Putting patient safety and quality data where you might not expect it: Johns Hopkins Medicine goes performance-transparent with dashboards

Hospitals are constantly having their data collected, combed through and compared. Whether in quality and safety databases or financial rankings and credit ratings, third parties like U.S News & World Report and federal organizations like CMS are watching to see how health systems stack up against one another.

Some hospitals are making an effort to take data collection into their own hands, getting a better perspective and diving deeper into their data than others do in order to drive improvements. Two years ago, Johns Hopkins Medicine decided to get a more informed picture of the performance of its five hospitals by rolling out a dashboard that collects data on a number of quality and safety metrics within the system, organizing it in one place.

Making quality data available to staff
To drive improvements in patient outcomes and employee performance on the micro level, for individuals and their units, information and metrics pertaining to hospital-acquired infections, core measures from CMS and The Joint Commission, HCAHPS results, hand hygiene performance and measures of patient experience, among others, are gathered into the database. Johns Hopkins' 41,000 employees can visit the dashboard to view their individual performance numbers, as well as overall hospital ratings.

"I think an area where we've really benefited from the dashboard is around HCAHPS," says Matt Austin, PhD, professor of anesthesiology and critical care medicine at Johns Hopkins' Armstrong Institute for Patient Safety and Quality in Baltimore. "We've had a large, systemwide focus on HCAHPS in the last 12-18 months and the ability to easily share unit-level information across a large enterprise has really been helpful in both having everyone understand where we are and improving performance."

The goal of the internal dashboard is to share key quality and safety measures with the aim of being able to look at data all the way down to unit-level performance, Dr. Austin says.

"We feel like real change happens at an individual unit level, so where we can share that data, our experience has been that's what will drive the greatest improvements."

Going public with performance data
More recently, the health system implemented an external-facing dashboard, including much of the same information, which is accessible to patients and anyone curious about Johns Hopkins Medicine's performance data.

The health system had four major goals in making its performance data visible to the general public via the second dashboard. First, as a way to hold itself accountable to patients, their families and the communities it serves. If the hospital makes claims about its performance measures and how they stack up against competitors, what better way to reassure patients that those claims are true than by displaying the numbers?

Second, it consolidates all of the disparate data about Johns Hopkins into one place — when patients go seeking information about a hospital or health system online, they are inundated with reviews, numbers and measures of performance that may not be from credible sources. Patients might also be hunting for a specific measure of performance and having a hard time finding it. The dashboard is a one-stop shop for all of the data that is available.

Third, there is a market demand for this type of transparency and information consolidation. Not only did Johns Hopkins see its competitors undertaking similar initiatives, but patients had indicated that a tool like this would be very helpful to them, and the system wanted to engineer a way to collect all the safety and quality data that might help them make better informed decisions about care in one place.

Lastly, taking full ownership of all of its measures and organizing them in one place enables Johns Hopkins to create a narrative around the data.

"It allows us to talk directly to our patients about why the data are important and what we're continuing to do to improve our performance in each of the areas," Dr. Austin says.

Unintended benefits of sharing performance data
Beyond giving patients a direct line to important hospital data, the dashboards allow Johns Hopkins officials to track performance on whatever measures they see fit in one place. If there's a particular area that CMS doesn't require the system to report on, Johns Hopkins still has a platform it can use to gather information and improve on that data point.

"It's a feedback loop, it's understanding where performance is, being able to understand when interventions are put into place and seeing how performance changes over time," he says. "One of the pieces of feedback we've gotten from employees of Johns Hopkins Medicine is they are really interested in being able to compare their unit's performance to another unit's performance and we're working on a functionality to would allow for that."

In that sense, Dr. Austin says the decision to go live with the internal dashboard has given hospital staff more of a voice about the tools they'd like to have at their disposal and the steps the administration could take to help them improve. It has also encouraged a healthy sense of competition and spurred cultural change.

"One of the things we have seen is a greater awareness of performance and how we're doing in quality and safety. We've been creating a culture of data where people are comfortable talking about data and making decisions about data," he says. "That's a big cultural change for us."

Both initiatives also helped foster collaboration across the system. The external dashboard was designed with input from the health system's patient-family advisory councils and the implementation required a multidisciplinary team of health IT and quality professionals, among others. The two dashboards have required team members from different backgrounds to work together and figure out the best way to share and show data so that everyone can understand it.

Creating both the external and internal dashboards also enabled Johns Hopkins to reconsider how it organizes and shares data among teams. Dr. Austin says the system didn't have a very efficient way of doing so before the dashboards.

"The process of needing to work with various data stewards across the healthcare system has forced us from a systems perspective to improve and refine, which in turn has improved other initiatives." Dr. Austin says. "Additionally, it's offered a platform to talk about quality and safety. It's just one more way of having that important conversation and ensuring that conversation is happening at a unit level as well."


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