I am very pleased to welcome back LaKesah Cotton, The Director of Operational Effectiveness for UF Shands. She is going to discuss the effective use of key process indicators, KPIs, as a very helpful visual control for monitoring process improvement. I asked her three questions; how can we create graphs that will encourage everyone to monitor their daily performance? How can KPIs end the blame game and encourage teamwork? How can KPI's drive continual improvement? So what are KPIs? KPIs are key performance indicators, and we should all have some type of indicator to let us know that we're doing well or that we're not. So in the clinic, if we want to talk about outpatient clinic, what would be our KPIs and how do we create graph that encourage everyone to monitor their daily performance? So we're going to talk about the checkin to room, we are going talk about a patient throughput. So if we talk about checkin to room, we should have a board that's displayed somewhere that everyone in the office can see that tells what these KPIs are. Again, this is your process, so your key process indicators should be process indicators for your process. So if we're going to do a checkin to rooms, we would have a board that was displayed and it would have checkin to room. So then every month someone will be responsible, the clinic manager will be responsible for coming in. This is month to month, let's say this was January and let's say this was February. So now we're trending here. So every month everybody can come in and say, "Man, last month we took us 15 minutes to room a patient and this month is taken us 20." But every month we can do month over month and we can trend to see how we're doing and where we're going. Another important thing on your KPIs is that you have some type of goal. So we know that maybe this is where we are, but this is where we're trying to get to. So everybody can understand that we are not where we need to be. We work on action plans to get us where we need to be. So this is a key process indicator board or a board that you can have in your area that everybody can see. You don't necessarily want your patients to be able to see this, but you do you want it to be in a place that's visible to your staff and it's a constant reminder of where we are trying to be, these are our goals. How do we make these end the blame game? So if we have one set of staff maybe the nurse is saying, "Well, it's not my fault the patients are taking too long to be in the clinic". We do our piece, we give room to physician. We get that piece right every time. So you'll assign these areas to who they belong to. You assign owners. So you're checking in a person? This is their metric. Everyday this is how they're measuring themselves. This is for your nurses. This is how they're measuring themselves. So then the total visit time, that could be a gap between when the physician leaves the room until we get a patient out the door. So every metric should have an owner, and that owner should be able to speak to, maybe there are reasons that metric went down that month. There's nothing wrong with it, but you need to be able to speak to it and if you can't speak to it, if there's not an owner then nobody's taking responsibility to be able to speak to it or to dig in and to figure out what was going on that month. So that's how you use metrics to help in the blame game. You assign an owner and you have them responsible for reporting out and giving you suggestions because there shouldn't be one person giving all the suggestions on how to improve, the process owner should be doing that. Five, how do we drive continual improvement? Maybe last year was a very bad year for us, and it was taking our patients 75 minutes total time. But our goal was 65. So we've done a lot of process work, we've put in some things in place, we've had our nurses give us great feedback on how we can improve this time, and we've driven this down. Now, we're down to 65 minutes we're hitting our goal. It may be time to create new goals. So continual improvement happens when you constantly surveying where you're at and you're analyzing that information and then moving forward. I think every health care organization or everybody takes pride in what they do when they want to be a center of excellence. So you look at where your goal is and then you also measure that to other national healthcare facilities that are the same demographic and makeup, and you look for ways to figure out what your benchmark is and where you should be. There's a lot of literature out there on process improvement, there's a lot of literature out there on base lining and goals, and you continue to look for ways to improve and breakdown these different processes to improve. So for example again, if we want to talk about room to physician, we may want to break this down to say into a further category and say, our patients that need immunizations, how long do they take? Do they take longer? That's a different project, but that's another opportunity that you have to improve to figure out exactly where your breakdowns are and what you want to improve. But you use your metrics, you use your data, and you push for your data and you make sure that everybody is comfortable with the data, and they agree and approve and have body in these data points are correct. That's how you use data to help you in your organization.