her department heads and quality teams are becoming more sophisticated in their ability to develop and manipulate the data as time goes by. Initially, the process was one of basic benchmarking and research.
For each of eight areas reported on, the process is much the same. Each reporting group or department is responsible for literature searches. The hospital is on-line, so the groups have access to the Internet, but much of the work is done through journals, sometimes with the help of the hospital’s librarian. Through this work, which is done annually, the departments or quality teams identify baseline data and indicators, as well as benchmark data.
Lathrop also contracts with Press, Ganey Associates in South Bend, IN, for patient satisfaction benchmarks and questionnaires and with Iameter in San Mateo, CA, for severity adjusted data by DRG. The state of Arizona also publishes outcomes data PBH uses for regional or peer hospital comparisons. All are incorporated into the final reports, which are generated quarterly.
These areas are covered in graphical format:
• quality improvements (severity-adjusted mortality and length of stay);
• obstetrical/gynecological data;
• patient satisfaction;
• service delivery standards;
• risk management;
• infection control;
• safety.
Team updates are in a grid format. Lathrop uses no special software to make the graphs; her Lotus program has proved sufficient for the task.
In each of the graphical presentations, the benchmark data are expressed as a baseline, mean (peer hospitals), or goal. (See cardiac care charts, p. 31.) Lathrop and her quality teams go to a great deal of trouble to provide detail, but because of the graphical presentation, the reader is not overwhelmed with the information. For example, Lathrop is able to provide patient satisfaction data for dozens of indicators across several departments. But to bring each department or function into focus, the report features a bar chart that shows the previous quarter’s rating, the current quarter’s rating, and the mean or peer hospital rating for each function.
Information at a glance
Users of the reports are able to see on one page, for example, six months of patient satisfaction ratings together with peer ratings for nurses, physicians, tests and treatments, discharge, admissions, services, visitors and families, finals (final overall impressions of the acute care experience), room/accommodations, and diet and meals. An overall summary is shown to one side, with a small chart illustrating the hospital’s overall goal and performance for the past four quarters.
At a glance, the reader can see how the hospital is doing in 10 critical areas and how these stack up overall. Similar charts break down critical performance areas in all departments. (See sample patient satisfaction graphical report p. 32.)
Grid makes report more user-friendly
Lathrop treats service delivery standards for six key areas much the same, but the chart includes a key that briefly delineates what the standards are as they were set by each department or team’s benchmarking. The six areas monitored are antibiotics, thrombolytics, sterile processing and delivery, radiology, laboratory, and pharmacy. Within each of those areas, the managers and teams identified key components or critical elements needed to deliver care in a timely and efficient manager. (See the Service Delivery Standards chart, p. 33.)
The report consists of totally graphical information for virtually every area included. Quality team updates could be the exception to the rule for PBH, but Lathrop has found a way to make even what is normally a narrative report into a user-friendly grid. The grid shows the area of study, the departments involved, their goals, the rationale behind the project, the current activity, and the outcomes. (See Performance Improvement Summary, p. 34.)
As most of the quality improvement teams are multidisciplinary, the graphical reports have proved invaluable in promoting teamwork across departmental lines, says Lathrop. Because each team member understands how his or her contribution affects the overall results, members interact more easily and share data more readily than when their input was buried inside a 60-page narrative, she says.
Because the reports are formatted consistently and show the hospital’s improvements in a way that historical data and the progression of improvements are clear, hospital managers support the data gathering effort and have made it a priority. "The reports are an ongoing reinforcement of what we’re doing and why," she explains, which helps cement the manager’s continuing support.
[For more information, contact Caroline B. Lathrop, Phoenix Baptist Hospital and Medical Center. Telephone: (602) 246-5777.]
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