Leverage Data to Drive Quality Improvement


March 2020 - Vol. 17 No. 3 - Page #8

Health systems are among the biggest producers of data. In fact, approximately 30% of the world’s stored data is generated within the health care industry.1 Capturing a large amount of data and putting it to use in health care initiatives can enhance quality, help predict outcomes, and improve operational efficiency.2 Technological advancements have exponentially increased the amount of data routinely generated, as well as the ability to analyze it. Machine readable data can be translated into formats ranging from daily reports to detailed annual summaries.

However, the value of massive amounts of information, also referred to as big data, can only be realized when it is analyzed to help improve or validate performance. While a health system may have access to a significant amount of information, the act of simply collecting it is insufficient; this data must be leveraged to provide actionable insights that help maximize safety and operational benefits.

Data Analytics in Pharmacy Operations

In pharmacy, data can be collected from a multitude of sources, including EHRs, smart pumps, ADCs, and software platforms.1 With the advent of big data, pharmacy managers can forecast product demand to plan and optimize inventory. For example, big data collected from cloud-based inventory management software using a bi-directional interface can provide just-in-time inventory replenishment models for the entire health system, which ensures that medications are stocked and available when needed, thus improving the efficiency of daily operations.

University of North Carolina (UNC) Health Care is a non-profit, integrated health system comprising UNC Medical Center (UNCMC) and 10 other hospitals across the state of North Carolina. UNCMC is a 950+ bed facility in Chapel Hill, with an 83-bed community hospital in Hillsborough. UNC’s Pharmacy Analytics and Outcomes team provides analytics support at the system level and delivers strategically aligned, actionable data to pharmacy employees and administration in order to drive greater insights, a better patient experience, and meaningful value in pharmacy services.

By providing pharmacy end-users with more than 150 recurring reports and dashboards on a daily, weekly, or monthly basis, the Pharmacy Analytics and Outcomes team promotes a culture of data-driven decision-making and metric-based strategic planning. Since its establishment in 2013 with just a 0.5 pharmacist full-time equivalent (FTE), the Pharmacy Analytics and Outcomes team at UNCMC has since grown to support three pharmacists, six business analysts, a biostatistician, a pharmacy intern, and a
pharmacy manager.

Continuous Quality Improvement

In support of continuous quality improvement, the UNCMC pharmacy department worked with the Pharmacy Analytics and Outcomes team to analyze several key value streams. The goal is to evaluate value streams that comprise the activities and processes necessary to deliver care and services to meet a patient’s needs.3

The Central Inpatient Pharmacy (CIP) and Sterile Products Area (SPA) value stream, for example, is responsible for the ongoing procurement, preparation, and delivery of medications for UNCMC patients. To analyze this value stream, members of CIP/SPA mapped out existing processes to identify opportunities for improvement. This event identified a significant need for additional data collection. Following subsequent value stream analyses and a concerted effort to obtain data, the UNCMC CIP/SPA team began putting the data into action through the development of dashboards and other quality improvement initiatives.

Value Stream Dashboard

Creating dashboards that provide a visual representation of key metrics is one method of organizing and maximizing use of big data. The Pharmacy Analytics and Outcomes team developed a value stream dashboard for CIP/SPA as a visual representation of the key performance indicators identified during value stream analyses events (see FIGURE 1). This dashboard is used to assess a variety of operational metrics, such as:

  • Medication turnaround times (TATs). The TAT is defined as the amount of time from when the drug order label prints (ie, the dispense time) to the time the drug leaves the pharmacy (ie, the send time)
    • Average TAT for first doses
    • TAT for STAT medications
  • Missing doses
  • Re-dispenses (eg, a medication must be re-dispensed when it is lost during patient transfer, when a PRN dose is required, or when the first dose was not dispensed, etc)
  • Responses to in-basket messages
  • Corrected and verified orders

Click here to view a larger version of this Figure

Each day, the top 10 medications with a TAT greater than 30 minutes are recorded on the dashboard to identify which drugs require the most time to prepare. The dashboard also shows a list of the top five missing medication doses from the CIP; this feature tracks the frequency of notifications that an expected dose is not on the nursing unit.

The value stream dashboard is an important tool to assess operational productivity and efficacy. Missing doses are automatically sent to CIP/SPA management on a daily and monthly basis, and are also printed for display on a huddle board in the CIP/SPA, which increases staff awareness. During daily huddles, targeted measures are reviewed to facilitate discussion about performance goals, analysis of why performance measures are not met, and strategies to improve.

Individual Operations Performance Summary Dashboards

While the value stream dashboard provides a broad overview of operational efficiency in the CIP/SPA, dashboards that focus on the performance of each individual pharmacist have also been implemented. Individual operations performance summary dashboards assess the work of each first- and second-shift SPA pharmacist (see FIGURE 2). These dashboards are designed to enhance accountability, identify trends, and foster conversations with staff regarding process-based improvements.

These dashboards detail key metrics from the prior 2-week period. One of the metrics included is a list of the top 10 orders with the longest TAT for each individual pharmacist, compared with the average TAT for those same medications among their peers. This metric increases awareness of any workflow disruptions the pharmacist is experiencing, which creates an opportunity to discuss the variances and implement steps to improve existing processes.

A list of all orders changed by the pharmacist is also included on the dashboard because within the practice model at UNCMC, CIP/SPA pharmacists do not complete order verification as part of their routine responsibilities. After a decentralized clinical pharmacist verifies an order, this order is routed to CIP/SPA to be dispensed. Occasionally, there may be issues with these orders (eg, incorrect dispense code), prompting a CIP/SPA pharmacist to make the necessary changes to ensure the correct product is dispensed from the right location (eg, medication carousel or automated dispensing cabinet). These changed orders identify when orders are sent to CIP/SPA improperly and help resolve various problems, such as EHR dispense logic issues, order build concerns, and improper ordering practices.

The individual operations performance summary dashboards are sent to each pharmacist’s manager, who reviews them with the pharmacist individually to identify and discuss potential system issues. This creates a level of accountability for the pharmacists, which helps improve overall operational performance. Note that it is important to review the dashboards one-on-one with the pharmacist, rather than display them in the pharmacy department. This allows for the identification of root causes to any workflow disruptions and supports a focus on opportunities for individual process improvement as well as overall system-level improvement.

Current Limitations and Future Directions

While the UNCMC pharmacy department has reaped significant benefits by collecting and analyzing data, challenges and limitations exist. With the exponential growth in the amount of data captured, there is concern that we may not be able to evaluate the data quickly enough to meet real-time needs. To navigate this challenge, the Pharmacy Analytics and Outcomes team has been extremely supportive in providing dashboards on a regular and timely basis. Assessing and discussing the dashboard results with team members during huddles soon after receiving the data allows us to act on issues more quickly than we were previously able to. However, we are still investigating strategies to increase our access to real-time data.

Introducing a workplace culture where data is collected to promote accountability can be challenging, as some SPA pharmacists were apprehensive with the introduction of the operations performance summary dashboards. We have begun to gain buy-in from these pharmacists through strategic conversations focused on explaining the rationale and primary intent behind capturing this data, which is to address system issues and eliminate potential medication errors. Framing discussions in this manner has proven to be effective, as staff members are actively involved with creating solutions to identified issues to improve patient care.

Key metrics gleaned from our dashboards are currently documented and tracked with the goal of later assessing the impact of data transparency on operational performance. We hypothesize that the use of broad, team-based dashboards, in combination with individualized performance dashboards, will improve key metrics over time. Additionally, the UNC Pharmacy Analytics and Outcomes team plans to make the dashboards more interactive by adding drill-down capabilities. The ultimate objective is to increase our use of metrics and display real-time data on screens in the CIP and within the EHR for UNCMC pharmacy department use.

Conclusion

Utilizing dashboards with data analytics within the pharmacy department has been essential to assessing operational efficiency, improving acute care operations, and promoting a culture of continuous quality improvement. Looking to the future, pharmacy leaders will continue to leverage data to improve decision-making, optimize workflow, allocate resources, and improve outcomes.


References

  1. Huesh MD, Mosher TJ. Using It or Losing It? The Case for Data Scientists Inside Health Care. NEJM Catalyst. https://catalyst.nejm.org/case-data-scientists-inside-health-care/. Accessed November 12, 2019.
  2. Marr B. How Big Data is Changing Healthcare. Forbes. www.forbes.com/sites/bernardmarr/2015/04/21/how-big-data-is-changing-healthcare/#1c6e7d6f2873. Accessed November 12, 2019.
  3. Wendland D. Value Stream Mapping Made Easy. Forbes. www.forbes.com/sites/forbesagencycouncil/2019/07/25/value-stream-mapping-made-easy/. Accessed November 21, 2019.

The authors would like to acknowledge Emily Torgerson, MPH, business analytics specialist on the UNC Pharmacy Analytics and Outcomes team, for her contributions in the development of these dashboards.


Charles Summerlin, PharmD, is a PGY1 health-system pharmacy administration and leadership resident at the University of North Carolina (UNC) Medical Center and an MS degree candidate at the UNC Eshelman School of Pharmacy in Chapel Hill, North Carolina. He earned his Doctor of Pharmacy degree from the University of Maryland School of Pharmacy. Charles’s professional interests include ambulatory care, specialty pharmacy, clinical management, and practice advancement.

Judith Lovince, PharmD, is a PGY1 health-system pharmacy administration and leadership resident at the UNC Medical Center and an MS degree candidate at the UNC Eshelman School of Pharmacy. She earned her Doctor of Pharmacy degree from Florida A&M University College of Pharmacy and Pharmaceutical Sciences. Judith’s professional interests include 340B, pharmacy operations, continuous quality improvement, and transitions of care.

Mary-Haston Vest, PharmD, MS, BCPS, is the clinical manager, analytics, outcomes, and impact, at UNC Health Care and assistant professor of clinical education with the UNC Eshelman School of Pharmacy. She received her PharmD from the University of Mississippi School of Pharmacy, and completed her PGY1/PGY2/MS with UNC Hospitals and the UNC Eshelman School of Pharmacy. Mary-Haston’s professional interests include practice advancement through analytics and data-driven decision-making, as well as practice-based outcomes research.

Samuel M. Eberwein, PharmD, MS, BCPS, BCSCP, is the clinical manager of pharmacy for the sterile products area, perioperative services, and special formulations at the UNC Medical Center. He earned his Doctor of Pharmacy degree from Campbell University and his Master of Science degree with an emphasis in Health-System Pharmacy Administration from the UNC Eshelman School of Pharmacy while completing his 2-year Health System Pharmacy Administration residency at UNC Hospitals. Sam is a board-certified pharmacotherapy specialist and board-certified sterile compounding pharmacist.

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