Health Care Provider Improves Performance With Metrics

Presbyterian Healthcare Services is using performance management software to keep track of a vast array of metrics to improve patient care and operational efficiency.

The Albuquerque not-for-profit runs seven hospitals and a medical group with 60 clinics. With 9,000 employees, it's the largest healthcare provider in New Mexico.

In 2002, Presbyterian Healthcare decided it wanted to win the Malcolm Baldridge National Quality Award, an honor given by the National Institute for Standards and Technology to recognize organizations in business, health care, education, and the nonprofit sector for operational excellence. NIST visited Presbyterian later that year, and said the health care provider needed a formalized methodology for measuring performance. So Presbyterian studied another Baldridge winner, Los Alamos National Bank, and adopted the performance management software it was using: Performancesoft Views, which Actuate Software has since purchased and renamed BIRT Performance Scorecard.

The software measures effectiveness in key areas, including clinical outcomes, customer loyalty, staff retention, and financial results, comparing internal performance with industry benchmarks.

"Malcolm Baldridge is all about continuous cycles of improvement and continuous learning," said Molly Payne, performance management architect at Presbyterian Healthcare. "One of the things we figured out early on is the only way to improve is to study what we're doing."

Using Actuate's software lets Presbyterian document the metrics it considers important and "instill accountability system-wide," Payne said. When a hospital manager institutes a change designed to improve performance, the software can monitor performance to see if the improvement materializes. "What's great about this tool is it allows us to go back and follow up with people," she said.

All told, the hospital takes 2,900 measurements across 1,500 geographic locations, business units, departments, and individuals, each of which is set up as a separate "location" in the software, Payne said. Each of the 420 staff physicians is designated as a separate location. The organization bases compensation on Actuate results.

For example, Presbyterian Healthcare uses the software to track how well it's managing diabetic patients. It looks at A1C blood tests, which measure blood glucose levels, for all its patients and enters those results into Actuate to keep track of its performance treating diabetes.

Also, the Actuate software lets Presbyterian measure its performance against Medicare and Medicaid parameters for results treating acute myocardial infarctions, congestive heart failure, and pneumonia. The health care provider also uses the software to measure customer loyalty and satisfaction across multiple dimensions. And the software is used to measure the time it takes for patients to get an appointment after calling.

On the business side, Presbyterian Healthcare uses Actuate's software to measure operating margins and supply costs. Employee turnover is measured against expectations for each department--some departments, like housekeeping, have higher turnover rates than others, like the IT department; that's expected and accounted for. Likewise, the hospital experiences regular, seasonal fluctuations in turnover, which are taken into account in the scorecard.

The hospital posts its performance scores on its Web site, in areas such as breast cancer screening, diabetes control, and health plan member satisfaction, using the Internet publishing tools that come with the scorecard software.

The software costs $25,000 per year, with a concurrent user license, and requires two employees to run it. Presbyterian Healthcare has 750 active users who can access the software and make changes, although 9,000 employees can view the data but not make changes.

Ironically, because the software measures 2,900 parameters, boiling that down to one or two metrics for overall performance is overwhelming. However, Payne points to a few scores that demonstrate the hospital's improvement.

The hospital's pharmaceuticals department was able to reduce the time spent filling out paperwork by 53 hours per month--about 30-45 minutes per person. It also saw a 12% increase in improvement measured across 105 metrics during the past year. The health care provider has seen a steady improvement in scores in critical areas such as patient safety, mortality, heart attack care, congestive heart failure care, and surgical infection prevention.

And how's the Baldridge award going? Still a work in progress, Payne said. They had another visit this year that went well, and they're optimistic they'll get the award soon, she said.

Blue Cross of Northeast Pennsylvania, the University of Louisville School of Medicine, and a range of large and small healthcare providers are using mobile apps to improve care and help patients manage their health. Find out how. Download the report here (registration required).