Driving Quality with Visual Management

Scott Knoer, MS, PharmD, FASHP

Chief Pharmacy Officer

Cleveland Clinic

Objectives

Identify various operational and clinical metrics to incorporate into your dashboards

Discuss the development of an electronic pharmacy dashboard

Describe the utilization of the system and improved outcomes seen by pharmacy leadership

50 Buildings on 180 acre main campus

9 Community Hospitals

18 Family Health Centers / 7 Ambulatory Surgical Centers

2,700 Physicians

11,000 Nurses

43,000 Caregivers

1,300 Residents and Fellows

65 Accredited Training Programs

Cleveland Clinic FloridaWeston, Fl

Additional Locations

Cleveland Clinic NevadaLou Ruvo Center for Brain Health (Las Vegas)

Cleveland Clinic CanadaToronto Health & Wellness Center

Additional Locations

Cleveland Clinic Abu Dhabi, UAE

Sheikh Khalifa Medical City Abu Dhabi, UAE

Cleveland Clinic Pharmacy Enterprise (2012)

– 743 Pharmacy FTE’s– $66 M Salary Expense– $367 M Drug Expense

Drug Budget $367,000,000

How do you keep track of it all?

Business intelligence• Business Review Deck• Quality Dashboard

• Readmissions• Core Measures• HCAHPS

MedBoard• Turn-around times

CoPAT dashboard• Home Care

Knowledge portal

Business Review Deck

User defined Key Performance Metrics • Benchmark• Quality • Financials

Key Volume Indicators • # of doses• Just data: not necessarily benchmarked

Top Projects Goals

• Have discussion• Are we on task or not?

Business Review Deck

Development• Two ½ day sessions

Maintenance• Monthly input• Financials feed directly• Manual

Standard product across Cleveland Clinic (proprietary) Review

• Monthly review with dept. leadership

Opportunity to discuss issues with the team

Pharmacy Business Review Deck

Top Projects

Quality / Risk Management

Key Volume Indicators

Key Volumes

Productivity / Financial

Quality Dashboard

System wide• Drill down

Core Measures• SCIP

HCAHPS Readmissions Also have financial dashboard

SCIP

SCIP

MedBoard®

Retrospective• Turn-around times• Identifies areas to focus on

Real Time• Where is the dose right now?• Where was it delivered to?

5 5 4 4 4 4 3 3 7 7 4 43 4 4 4 3 4 3 3

6 65 2

7 6 9 7 6 65 5

8 7

1

27

35 35

17 1711 9

8

8

2 3

3 2 11

1

1

13 13

12 116

6

6

6

49 50

42.535

56

28.5

2013.5

50 57

61

35

0

20

40

60

80

100

120

140

Med

ian

Tim

e (in

min

utes

)

May-June MedBoard Data

Documented to Admin Time Delivery Time

On Cart Time RPh Check to Cart Time

Rph Check Time Prep Time

Verification Timen= 6,117

n=12,584

n=851

n=4,946

n=1,159

n=3,856

n= 6,496

n=12,004

n=4,797

n=3,688

n=1,078 n=1,156

0.07 0.04 0.07 0.07 0.03 0.07 0.07 0.07 0.08 0.07 0.07 0.08

0.18 0.19 0.18

0.48 0.53 0.49

0.79 0.82 0.790.58

1.02 0.95

0.5

1.13 1.05

0.780.56

0.43

0.83 0.77 0.73

0

0.5

1

1.5

2

2.5

3

Med

ian

Tim

es (i

n ho

urs)

Inpatient Medication Turnaround Times: April - June

TD»TA = Time Delivered/Available to Time Documented as Administered

TE»TD = Time Entered/Verified to Time Delivered/Available

TS»TE = Time Scanned to Time Entered/Verified

TW»TS = Time Written to Time Scanned

Central PharmacySatellites (HC, Peds, & G5)Nursing Unit Based PyxisOverall474 ,017 113,383 119,377 116,49418 ,308 48,893 50,971 487,487375 ,480744 ,406 650,655066 ,647Doses:

% 4.17% 2.18% 0.18% 6.7% 4 .7% 8.7% 0.75% 5.74% 2.74% 100% 100% 100: %121 ,18n=080 ,19n= 960 ,19n= 135 ,13n=893 ,12n= 410 ,13n=200 n=200 n=200 n=456 ,31n=173 ,32n= 570 ,33n=:

100%100% 74.5%

7.8%

17.4%

75.0%7.4%

18.0%

7.6%

74.2%

18.2%

100%

CoPAT Dashboard

Community Parenteral Anti-Infective Therapy Quality and financial Referrals / market share Outcomes

• Readmissions

Knowledge Portal

Proactively manage automated dispensing cabinets• Inventory• Controlled substances diversion

Knowledge Portal Home Screen

Knowledge Portal – Watch List

Dashboard Challenges

Purchase product vs. create Data feed

• Direct• Manual

Ensuring your team understands the importance• Not useful if not updated• Accountability

Using it• What is your process to review

Opportunities

Drive quality and finances• HCAHPS scores

• By hospital• By nursing unit

• Core measures• Readmissions• Ambulatory business

• Scripts• Revenue• Wait times

• Oversedation