But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Monday, April 16, 2007

What's in a number?

I have been searching for meaningful and effective ideas to present our central line infection rate that might supplement the one we use. We use the ratio of cases per thousand ICU patient-days. This is a good and accurate metric, but the problem that arises when you have a consistently low figure like 0, 1, or 2, is that there will inevitably be variation around it that may not be helpful in analyzing or explaining how you are really doing over time. Plus, is there another metric that gives just a bit more incentive to improve?

I am not talking about what our goal is. Our goal is "zero." Whether expressed as a rate or a simple number, the virtue of "zero" is that it is indeed "zero" in both cases. As Paul O'Neill has often noted, "Setting zero errors as a goal encourages breakthrough thinking, orients work cultures towards continuous improvement, and keeps people pushing toward the goal."

In factories, you often see a sign saying "x days since our last accident" that motivates people to pay attention to safety procedures and practices. We could do that for our hospital, i.e., "X days since our last central line infection," but I am not sure if it would be as effective. For one thing, we have several ICUs dealing with different kinds of patients and different degrees of difficulty in avoiding central line infections.

For example, we have heard an excellent report from folks in Pittsburgh championing a year without a line infection, but this was for their cardiac care unit only. In our CCU, they are past the 300 day mark without a line infection, but CCUs are lower risk than other ICUs.

Of course, this problem already exists for our composite ICU rate, too. And people will point out that factories have lots of different manufacturing sections with variation in risk. A company-wide figure creates both an overall sense of pride and community and internal peer pressure among the various corporate divisions to not let the whole group down by being the site of an accident.

Would that work within the setting of academic medicine? What's the verdict from those of you out there? Have any of you done this? Did it make an appreciable difference in how people behaved? In public perception of your institution?

Would it matter to you as a prospective patient? If you read a website saying "60 days since our last infection", would you say to yourself, "What an excellent hospital" or would you say "That's a long time -- there is bound to be an infection soon, and maybe it will be me"? Does it work better or worse than posting an infection rate of "1.2 cases per thousand ICU patient-days"?

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