H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016

Measure, Share, Improve: Using Performance

Dashboards to Impact Home Health Documentation

Times and Quality

Juanita Gross, Cheryl Adams, Mark A Bassett

n the fall of 2014 a pilot project was initiated at Sparta Community Hospital (Sparta, IL) to study the impact

of a new clinical dashboard that displays timely performance measurements for its ﬁeld clinicians. Recognizing

that “you can’t improve what you don’t measure” the organization worked with its home care software vendor

to develop a new tool for capturing and displaying key performance indicators, like the percentage of TP9

(discharge) visit notes as well as regular visits notes completed during the visit. The results were dramatic: Sparta’s home

health agency increased the rate of in-home completion of regular visit notes by more than 35% (from 60% to over 95%).

Moreover, they reported a marked improvement in documentation quality, including a signiﬁcantly lower error rate during

the plan of care process. And these were not short-lived gains. Sparta’s improvements in the timeliness and accuracy of

their home health documentation have been lasting (> 2 years). In essence, they have set a “new normal” and established a

signiﬁcantly higher baseline for quality, accuracy, and timeliness that has made them one of the top-performing agencies in

their region. Upon learning about these results, SwedishAmerican (Rockford, IL) agreed to participate in a follow-up study

to validate the impact of real-time clinical dashboards on clinician performance. This expanded study focuses on an agency

with more than 5,000 regular visits per quarter, with a current completion rate of end-of-day-shift documentation near 68%.

Methods: Swedish-American will discuss with its staﬀ its desire to improve in-shift visit note documentation rates as a means

of improving quality and clinician job satisfaction. Four pairs of clinicians, each with similar documentation completion rates,

will participate in a blind study with a control group. Under the guise that they are testing a software update, one clinician

from each pair will have access to a web-based dashboard displaying their current performance results. The rates of in-shift

documentation completion will be calculated on a weekly basis through the acquisition and analysis of visit metadata, and

transferred to a dashboard that renders overall agency results as well as individual performance results for the four clinician

test subjects. The results will be compared between the partners in each cohort/pair to determine if the mere presence of a

performance dashboard improves their in-shift documentation completion rate.

Results: As in the pilot study, we expect to see measurable, statistically-signiﬁcant improvements in performance even

amongst the clinicians without dashboards, as a result of the Hawthorne Eﬀect (also known as the “observer eﬀect”) wherein

improvements in performance result simply because the individuals know their performance is being observed. We will also

compare performance improvements between those with access to performance dashboards and those without access to this

data. The study duration will be one calendar quarter (three months), after which time the dashboards will be adopted by

all clinicians. Improvements in documentation timeliness and quality will continue to be measured after completion of the

oﬃcial study.

Conclusion: Improving quality and eﬃciency requires ﬁrst measuring what you wish to improve, then sharing the data with

those in a position to aﬀect the improvement. This study aims to validate positive preliminary ﬁndings that suggest signiﬁcant

quality and eﬃciency gains are possible when home care ﬁeld clinicians’ have access to timely personal and organizational

performance data. Data from both studies will b e presented along with conclusions about the value and impact of real-time

performance feedback on performance improvement.