Monitoring compliance and identifying improvement potentials in a complex healthcare standards landscape

With a new era of focus on accountability of quality rapidly emerging, insight and oversight of quality is becoming more clearly recognized as major area of responsibility of health care organization directors and quality managers. Rounds provide valuable information, and a highly efficient and effective mechanism for improving quality and patient and staff safety. Also endorsed by the necessary desire of health organizations to meet international accreditation standards a need is created on building capacity and improvement methods to measure themselves against these standards resulting in calls to recognize new compliance challenges. Different types of rounds are applied nowadays and some of them are becoming incredibly popular, like tracers and appreciative inquiry surveys.

New are the advantages automated technologies can offer organizations in collecting compliance data and improvement potentials by means of rounds. So-called tracer rounds with staff, physicians and patients have been proven to dramatically increase levels of safety and quality in the delivery of patient care.

I would like to identify a number of challenges in this context and share some ideas about how a technology supported working method can tackle important compliance concerns and education in a complex healthcare compliance landscape?

Challenge #1: Gain time and engagement for meeting compliance in busy work environments

Let me first tell you that I have great respect and admiration for most nurses and doctors who take personal responsibility when it comes to quality and patient safety and doing what is right. But I am tempted to compare health professionals with jugglers. It’s like on the one hand they have to deliver care and on the other hand they have to keep all the “standards” balloons in the air to comply to the overwhelming amount of regulations and standards requirements as the picture illustrates.

Health professionals must strike a balance on a daily basis between caring and meeting requirements to ensure quality and safety, while both responsibilities require time and full attention. The question then arises is how you can help professionals to make obtaining insight and meeting compliance standards more easier and attractive, while working on a busy job? If the challenge can be said to have a solution it can be found in (improving) structuring, standardizing and automating your real-time measurements and observations in order to obtain insight and as a result gain time for more professional dialogue and improving quality?

Automating the process of data collection and reporting in tracer rounds dramatically improves productivity in collections by streamlining rounding processes with all the data collectors need within an easy-to-navigate user interface. Healthcare workers can monitor their own performance against standards leading to improvement behaviour and compare and learn from other professionals or facilities challenging them to do better. This is exactly the experience University Medical Centre Utrecht encountered with the use of an in-house build tracer application. Since the introduction of the app staff save half the time normally needed to perform tracers and health professionals become more pro-active in their care, because they are happier and more engaged and have more time to take care of their primary care activities. Do you also share same experiences in your hospital?

From a technical perspective, the solution seems clear. Adopt an instrument to facilitate staff making them feeling comfortable to do roundings and make the communication actions in the rounding process easy and appealing to do so. This sounds like a good starting point for a new project.

Challenge #2: Structuring the compliance data collection process

The implementation of quality systems in the healthcare shift from handbooks and control of procedures to demonstrating compliance by self-evaluation against standards. Most healthcare organizations face a constantly changing compliance landscape and must comply with multiple regulatory and accreditation compliance standards, each with their own set of requirements having measurable elements. To ensure compliance to these standard requirements organisations are engaged in continuous monitoring of thousands measurable elements. Most organisations implement some kind of requirements/work breakdown structure to organise the working process for measuring and collecting compliance data.

The picture illustrates how you can support in a simple way your rounding process for structural measure compliance data collection and reporting. It is based on the three level structures of standards according WHO Europe and the tracer methodology. Level one is the level of the standard itself. Level two: sub standards operationalize the standard and break it down into its principle components. Level three are the measurable elements. The measurable elements simply list what is required to be in full compliance with the standard. The used content in the example comes from JCI, but other standards structures like ISO 9001 or Qmentum are of course applicable.

The real challenge lies in making it possible for health professionals to score measurable elements, process collected data and share results in real-time on a direct, simple and appropriate manner. It appears that direct positive feedback motivates individuals to direct their attention to improvement goals. Probably you considered designing your own system or you already have an applicable solution. If yes, it would be great if we could share ideas.

Challenge #3: Manage and track compliance data

Did you ever count the total number of measurable elements listed in your hospital? Figures from the COHSASA shows that a hospital with +/- 100 beds about 3,500 measurable elements are evaluated. And we haven’t spoken about your amount of measurements, yet.

It is becoming increasingly more challenging for health professionals to effectively manage and track an overwhelming increase of content and compliance data. These data must be aggregated and reported at the organizational and individual level cross round types, standards and even departments using own reference frameworks.

Exemplary template structure for collecting and storage of compliance data using multiple individual dashboards and standards.

The picture illustrates a structured approach of how an advanced system collects measured data compiled by surveyors and quality advisors during tracer rounds or other surveys. The collected data will be captured in real-time in the selected dashboard (blue circle) and ready to share. Question sets (fuchsia circle) and standards (green circle) can be used by other dashboards for all rounds, but cannot be altered. A question set is a collection of questions retrieved from selected standards.

The Individualized dashboard gives real-time visibility and accountability into daily tracer and rounding activity, a transparent process of sharing data. Make sure that the system has a high degree of flexibility to select making it possible for health professionals to create specific analyses and recommendations for improvement within the organization. What do you look for in a rounding dashboard?

Addressing these challenges enables professionals to understand and prioritize the technology needs to defeat the complexity and time-consuming activities of tracers and other rounding types and identify deficiencies, prioritize interventions and monitor improving compliance with multiple standards at individual healthcare facilities and across groups of them.

It explains also why it matters to implement a flexible one centralized, user-friendly system to run rounds efficiently. Summarizing ideas:

  • Make it accessible and easy to work on any mobile device to round, survey or audit.
  • Using one system for measurements and reporting enhanced data integrity.
  • Make it possible to report and aggregate your collected compliance data across round types and multiple standards, even for customized reference frameworks, in one centralized dashboard.

The information in this publication is based on experiences and thoughts from the mind of developers and consultants initiating the new QTracer web-based platform, which is under development and being tested in association with healthcare professionals, taking into account their well-known needs. Thanks to my partner Bas Hennekam (full stack software developer) for his technical input and insights.