Overcoming the obstacles to measuring outcomes
Overcoming the obstacles to measuring outcomes
Involve key staff and play up quality indicators
The question is not whether to start measuring outcomes. It’s when.
Outcomes measures are an essential survival tool in the competition for managed care contracts. But don’t expect your staff to jump at the opportunity to design a system. Creating useful measurements will heap more work on everyone for at least a year. To muster the cooperation you need, involve the key players from day one.
Here are the steps to sparking and upholding commitment to the project:
• Identify a few enthusiasts. Choose staff who have enough influence and respect to generate cooperation among the others. These are your project champions, explains Carol Hull, ART, CPHQ, manager of risk quality management at San Antonio (CA) Community Hospital. Next, Hull advises, "have a key peer talk to your clinicians."
• Don’t overlook your receptionists. Their acceptance or resistance to data collection will affect your patients’ willingness to provide information. Receptionists often possess a realistic sense of the best times to collect data. They know whether patients are more likely to give complete health histories by phone or on a pencil and paper questionnaire at their first prenatal visit.
• Be sure to touch base with the ultimate consumers of your data. Talk with your hospital’s top management or your managed care plan. You could waste a lot of time and resources, for example, if you collect data on the rate of C-sections while your managed care plan is focused on lengths of stay among maternity patients.
It’s tempting to take on too much when you start. Resist this hardy impulse at all costs it’s a pathway to failure. Your first exercise in measuring a health outcome will involve far more than producing a report, says Marianne Weiss, RN, DNSc, associate professor at Marquette University College of Nursing in Milwaukee. You’ll also be learning to collect data and testing your computer systems.
"It’s more efficient to target one key clinical outcome like improving outpatient management to achieve fewer C-sections," Weiss advises.
Be sure to integrate a reading of patient satisfaction in your outcome measures, says Tricia Wagner, RN, perinatal programs coordinator at the Women’s Center of Cox Health Systems in Springfield, MO. That will offer your staff immediate feedback on the quality of their interactions with the women they serve. High ratings will reinforce their patient relations skills and boost their motivation to persist with the projects. Low marks will offer an objective they can readily target for improvement.
Separate clinical from technical tasks
Delegate tasks when you can. As women’s health providers, your job is to figure out which pieces of information will be helpful and meaningful. With that in mind, involve technical experts to program the computers and crunch the numbers in ways that produce your outcome reports.
At Cox Women’s Center, Wagner and the staff engaged technical experts to help examine their existing data. They found they already were capturing some of the information they needed. Birthweights were routinely recorded, for instance. The technical consultants programmed the computer software to convert the weights into grams or pounds and ounces depending on the preference of third-party payers. (For information about outcome measurement resources, see story, p. 61.)
You undoubtedly know that close scrutiny of care practices might threaten the most confident of caregivers. Hull notes that clinicians at her facility became uncomfortable when they realized that the outcomes data on hysterectomy recovery could expose shortcomings in their professional practices.
"We had to emphasize that the results would inform all of us about what interventions are best practice, not that we would be looking for bad practitioners," she says.
A sure antidote to defensiveness is to spot and tout every indication of quality care and service, however small. Applaud all improvements in your outcomes. At Cox, for example, the staff saw dramatic evidence of their good work as the rate of C-sections dropped by 6% in a year. The rate of low birthweight babies dropped from 10% to 2%. The dollars spent on care of premature infants plunged 61%.
(Editor’s note: In next month’s issue, we’ll tell you how Cox achieved these cost savings and improved prenatal care in the process.)
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