CS&E News - Fall 2011

Fall 2011

Ibi Opuiyo, left, and Dr. Joseph Steele, right, are congratulated by Dr. Thomas Burke for winning the top project award.

MD Anderson Projects win UT System Awards

Three projects by MD Anderson clinicians were honored at the recent University of Texas System Clinical Safety and Effectiveness Conference in San Antonio.

Joan Woods, left, and Charisse Acosta after winning award. 

The project Neuro-interventional Ultrasound – Improving Patient Access by Ibi Opuiyo, RDMS, and Joseph Steele, M.D., of Diagnostic Radiology won first place honors at the meeting held Oct. 27-28. See video explaining project.

Third Place honors went to Charisse Acosta and Joan Woods of Pathology Lab Medicine Quality Improvement for the project Decrease Patients with No Lab Orders sent to Outpatient Diagnostic Centers for Blood Draw.  See video.

The UT Southwestern project Decreasing Duration of Mechanical Ventilation by Implementing Evidence Based Protocols in Medicine ICU won second place honors.  See video.

Another project from MD Anderson, Improving Access to Dermatology garnered a sustainability award for Cancer Prevention’s Margaret Bell, R.N., and Carol Drucker, M.D., of Dermatology.
During the Recognition Dinner at the meeting, MD Anderson’s Lavinia P. Middleton, M.D., of Pathology was inducted as a Clinical Safety and Effectiveness Fellow.  For more information on the meeting, go to UT System CS&E Conference.

Flowcharts, Costing Methodology Used to Bring Change

Both in-patient and out-patient areas at MD Anderson are becoming very knowledgeable about flow charts through the use of a new methodology called Time-Driven Activity-Based Costing (TDABC).

The activity led by the Institute for Cancer Care Excellence and supported by the Office of Performance Improvement will document current processes in order to determine the cost of caring for our patients.   The ultimate goals are: to meet the coming reform that calls for bundled payments for care to replace our current fee-for-service model and to produce a useful map for the clinical areas that identifies opportunities for improvement.  

TDABC, based on work by Harvard Business School’s Robert Kaplan, Ph.D., uses time equations that directly assign resource costs to the activities performed.  This leads to more accurate determination because cost is based on actual time and compensation for providers to deliver care.

Clinical Quality Improvement Consultants in OPI begin work on TDABC by working with business analysts to gather data from MD Anderson’s Enterprise Information Warehouse to assist in determining the scope of process flow that will be mapped.  Data driven clinical pathways are used to determine which path is used more often and scope of process flow mapping is finalized with the clinical content experts, in attempt to capture the greatest costs in care.

Then a blueprint of the planned work is created that shows the major process flows that will be mapped.  Also, a chart key is created with color codes for each provider and the job code of the provider.  The consultants work with staff and management team in the clinical areas to complete the mapping of processes.  The work involving planned weekly interviews of those caring for the patients to capture what is currently happening.   For each of the job codes, the work for a shift will be mapped and the time and frequencies of patient care procedures determined.  

The next step involves transcribing the steps of a flow into a spreadsheet that uses formulas to calculate the cost of processes using the time, frequency and average salaries of the providers and probabilities.  Here is the formula for TDABC costing:

Cost for Activity = (Adjusted Hourly Rate of Job Code performing activity) x (Time) x (Frequency) x (probability)

All activities are added together and combined with overhead costs to determine the cost of the process.  

Work on TDABC mapping continues to capture the care of the Head and Neck patient in diagnostics, treatment and other ancillary services.   One other Center, Gynecologic Oncology has been captured as well, with plans to roll out to other areas in 2012.   A poster Process Mapping: Fundamental Step for Improving Value was selected for December’s Institute for Healthcare Improvement conference.

OPI has also developed a video Flowcharting Basics that discusses the basics of process mapping and is available on the Quality College site.

Behal's Celebrating Talk on Taming Your Dragon 

Raj Behal, M.D., M.P.H., said academic medical centers should use face the challenges of health care reform by managing variation, cost and quality in is talk at the 2011 Celebrating Improvement at MD Anderson Program.

Behal, associate chief medical officer and senior patient safety officer at Rush Medical Center in Chicago, said his medical center is working to improve care by “minimizing variations unless driven by patient needs.”  At Rush, the improvement initiatives begin with the engagement of physicians to develop Evidence-base, Lean Care Maps...  The projects are focused on all of the elements of a program “without a “top down” mandate to “cut costs by x%,” he said.

Results from the improvements at Rush resulted in change of direct cost per case up to 30%, but Behal said confounders such as drug shortages can drive the costs higher because higher priced drugs have to be used. For more on Behal’s talk see Celebrating Improvement.