Data-Driven

The results of this shift towards data-driven performance improvement speak for themselves. Among the many metrics that Reynolds and his colleagues have to show for their work:

A 59-percent reduction in medication errors reaching patients;

The elimination of prescribing errors associated with therapeutic heparin orders and insulin orders, with new order sets for each ordering process;

The reduction in clinical alerting rates for CPOE orders to below 3.6 percent with regards to allergy, pediatric dose range, duplicate checking, and drug-drug interaction alerts, meaning that alerts have been optimized to ensure that physicians no longer experience “alert fatigue”;

A 12-percent increase in annual examinations for asthma patients, and a doubling in the percentage of patients receiving detailed asthma management plans;

An increase in autism screening rates from 65 percent to 94 percent;

An increase in screening for lead exposure from 59 percent to 96 percent;

An increase in rates of follow-up for care of patients with ADHD (attention deficit hyperactivity disorder) from 57 percent to 100 percent;

A 95-percent reduction in transcription costs among the affiliated general pediatric practices;

The shortest emergency department wait times among any of the children's hospitals reporting data to the Child Healthcare Corporation of America, the pediatric hospital association;

A 5-percent reduction in the hospital's overall operating budget using targeted reductions identified by financial and productivity-based dashboards.

Of course, none of these results has come about because of a single person, or even because of a handful of people. People across the extended Children's of Omaha enterprise have, in the past few years, become boldly energized to become change agents and take on a variety of clinical, operational, and financial challenges in every corner of the organization.

CHANGE CHAMPIONS TO THE FORE

Certainly, the impact of certain change champions has been very significant in convincing large numbers of clinicians and others to embrace data-driven change. Among those most cited as a change champion by others at Children's of Omaha has been Nancy Knowles, B.S.N., M.D., the medical director of Children's Physicians, one of the two large salaried-physician practices affiliated with the hospital.

WHEN THEY FIRST APPROACHED ME WITH THE DASHBOARDS, I DIDN'T EVEN KNOW WHAT DASHBOARDS WERE, AND I DIDN'T EVEN KNOW WHAT BUSINESS INTELLIGENCE SOFTWARE WAS! BUT IT SHOWS YOU THAT YOU CAN LEARN NEW THINGS.-NANCY KNOWLES, M.D.

Indeed, Knowles's involvement in the initiative is particularly intriguing, because of her combination of decades of clinical experience, yet almost no experience with IT-driven change efforts prior to this initiative. “Honestly,” says Knowles, who has logged decades as a clinician, first as a nurse and then as a physician, “when they first approached me with the dashboards, I didn't even know what dashboards were, and I didn't even know what business intelligence software was! But it shows you that you can learn new things.”

What Knowles instantly recognized was the potential the dashboards offered to leverage data to effect clinical transformation. “I've always been interested in quality and quality improvement,” she says. “And the way I look at it is, if we do what's best for the patient, everything will fall into place; and secondarily, I want to make sure the clinicians have the tools to deliver the best quality care. And we take care of 70,000 kids in Omaha,” she adds, “so I'm always looking at the big picture.” Knowles quickly allied with Reynolds, and set to work on developing a variety of dashboards to improve care delivery and care management quality in her 35-physician practice. Among the numerous areas she and her colleagues have applied dashboards to have been the tracking of check-in appointments for patients with ADHD; quality of asthma assessment; child immunization status tracking; and treatment of children with pharyngitis.

WHEN IDEAS ARE GENERATED THAT ARE CONSISTENT WITH THE GOALS AND VISION OF THE ORGANIZATION, OUR C-SUITE GETS 100 PERCENT BEHIND THOSE GOALS AND THAT VISION.-GARY A. PERKINS