9/27/2017

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Dashboard Culture: How to Get Stakeholders to Pay Attention and Bring Value to Healthcare

Jennifer Bailey, RN, MS

Vice President of Quality & Transformation

Johns Hopkins Community Physicians

Armstrong Institute for Quality & Patient Safety

Office of Johns Hopkins Physicians

Agenda

• Introduction

• Data Accuracy

• Data Displays & Dashboards

• Making data actionable

• Using data to drive change & improve value

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The Johns HopkinsHealth System

Corporation (JHHSC)

The Johns HopkinsUniversity (JHU)

The Johns

HopkinsHospital

JohnsHopkinsBayviewMedicalCenter,

Inc.

HowardCountyGeneral Hospital

JohnsHopkins

CommunityPhysicians

SchoolOf

Medicine

JohnsHopkins

HealthCareLLC

JHVentures,

LLC

Johns HopkinsMedicine

(JHM)

JohnsHopkinsMedicine

International,LLC

JohnsHopkinsHomeCare

Group

SuburbanHospital,

Inc.

SuburbanHospital

HealthcareSystem,

Inc.

SchoolsNot Part of JHM

NOTE: Johns Hopkins Medicine is an unincorporated organization with delegated powers from JHU and JHHSC. Various trusts supporting JHU and JHHSC are not shown separately.

SibleyMemorialHospital

Johns Hopkins AllChildren’sHospital

Property of Johns Hopkins Medicine, all rights reserved

Johns Hopkins Medicine Organizational Structure

JHM: Clinical Enterprise Integrated Delivery Network

• 5 Hospitals-Baltimore/DC

• Community Based Health Centers- ASCs, Specialty Care, Primary Care

• Primary Care Sites

• Patients seen in and out of network

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Creating Value from Data

Wisdom

Knowledge

Information

Data

Value

Steps to getting value from data & dashboards

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Data Accuracy

Data Displays

Actionable Data

Use: Driving Value

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Data Accuracy Data Accuracy

• Data needs to be accurate in order to use it effectively– Data inputs

– Data definitions

– Data Quality Assurance

Builds trust in the data

Use of a Team- Data Entry into EMR

Patient

Nurse

Doctor

Other

Office Staff

Office Staff- enter in demographics (language, preferred method of contact)

Nurse/Medical Assistant- enter in vital signs, social & family history, patient reported screenings

Doctor- enter review of systems, physical exam, assessment & plan

Data Accuracy

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EMR Workflows

Orchestrate who does what and 

when

Data Accuracy

Clinical Decision Support

View reminders in the EMR at the point of care

One click to address reminders for overdue services‐ easy to do the 

right thing

Data Accuracy

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Coded Data Entry-Reportable

• Standard code sets/taxonomies Problems/Diagnosis- ICD9/10

Procedures- CPT codes

Labs- LOINC codes

Medications- RxNorm, NDC

• Flowsheets- vital signs

• Patient- unique ID’s

• Provider- National Provider Identifier

Data Accuracy

Report Writing- Specifications and Data Definitions

• Key Principles– Data steward to create

specifications: need an understanding of workflows

– Leverage coded data sets to write report specifications

– Use the same definitions in reports as in point of care clinical decision support

– Create data definitions that can be used repeatedly in reports

– Review specifications in person with report writer to assure understanding

Data Accuracy

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Registries

Internal‐ Electronic Medical Records

* Allow for population segmentation that can be used repeatedly

Immunizations

Diseases-diabetes,

hypertension

Patient Characteristics (Age, Sex)

Data Accuracy

Roles in report generation & Quality Assurance of Data

User-squeaky

wheel

Analyst/ Data

Steward

Programmer

• Programmer- get the data out of the system

• Analyst/ Data Steward- define, understand and present the data

• User- assure accuracy, validate, and use data

Data Accuracy

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Dashboards, visualizations, and data displays

• Improve quality and drive behavior change Dashboards

Detail Reports

Visualization techniques

50%

60%

70%

80%

90%

100%

50% 60% 70% 80% 90% 100%Co

mm

un

cati

on

Rat

ing

Overall Rating

Overall Provider Rating vs. Communication

Data Displays

Dashboards, visualizations, and data displays

• Improve quality and drive behavior change Dashboards easily communicate

performance

Visualization techniques are important

50%55%60%65%70%75%80%85%90%95%

100%

50% 60% 70% 80% 90% 100%

Co

mm

un

cati

on

Rat

ing

Overall Rating

Overall Provider Rating vs. Communication

Data Displays

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Dashboards for monitoring and feedback

Sites are provided monthly feedback dashboard reports

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Data Displays

Run Charts: Show progress over time

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Data Displays

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Heat maps: Show population concentrations

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Data Displays

Bubble graphs: show outliers based on correlations

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Data Displays

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Deep data dives to answer specific questions

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Sites with opportunities to expand office hours

45% of ED visits occur when offices are open

Data Displays

Bar & Line charts to show correlations

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Data Displays

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Data aggregation and analysis

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Drill down readmission rates by service and discharging hospital

Data Displays

Embedded in Quality Improvement Plans

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Data Displays

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How to make data actionable

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• Communicating data

• Drill down capabilities

• Data discovery

Actionable Data

Communicating and Summarizing

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Actionable Data

Hot links to Dashboards and Patient detail reports

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Drill down based on org structure

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Actionable Data

Entity Specialty Site Provider

Data Discovery

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Actionable Data

Lots of Filter Options

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Using Data to drive change and value

• Aligning incentives

• Transparency

• Linking to governance

• Linking to accountability

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Use: Driving Value

Aligning Incentives

• Add metrics to bonus’s and salary structure for providers, managers and executives

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Use: Driving Value

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Reporting transparently

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Use: Driving Value

• Drop down menu options for anyone to select

• No access restrictions on results

JHM Quality and Safety Governance Structure

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JHM AI Patient Safety and

Quality Board Committee

Armstrong Institute

Inpatient Hospital Pediatrics

Population Health Home Care

Johns Hopkins

International

Ambulatory Practices

Ambulatory Procedures

Use: Driving Value

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Ambulatory Quality & Safety Governance

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Use: Driving Value

Ambulatory Quality & Safety Governance

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Use: Driving Value

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JHM Strategic Planning Process

• Sets clear & measureable goals annually

• Progress reported to JHM Armstrong Institute Quality & Safety Board to assure accountability

• Aligns incentives for Directors

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Use: Driving Value

Ambulatory Quality & Safety Governance

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Use: Driving Value

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OJHP Monthly Dashboard shared at Joint Council

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Use: Driving Value

• Safety• Outcomes• Patient 

Experience• Value• Health 

Equity

Ambulatory Quality & Safety Committee Structure and Governance

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Use: Driving Value

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Regional Advisory Councils

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Use: Driving Value

Ambulatory Quality & Safety Governance

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Use: Driving Value

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Entities execute on Performance

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• Use Dashboards routinely to determine metrics that need improvement

• Transparent results• Multiple data displays for PI

Use: Driving Value

Local Performance Improvement: down into the entities

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• 30 Primary Care Practices all over the state

• Front line staff and providers drive local change

• Central Quality Team (enabling infrastructure)– Supply data/dashboards

– Lean trained green belts facilitate performance improvement plans

– Document using A3’s

– Team developed PI plan: providers & staff

Use: Driving Value

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Sites develop Performance Improvement Plans

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Use: Driving Value

Accountability: Reporting variances to the board

• Report PI plans for metrics in red to the board

• Using Management, Discussion, and Analysis format

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Use: Driving Value

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Data Accuracy

Data Displays

Actionable Data

Use: Driving Value

Steps to getting value from data & dashboards

Creating Value from Data

Wisdom

Knowledge

Information

Data

Value

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Thank you!

Jenny Bailey

jbailey@jhmi.edu

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