"No one wants to be an Outlier" - Spine Surgeons at BIDMC Use Performance Improvement Tactics to Reduce Waste

This initiative at BIDMC to reduce waste in spine surgery is a great example of a "performance improvement system" (in this case they used Lean) to improve outcomes (in this case clinical utilization). A similar "performance improvement" approach can work in improving quality, mitigating risk, and improving patient safety.

The article identifies the following "performance improvement tactics" that should be integral components of all improvement projects:

• Examined how much they used and spent (review and monitor data)
• Questioned why each device was being being used (ask why five times)
• Studied reasons for wastage (undertake root cause analysis)
• Asked surgeons, operating room personnel, industry representatives, and nurses to help them identify waste (seek multi-disciplinary input)
• Compiled lists of who had been wasting more instruments than others (create profiles)
• Shared lists [of waste generators] with each other (create report cards)
• Awareness campaign (educate)
• Physician leadership prompted change (get support from leadership)

The key behavioral drivers that project leader, Dr. Kevin McGuire, Chief of Orthopedic Surgery, identified are "physicians are competitive in nature" and "no one wants to be an outlier". Understanding these drivers is key to understanding some of the performance improvement tools and how to deploy them effectively.

Performance Improvement Tip of the Day: The "SMART Profile"

As you can gather from previous posts, SMART is a recurring acronym from our "performance improvement perspective".

The SMART Profile is a tool that can help you generate a sense of who the “top performers” are for any performance measure, who the “outliers” or “low performers” are, and how each individual practitioner ranks within his/ her peer group. When prepared with an eye to the SMART elements below, this tool can provide an important impetus to behavior change.

PPII SMART Profile Tool

Physicians in general are data-oriented and competitive. The SMART Profile comparing an individual's performance to others in their professional peer groups provides a helpful reference for the individuals to know where they fall "within the ranks". Those on the "Top Performer Reports" are supported and reinforced to continue their positive behavior, while those on the "Low Performer Reports" are motivated to improve their performance.

Performance improvement staff often worry about the negative ramifications of Profiles and the potential for "angry physicians". However, most individuals do not react negatively - particularly if the profiles follow the SMART paradigm. Those rare individuals who do get upset about the profiles generally become quite compliant once they have blown off steam and understand how these contribute to the overall improvement effort. 

It is important for PI Specialists to understand that behavior cannot change unless one provides some "framework" for the same. SMART Profiles are an important means to establishing such a reference.

These Top Performer and Low Performer Report Cards were provided courtesy of Physician Performance Improvement Institute. 

Story about the "Story Board"

One of last week's Performance Improvement Tips of the Day was about the use of Story Boards to improve communication related to performance improvement projects:

In this regard, I received a wonderful story from a PI project leader related to the Story Board.

Who says performance improvement can't be exciting?

Perfomance Improvement Tip of the Day: The "Story Board"

The "Story Board" represents a simple but effective way to improve communication related to your PI project.

It serves many functions:

• Makes everyone aware this is a priority project. 
• Lays out the rationale for the initiative. 
• Communicates the latest data and trends. 
• Can be easily updated.

The Story Board above was contributed by 

Physician Performance Improvement Institute.

Performance Improvement Tip of the Day: The "PI Pitch"

What is it?

A short sound bite that succinctly and memorably reports on a project's success and activities. It “hooks” the listener to want to know more! It also tries to get the listener to "take the next active step" needed to make a project successful.

Why do you need it?

It provides a mechanism to engage physicians and other providers in an initiative, while respecting the limited time that most professionals have available for such interactions. It brings visibility to the project and gives team members credibility.

What makes it great?

Keep it short, make it "easy to get", and make it conversational.

Scripting (Example)

"We’ve been participating in the Diabetes Performance Improvement Project for 7 months. We're excited that lipid profile testing has improved from 42% to 57%. Our team implemented a check off for lipid profile on the General Admission order set to remind physicians to order this test on all diabetes patients if no documentation within last 12 months. What is your practice related to this measure?"



Follow Up (after initial PI Pitch engages):

-- "Do you have any questions or suggestions about this initiative?"
-- "We would love to have your participation or help (if appropriate)."
-- "I'll plan to followup with you again when I have updated results."

This PI Pitch is provided courtesy of 

Physician Performance Improvement Institute.

Performance Improvement Tip of the Day: The TrendWatch

The Trendwatch is a finely crafted performance improvement tool that provides a lot of "punch" in just one page.

(1) Updated Performance - helps to communicate the latest data to your team, physicians, and staff members.

(2) Barriers or Gaps to Performance - helps your team to keep their eyes on the "root causes" of poor performance.

(3) Initiatives Implemented - helps you keep track of what interventions you have tried to improve performance, along with dates of implementation.

(4) Other Prioritized Initiatives - helps you keep track of interventions that you intend to try, lest you forget some great ideas that someone brought up earlier in the process!

Those who have used the tool report that it has been a great aid to their initiatives - it keeps information organized, provides focus, and helps to keep everyone on the same "page".

This TrendWatch tool was provided courtesy of 

Physician Performance Improvement Institute (PPII).