Quality
How To Drive a Quality Dashboard
By Laurie Larson
Quality dashboards are a hot tool—displaying numbers, percentages and trends in a colorful, quick-read format designed to help hospital boards track safety and quality improvement efforts. Following is an interview with Eric D. Lister, M.D., managing director of Ki Associates, Portsmouth, N.H., explaining how and why to create a quality dashboard and how the board can make the best use of it without becoming “hypnotized by data.”
Trustee: What is a dashboard?
Lister: A quality dashboard is a graphic array of information that highlights an organization’s performance in a number of designated areas of quality. It is meant to be visual, focused data contained in a small amount of space.
Trustee: Why is a dashboard useful?
Lister: If a dashboard is properly constructed, it should give the organization a good idea of how it is performing in key areas against expectations for itself.
If the board is driving the car [the organization], the dashboard is what the board is looking at while driving. The “automotive engineers” are the staff that gather the data and decide how to display them. Staff provide the right gauges and look at how to calibrate progress. If the goal is high-quality care, the dashboard is one tool to [help] get there. However, the dashboard is a springboard for discussion rather than an end in itself.
Trustee: Should every hospital have a dashboard?
Lister: There is no reason not to have one. It has the ability to convey a lot of information with simplicity and clarity. However, having a dashboard is not equivalent to doing the work of quality improvement. In other words, every hospital should have a dashboard, but a dashboard is not all every hospital should have.
Trustee: What should be the board’s process in creating a dashboard?
Lister: The first thing the board needs to do is educate itself on quality and safety and its responsibility for them. Based on the hospital’s history, it can then determine what specific goals and targets it wants to set to make improvements. Next, the board should charter a quality committee, parallel in structure to the finance committee, to oversee the creation and monitoring of the dashboard.
Trustee: Who should decide what goes on the dashboard?
Lister: This should be an interactive decision-making process between the board, its quality committee and key staff, which should include the vice president of medical affairs and his or her staff, the vice president or director of quality, and possibly the elected president of the medical staff. All should discuss “What types of data do we need to track?” “What are our goals for these variables?” and “Which variables are more amenable to dashboard measurement?”
Trustee: Who should be on the quality committee?
Lister: The committee’s chair should have good content knowledge about quality. Among [the committee’s] five to nine members, there should be one or two physicians and a mix of experts and laypersons—it should reflect the board as a whole.
Trustee: What types of data belong on the dashboard?
Lister: The dashboard should include [at least one] variable from each of the following nine topic areas: outcomes frequently compared with nationally established benchmarks; critical national initiatives; publicly reported data; progress on local initiatives; patient satisfaction; patient complaints and potential lawsuits; significant incidents; workforce issues, such as retention; and peer review summaries. Specifics will vary by hospital and service area, but only when all variables are put together will a comprehensive picture emerge.
Trustee: How many variables should be on a dashboard?
Lister: A good number is 10 to 20. Each variable should have a meaningful corresponding number, trend, percentage or a ranking against hospitals of comparable size as a way to measure progress.
Trustee: What resources should be consulted in selecting dashboard variables?
Lister: The Centers for Medicare & Medicaid Services Core Measures; the Joint Commission’s hospital quality measures; the Institute for Healthcare Improvement’s “Alignment with National Health Care Improvement Initiatives” and its “Six Bundles” national quality initiative; and the National Quality Forum’s “Safe Practices” are all good.
Trustee: How often should you track dashboard data?
Lister: The quality committee should give a report at every board meeting.
Trustee: How should hospital and system dashboards be coordinated?
Lister: There needs to be explicit clarity about which quality responsibilities belong to individual hospitals and which responsibilities belong to the system. Without that clarity, things won’t get done. Credentialing and peer review should be reported and tracked by each individual hospital, but beyond that, it depends on how responsibilities are allocated between the system and its hospitals. Some dashboard variables should be similar at all hospitals within the system, but each facility should have some dashboard variables unique to itself. However, the system holds ultimate responsibility for quality.
Trustee: How should the board use the dashboard to turn data into action?
Lister: The dashboard should alert the board to places where a corrective action plan is needed and provide a way to track progress on that plan. For example, if the board is tracking incidents of ventilator-associated pneumonia and sees that its occurrence is up, it should ask staff leadership and the quality committee to come up with an action plan [in the near future] on how to improve outcomes. It’s not the board’s job to make an action plan, but it is its job to not let the topic go until the plan is substantive and specific. The board should be able to say, “If the plan works, here’s how we’ll know it’s working.” Follow-up is a critical use of a dashboard.
Trustee: How often should you revisit your dashboard choices?
Lister: Annually. The full board and the quality committee should look at the dashboard and suggest changes. The dashboard’s usefulness in achieving quality goals also should be examined during the board’s annual self-evaluation, using it to ask “How can we do better?” “What have we learned?” and “What are we doing differently now?”
Trustee: How can the board ensure that it is not tracking data for its own sake, i.e., becoming hypnotized by data?
Lister: An annual review of the dashboard’s structure, possibly at a retreat—the “30,000-foot view”—is a good reminder to look at everything in context. Also, it is important to remember that not all data are measurable on a dashboard. Some areas for improving safety and quality require discussion that can’t be quantified. This is where you really need physician engagement. Similarly, first-person patient experiences heard by the board can do a great deal to prevent data hypnosis.
Programs and Resources
Programs
• Creating a Culture of Excellence and Sustaining Cultural Excellence Sponsored by the Baptist Leadership Institute, Pensacola, Fla. May 14-15, St. Louis To register, go to www.baptistleadershipinstitute.com.
• Implementing LEAN in Health Care Sponsored by the Baptist Leadership Institute, Pensacola, Fla. June 5-6, Sioux Falls, S.D., To register, go to www.baptistleadershipinstitute.com
• Hospital Trustee Professionalism: Building Capacity for Excellence in Governance Sponsored by the AHA’s Center for Healthcare Governance, Chicago June 26-27, Sacramento, Calif. Call (888) 540-6111 or go online to www.americangovernance.com.
• Fall Symposium on Governing & Leading Healthcare Organizations Sponsored by the Center for Healthcare Governance, Chicago Sept. 14-17, Boston To register, call (888) 540-6111 or go to www.americangovernance.com.
RESOURCES
• Trends and Implications, 2007-2012, written by the AHA’s Society for Healthcare Strategy and Market Development and American College of Healthcare Executives, covers trends in: health insurance and access to care, electronic medical records, physician-hospital relations, philanthropy, workforce, clinical technology and quality. Cost is $42 for AHA members; $62 for nonmembers. To order, call (800) 242-2626 or go online to www.shsmdstore.com.
• Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors, from the U.S. Department of Health & Human Services, the Office of the Inspector General and the American Health Lawyers Associa-tion, seeks to help boards carry out their oversight responsibility for quality. This free resource is available at http://oig.hhs.gov/ fraud/docs/complianceguidance/CorporateResponsibilityFinal%209-4-07.pdf.
• The Excellent Board II: New Practical Solutions for Health Care Trustees and CEOs, published by Health Forum, contains 39 new articles and six reprints from the first volume. Cost is $76 for AHA members; $95 for nonmembers. To order, go to www.healthforumonlinestore.com, and use order number 196126.
This article 1st appeared in the May 2008 issue of Trustee Magazine.
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