[MUSIC] Hello, and welcome to the course on Performance Measurement in Patient Safety and Quality. I'm Matt Austin, and I'm a faculty member in the Johns Hopkins University School of Medicine in the Department of Anesthesiology and Critical Care Medicine and the Armstrong Institute for Patient Safety and Quality. My background is as an industrial and systems engineer. And prior to joining healthcare, I worked in the airline industry for 12 years, both for Continental Airlines and American Airlines. This week, we're going to talk about performance measurement in healthcare. We're going to talk about what is performance measurement, provide you with some definitions, talk a little bit about Donabedian's model. Then talk about domains of healthcare performance measurement, how you define a measure and data sources for those measures. We'll then give a global example of the International Consortium of Health Outcomes Measurement. And then wrap up the week with information on challenges in performance measurement, and things that you might need to know in greater detail. Before we get going, I thought maybe we would start with an example of performance measurement in another industry, and maybe one that you might be familiar with. What would you consider to be a quality airline, and how would you measure the quality of an airline? I'll give you just a moment to think about that. So here are some of the common examples of quality measures in the US airline industry. One key measure of quality is accidents. The measure of this can be defined as the number accidents per 1 million takeoffs, or the number of accidents per millions of miles traveled. Another measure of quality might be flight cancellations. The measure here would be the percentage of scheduled domestic flights that were cancelled, and l'd bring you attention to that term domestic. At least here in the US, the cancellation rate just looks at flights that are within the United States, and doesn't include international flights. Mishandled bags, so this is where your bags arrive at the airport, or you arrive at the airport and your bags don't. This would be the number of mishandled baggage reports per 1,000 passengers boarded. Another measure of quality would be on-time arrivals. Did your flight arrive when you expected it to? This measure is the percentage of operated domestic flights that arrive within 14 minutes of the scheduled arrival time. So for purposes of the US airline industry, an on-time flight is one that gets there within 14 minutes of the scheduled arrival time. So if your flight was scheduled to arrive at 10 o'clock, as long as it arrives by 10:14, that's considered to be on-time. If it gets to be 10:15, now it's considered late. Here are a couple of additional examples of quality measures in US airlines. One is involuntary denied boardings. So airlines, or many airlines here in the United States, actually book more passengers on a flight than there are seats on a flight, knowing that some passengers aren't going to show up. So one of the measures of performance or quality is the number of involuntarily bumped passengers per 10,000 passengers boarded. There's also measures of customer complaints to the Department of Transportation. So if a customer submits a complaint to the Department of Transportation that actually gets tracked. And then there's customer satisfaction surveys, looking at things like the frequent flyer program, the quality of the service, the seat comfort, and food as well. These data that are collected are also made publicly available for airlines. So this is an example of the airline's performance for on-time performance of US airlines in June 2016. So these are the percentage of domestic flights that arrived within that 14-minute window. So Hawaiian Airlines actually led the way in June 2016, with performance around 90%, followed by Alaska Airlines and Delta Airlines. American Airlines in this one particular month was actually well below those, well into the mid-70s range. These data are made publicly available each month, and it's really an example of transparency driving performance. Now that we've sort of giving you some background around performance measurement in other industries, I thought I'd spend some time actually going through definitions and what do we mean by performance measurement? I've presented two definitions, I think both are very useful and helpful in terms of thinking about this concept of performance measurement and what we mean by it. The first definition is the process of collecting, analyzing, and/or reporting information regarding the performance of an individual, group, organization, system or component. And I would actually draw your attention to two pieces of part of this definition. The first is the collecting, analyzing and reporting. It's really that trio of activities that really constitutes what is performance measurement. It's collecting data, it's analyzing the data, and it's reporting those data out. I would also draw your attention to the last part of that definition, the individual group, organization, system or component. There's really many different levels of where we can apply performance measurement, and we'll talk about this a little bit later in the lesson. About, are you looking at the performance of an individual, are you looking at the performance of a group of individuals, the performance of an organization? The second definition is the regular measurement of outcomes and results, which generates reliable data on the effectiveness and efficiency of programs. And here I'd really draw your attention to two pieces, one is reliable data. We want to make sure that what's being collected is actually reflective of what's actually happening. And you're also looking at the effectiveness of programs, how well are things working in the system? How well is performance actually happening? There's many different ways that performance measures get used. Here are five of the key ways. The first one is external or public reporting. If we look back at that airline example in terms of the online performance for airlines, and how those data were made available by the Department of Transportation, that's an example of external or public reporting. The data about the organization or the individual's being put out there for public consumption. The second use of performance measures is internal reporting. Are you reporting to individuals within your organization around the performance of either the individuals or the organization as a broader component. The third use is internal improvement efforts. Do you actually have a quality or safety improvement project ongoing? And are using these data or performance measures to actually track your performance? What was your performance before the improvement effort? What was your performance after the improvement effort? What was the impact of the intervention? Performance measures are also really useful for benchmarking to others. How am I doing relative to other organizations? How am I doing relative to other healthcare providers? Performance measures allows you to answer that question. And finally research, this is such an important use to performance measures. As we think about health services research and understanding how our healthcare delivery system works, it's really this performance measurement and performance measures that allow us information we need to understand what's happening in our healthcare system. Finally, I wanted to share some examples of some performance measures. We started with some performance measures for airlines. These are some examples of performance measures for healthcare. The first one is a hospital's intensive care unit's rate of central-line associated bloodstream infections. Another example of a performance measure might be a physician or a physician group's success in controlling blood pressure for patients that have a diagnosis of hypertension. Another example is a patient's view on how well the nurses in the hospital communicated with them during their hospital stay. And a final example would be the patient experience with urinary incontinence after surgery for localized prostate cancer.
