Inform and educate

How can a health system make best use of its quality and safety data? Johns Hopkins Medicine has gone further than most with the help of two dashboards—one for sharing the data internally and the other for sharing it with consumers. HRMR reports.

Transparency is a watchword in US healthcare in 2016, and with the generation of more and more quality and safety data, hospitals and health systems face the question of how best to make use of it.

In 2014 and 2015 Johns Hopkins Medicine launched a user-friendly resource that facilitates sharing data both internally and externally. It helps consumers understand and compare quality and safety data across the institution’s five inpatient adult hospitals and home healthcare group, while at the same time its internal interface helps staff understand how their units are performing.

“We have two concurrent efforts—one is a dashboard to share quality and safety data with our 41,000 employees; the other is to share our quality and safety data with the public,” says Matt Austin, an assistant professor with the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the faculty lead on the two dashboard projects.

“We’ve had strong support from our senior leadership to share our quality and safety data. They recognise there are some areas where we have room for improvement and they have had the courage to take the step putting it out there and being transparent.”

The data comes from a variety of sources: it includes infection data from the system’s infection control departments, who are monitoring issues such as central line infections, catheter-associated urinary tract infections and surgical sites infections, plus core measures reported through the Joint Commission, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data.

“We worked with a variety of divisions within the health system in collating these data, learning about how to pull together quality and safety data where we previously worked in silos, and creating infrastructures to better share quality and safety with each other,” adds Austin.

Informing the consumers

The Armstrong Institute led the development of the external dashboard with quality and safety leaders from Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Sibley Memorial Hospital, Suburban Hospital and Johns Hopkins Home Care Group.

More than 40 former patients and family members lent their voice to the project, advising the team on measures that are important to patients and reviewing the site for ease of use and functionality. Graphic designers and web strategists formatted the information into visually stimulating charts that are simple to navigate and comprehend.

"Visitors can view three years’ worth of performance data to see areas of progress and those in need of attention."

The final product is a consumer-friendly site that allows visitors to interact with the data. It provides a narrative to help patients decipher the information and draw their own conclusions about each hospital’s performance.

“Many individuals choose to review data about their healthcare providers and use that data to decide what matters most when it comes to his or her healthcare experience,” says Austin.

“We worked closely with our Patient and Family Advisory Councils to ensure we presented credible information about our health system’s overall performance in an easy-to-understand format that could help consumers digest the information, ultimately guiding their healthcare decisions.”

Consumers can access basic information on five key safety issues: the patient experience, infection rates, hand hygiene, hospital readmissions and core measures. Visitors can view three years’ worth of performance data to see areas of progress and those in need of attention.

Corresponding improvement initiatives are shared, and clinical staff members discuss how they support safety and quality every day. The HCAHPS star ratings are also displayed.

While dozens of rating systems publicly post their ratings, they often differ on their conclusions about which hospitals perform the best or worst, potentially adding to consumers’ confusion over healthcare quality. A study conducted by researchers at the Armstrong Institute found that under the four most popular hospital rating systems no one hospital was ranked as a high or poor performer by all four systems.

“To get the full picture of our hospitals’ health performance, consumers used to need to look at numerous websites and then interpret the data,” says Austin. “We created this valuable resource in the hopes of providing patients with easy-to-understand information about some of the most important safety issues in one simple location.

“It’s a one-stop shop for our patients about the quality and safety of care we are providing and what we are doing to continue to improve our performance.”

The web tool is available at no charge to consumers on the Johns Hopkins Medicine website. The Armstrong Institute plans to update the tool regularly with new performance data and measures. As the patient safety and quality arm for Johns Hopkins Medicine, the Armstrong Institute aims to eliminate preventable harm to patients and achieve the best patient outcomes at the lowest cost possible.

The site provides relevant information in an accessible format designed to appeal to potential patients. It also educates site visitors about the patient experience and key safety issues associated with high-quality, respectful care.

In order to help potential patients make informed decisions, it compares past and present performance data to national and state averages for the institution’s five adult inpatient hospitals and home healthcare group. The goal is to provide essential information about the safety of the institution in an accessible format that appeals to potential patients.

“Where you go for healthcare can have a profound impact on your health outcomes,” says Peter Pronovost, senior vice president for patient safety and quality for Johns Hopkins Medicine and director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

“Our patients and their families and loved ones deserve to be informed about the safety and quality of their healthcare. At Johns Hopkins Medicine, we are dedicated to continuously improving our safety efforts and sharing our performance data with our past, present and future patients and the communities we serve.”

Driving improvements

While the external dashboard has empowered customers to understand more about the system’s performance and make informed decisions about their care, the internal dashboard has dramatically improved the system’s ability to share quality and safety data with its employees, to make sure it is seen, and to drive improvements.

“Historically we sent out quality and safety reports by email,” says Austin. “Having a web-based dashboard that everyone has access to helps enormously with sharing information.

“We have also found that we are hearing more from front line staff about the types of data they want to see added. They are interested in seeing how their unit performs against other units.”

These efforts are in line with the system’s recent focus on using HCAHPS data to move the dial on performance.

“The internal dashboard has been really helpful in communicating scores and trends over time,” he says. “For HCAHPS we have seen our performance generally improve over the last 12 to 18 months.

“Another benefit of the internal dashboard has been that it has forced us to think about our own internal infrastructure and about how we collate data across different sources—and that is definitely internally beneficial.”

The dashboard does raise some risk management issues around the sharing of data, and Austin’s team have partnered with the system’s risk management team to ensure this process is properly managed.

“If you are sharing information with 41,000 employees you have to assume it’s going to leave the walls of the institution in some form—so we have shared with risk management what data we will be presenting and how we’ll be presenting it.

“All of the data we are sharing so far is aggregated data, so we’re not sharing individual patient information. We have kept risk management engaged and they have been very helpful partners in terms of supporting transparency.”

Another question is how granular to make the data: for instance, should colleagues be able to see information on their own individual performance, as well as their unit’s performance?

“At this point, we are drilling down only as far as the unit level. We have had some conversations about possibly sharing individual provider-level data: for example, the hospitals’ standard protocol is that when patients are admitted they receive prophylactics to prevent deep vein thrombosis while in hospital,” he says.

“One discussion we’ve had is the possibility of sharing individual provider-level information on how well each provider is doing in terms of sticking to that protocol. However, we feel that at this juncture, unit-level data strikes the right balance and there are probably better mechanisms for sharing that provider level information rather putting it out in front of 41,000 people.”

There is no doubt as to the success of the internal and external dashboards in terms of keeping customers and staff informed about the hospitals’ performance and progress, but this is not the end of the journey. Austin is optimistic about the future, and what more can be achieved using the dashboards.

“We continue to improve and enhance both of them. In terms of the external dashboard, we are looking at adding videos because users are often interested in seeing short clips. For both the internal and external dashboards we will be adding additional measures, so it continues to evolve—and the future is bright.”