Analytics and data access lead to quality improvements at Sick Kids

TORONTO – Quality and safety can be improved through the use of tools like business intelligence and analytics, but you need to “democratize” the data, so that everyone is on board across the organization.

That’s the message delivered by the Hospital for Sick Children’s CEO, Dr. Mike Apkon, at a session on analytics that was held last November during HealthAchieve, the Ontario Hospital Association’s annual conference.

“We want to be the safest children’s hospital,” he said. “But 10,000 people have to work toward it,” he added, referring to the 10,000 clinicians and employees of the organization.

As Dr. Apkon put it, “The key is transparency, so that someone who needs to know about their performance has access to the data.”

He reflected on his past experience with a U.S. hospital, where information was collected on the performance of staff and clinicians, but they didn’t have access to the data.

When the hospital finally shared the data, performance shot up. “And it happened without a single conversation,” said Dr. Apkon, noting that people looked at the data about their units or themselves and from that alone, were inspired to improve.

“It shows the power of giving people access to their own information,” he said.

David Grauer, senior vice president of Health Catalyst, and former CEO of Intermountain Medical Center, in Salt Lake City, Utah, added, “Most people are intrinsically motivated to do the right things, but they don’t have the right information.”

Grauer was on stage engaging in a conversation with Dr. Apkon about analytics, performance, quality and safety. Intermountain is itself a leader in the use of analytics and BI. Health Catalyst, a company spun off from Intermountain, helps hospitals build data warehouses and improve their processes.

That being said, Dr. Apkon did note that transparency of data can also motivate people in a different way.

“When people know that I can see the information each day, it improves their performance. It has an immediate effect.”

Indeed, with the democratization of performance data, everyone becomes more responsible for performance and quality.

Dr. Apkon commented that this kind of continual observation and monitoring requires “data literacy” by the leadership throughout an organization.

Gone are the days when executives would wait for reports to be printed and delivered to their desks. “You can’t just use a print-out,” said Dr. Apkon, explaining that these boiler-plate printouts are often out-of-date by the time you see them, and often enough, they don’t contain the information that’s needed.

By working with an analytics system, moreover, you can formulate your own questions and find your own answers.

Of course, implementing such technologies is expensive, as is the training and education that goes along with it. But the change that analytics and BI can bring about is significant.

Dr. Apkon said the systems have been enablers of quality improvement at Sick Kids, where clinicians aren’t just given reports and targets. They’re also able to dive into the data for themselves, to check it and come up with their own analyses and interpretations.

“We’ve given a lot of our physician leaders access to the data,” he said.

That’s been a big help when it comes to issues like length of stay, which the hospital has been trying to optimize.

LOS can have many facets and questions surrounding the figures and definitions that are used. “There are a million reasons why someone might question the number we have come up with,” said Dr. Apkon.

Indeed, physicians in particular may question the official wisdom. “Tearing apart data is a sport for physicians. We’re trained to have a critical eye.”

But by letting doctors explore the data, Dr. Apkon said, engagement and utilization are fostered. So is understanding, as the doctors can see how various numbers were arrived at.

Dr. Apkon said it’s important for the leadership to set goals and targets, but clinicians and staff have to be free to develop initiatives, as well. After all, the problems identified at the front-lines can have an impact on workflow, safety and quality, too. And giving teams control over their activities also contributes to morale and job satisfaction.

Linette Margallo, clinical director of ED at Sick Kids, commented that she has seen “a huge evolution in data over the past 10 years. “Having more data lets us really dig in.” She and Kate Langrish, clinical director of paediatric medicine, gave real-world examples of how analytics and parsing the data have helped improve the delivery of care at the hospital.

As one example, they described the incidence of supracondylar fractures in children. “Usually from falling from a jungle gym or tree,” commented Margallo. Over a five-year period, they could see from the data that admissions were increasing, and so were wait times for admissions and treatment.

By further analyzing the data, they could see that most of the arrivals were in the afternoon – when orthopedic surgeons were in the operating rooms. This meant the surgeons weren’t available to admit the patients from the ED to hospital.

The hospital then worked to change the admitting process, enabling young patients with fractures to get started sooner on pain management and other procedures. And the 10 to 12 hour wait time for admitting was reduced to an average of eight hours – a significant improvement.

“We used data to solve a problem and change a process,” said Langrish.