A key leader behind this effort is Stephen Wickham, MSN, RN, director of clinical performance excellence within the operations performance group for CommonSpirit. Mr. Wickham is part of a team overseeing enhancements of a clinical operations dashboard that monitors performance across the system’s hospital-based and standalone emergency departments. The dashboard allows emergency department leadership to identify opportunities to improve throughput and operations within specific markets or hospitals. The system’s emergency department operations performance group also works directly with clinical executives or ED directors at hospitals to implement improvements.
Mr. Wickham recently spoke with Becker’s about CommonSpirit’s journey to build a standardized, data-driven approach to ED efficiency, the insights gained from tracking performance at scale and the system’s next steps in refining emergency care operations.
A systemwide, data-driven approach
CommonSpirit’s ED performance dashboard, developed about six years ago, integrates data from 82 facilities in 32 states, accounting for 2.8 million visits over a rolling 12-month period. The dashboard will soon add about another 20 EDs from CommonSpirit’s mountain division, with all 100 hospitals using either Epic or Cerner EHRs. The system’s remaining hospitals are functioning on other EHRs that do not currently connect with the dashboard, according to Mr. Wickham. Once the system completes its consolidation to Epic and these facilities are added, he projects the dashboard will cover nearly 4 million visits annually.
The current dashboard includes data on 32 key performance indicators that Mr. Wickham’s team determined were necessary to measure across all EDs within the system. These metrics and definitions are standardized systemwide, with the KPIs organized into several domains, including length of stay, registration of provider, provider to decision, door to disposition and boarding hours.
Every employee with a login has access to the dashboard, which is updated weekly. The dashboard contains national, regional and hospital-specific views of ED performance, allowing clinical executives to view their own hospital’s data and then drill down by selecting a certain KPI. For example, one KPI collected is primary diagnosis, which allows teams to assess ED performance tied to specific conditions, such as heart attacks, sepsis or behavioral health issues.
Rather than relying on ad hoc solutions to correct performance challenges, CommonSpirit has established a framework that allows leaders to assess whether a best practice is in place, evaluate its effectiveness and implement necessary changes. This framework outlines 20 best practices for optimal ED performance: 10 focused on culture and leadership and 10 on process improvement. The dashboard tracks each ED’s performance with these best practices, providing a step-by-step road map for adoption when needed.
For Mr. Wickham, having a clearly documented and widely shared set of best practices has been instrumental in driving consistency and improvement across the system.
“This has been a game changer to have well-known leading practices that are published in a form in which we can share that information not only nationally, but locally,” he said. “It’s important to ensure your leading practices are not only in place, but can be communicated effectively.”
What’s next
The next iteration of the dashboard, set to launch this summer, will integrate national benchmarks using data from the Emergency Department Benchmarking Association, a group of more than 1,500 EDs nationwide that collects, analyzes and shares data to improve performance and patient outcomes. This will allow CommonSpirit to compare its performance against national standards and further refine its approach.
As part of this effort, CommonSpirit’s emergency services clinical council identified eight KPIs that will incorporate EDBA data for national benchmarking and established systemwide targets for each. Mr. Wickham emphasized that while these benchmarks create a standardized framework, individual facility goals will be tailored to their annual patient volumes.
“A freestanding ED’s goals will be very different from those that see more than 80,000 or 100,000 patients annually,” he noted.
Once implemented, these targets will mark the system’s first unified goals for emergency department performance. Beyond standardizing performance metrics, the updated dashboard will allow hospital leaders to identify top-quartile performers in their respective markets, fostering more opportunities for peer learning and best practice sharing.
