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Importance of data input

Six Sigma – iSixSigma Forums Old Forums Healthcare Importance of data input

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  • #25744

    Sorour
    Participant

    I was recently hired by a hospital to work in periop services as the data coordinator/PI coord.  This hospital has never had a position like this before.  I am basically starting from scratch and I’ve found several errors in data input from OR nurses concerning several PI key measurements, i.e. start and stop times.  I’m having difficulty in getting across to the staff the importance of inputing ACCURATE data.  Does anybody have any suggestions for getting everyone to understand why this info is so important??

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    #62333

    BritW
    Participant

    You will need to plead the case to the business-side of your VP/C-suite.  If you are using start and stop times for the normal surgical improvement projects, then you need to demonstrate the amount of additional cases that can be done if you  start on time.  You need to indicate how much “dead time” is there in terms of utilization – this will show how much $ you are leaving on the table.  The nurses could care less about the accuracy – they are concerned (mostly) about the care, not the time data.  Docs may care if they get more money from doing more cases.  In any event, you can’t tell these things unless you have accurate data, so someone wil have to make the decision to “make” them enter the correct start/stop times or create computerized times to take as much of the human error out of the equation as possible – that’s what w did.

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    #62334

    Torrance
    Participant

    Hi Paul, it would be worth focusing on the
    underlying reasons as to why the data is not
    accurate. Are you sure it’s because workers don’t
    understand the importance or that they couldn’t
    care less?
    I’d fully expect lots of other causes – but leave
    that to you to investigate.
    BritW made some good points about automating the
    data collection where possible. If this isn’t
    entirely possible, there are lots of ways to make
    data input much easier, and therefore with less
    errors.
    However, I don’t necessarily agree with “making”
    them enter the correct data, but would suggest
    working with them so they are more likely to
    understand.Tell me and I might forget,
    Show me and I might remember,
    Involve me, and I will understand why.PS – I like the idea that nurses are more concerned
    in the care than the data – long may that continue. If there’s data there that doesn’t improve the
    level of care, then don’t measure it, it’s not
    important. You might want to ask the nurses what
    data they feel would be important and work from
    there.Davy T

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    #62336

    Sorour
    Participant

    Ofcourse the RNs are more concerned with patient care than inputing data.  However, standard of care has changed now and it involves charting accurately to insure the same level of care is consistent and at the level it needs to be. 
    I agree that there are some data measured that does not improve care.  I’m curious as to what you would consider to be not worthy of gathering?
    Thanks for the ideas.

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    #62337

    Percy
    Participant

    Very good suggestions!
    Thanks.

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    #62338

    Torrance
    Participant

    Hi Paul, let’s ask the nurses if they feel there is
    any of the data not worthy of gathering and some of
    their reasoning behind their thoughts…(make sure
    this is a collection of thoughts rather than a
    debate – i.e. let them have their say, without
    trying to convince them otherwise at this point)As a minimum, you will perhaps bring out some
    underlying ‘perceptions’ they may have on what’s
    important and what’s not.
    Then we can use that as a starting point to build
    support behind the importance of accuracy of that
    data – i.e. why we collect it, and what impact it
    has (what decisions are taken based on that data,
    and how it affects 1. The patients and 2. the
    employees).
    I’ve yet to come across a situation where the
    involvement of employees in deciding what to
    measure and what not to will not give you a huge
    benefit for buy-in. Note, you don’t have to give in
    to all the nurses requests, just involve them in
    the decisions of what data should be collected.
    They may also have ideas on how the data can be
    collected in a consistent way.
    Nothing to lose in this, and everything to gain.Good luck Paul
    Davy T

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    #62340

    BritW
    Participant

    Of course if the issue is incorrect data entry or notification on the chart, then you might have a different egg to deal with.  Charting a procedure started at 10:00 when it started at 9:45 has other ramifications other than process improvement.
    Those of you who have read my posts before know that I’m all about teaming and group problem solving.  I would certainly want to start at that means to get to the right end. Today, though, I’m being pessimistic Brit.
    It is my experience that the problem faced here isn’t a “sell” problem.  The nurses and staff know that they need to enter the correct data on the correct form/computer screen.  They will do what you inspect not what you expect.  And if the inspection doesn’t have any accountability, then it won’t be done consistently – buy-in or not.  Need to reward and reconcile – both.
    If you don’t sell the need to the upper managemnet via $ (in this case) or safety/quality of care, then you might as well determine what your average variance is from the data you are collecting and make adjustments based on that.
    Again – maybe I’m having a bad day. But, in this case, you have to have an accurate start and stop time – shouldn’t need to have to have buy-in for that. Say you need it and let everyone know who doesn’t provide it to you.

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    #62342

    BritW
    Participant

    Paul – how did you determine that the data input was an error? 
    What was the error – no time noted, time later than actually started/stopped, time ealier than started/stopped, time standardized (meaning that every time entered ended in an even number like 10:45 instead of 10:43)?
    The response may help direct you to a solution – team based problem solve with buy-in versus not following policy.  Also – I like the other post about making sure the definition is clearly known about what is supposed to be entered.

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    #62343

    BritW
    Participant

    Paul – how did you determine that the data input was an error? 
    What was the error – no time noted, time later than actually started/stopped, time ealier than started/stopped, time standardized (meaning that every time entered ended in an even number like 10:45 instead of 10:43)?
    The response may help direct you to a solution – team based problem solve with buy-in versus not following policy.  Also – I like the other post about making sure the definition is clearly known about what is supposed to be entered.

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    #62347

    Sorour
    Participant

    I went over the definition for the Times as PT in (wheels in) and PT out (wheels out) when I got here, and that definition had already been established at the hospital and understood by all.  Charting pt in/out times has been fine.
    I noticed the error when times for cases in the same room were overlapping.  Then I thought there was a possible room change that was not charted.  THAT, has been the issue.  RN’s dont document room change. 

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    #62348

    madtexan
    Participant

    Do you use PI teams at your site? If so, then providing examples of why data accuracy is important in such a setting would be good. Also, you could get feedback from the team on any difficulties encountered would be helpful. Solving the problem in a teams effort, as a kaizen, would probably be the best approach.

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    #62349

    Sorour
    Participant

    Not really.  I’m the first person to have this type of job at my hospital.  In the past, they would hire consultants.

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    #62351

    madtexan
    Participant

    Paul,
    If you want to chat further about strategies, I would be glad to discuss solving the problem with a team approach, which is probably the best way. You can contact me through my website–http://www.bryantsstatisticalconsulting.com–if you like.

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    #62352

    Katie
    Participant

    The most powerful way to speak to other people, I think, is using illustrations from other examples. One of the ways I use this method with my team is either quickly summing up a case study or white paper that has to do with a problem we are facing. Not only does it not point any fingers at anyone in particular, as it is common for people to get defensive pretty quickly, but it proves to be a powerful tool that really gets my colleagues to start thinking just outside their outlined job descriptions.Novaces has a great white paper you might be interested in- http://www.novaces.com/healthcare.php. Good luck!

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    #62359

    Suze
    Member

    Paul,
    Several good points and suggestions have been offered in response to your data gathering activities.
    I am going to offer a different perspective with the hopes it will assist you in understanding the culture and context into which you find yourself.  This will establish priorities, and set the stage for action plans.
    Before any data gathering can be done with assurance in your case, consider and get clear the following:
    1)  Why was your position created?  It sounds like it is a revenue decision that is driving the creation of your position.  Hospitals are in trouble right now, given the economic conditions and the erosion of their investment dollars.  In order to create more revenue in the OR (the primary revenue driver in a hospital), more cases need to be performed.  In order to perform more cases, there has to be time in the schedule to accomodate those cases.  So is your #1 priority to find where/when this time exists, or whether it exists at all?  In other words, capacity?
    2)  Do you have access to the consultant reports?  There is a very good chance they have done time studies in your hospital.  Check to see if they documented times with overlapping cases, and room changes.  If this has been done in the past, why are you being asked to do it again?  It could be the consultant’s report isn’t well understood, or isn’t deemed valid by the OR staff.  Be sure to find out what is going on with past consultant reports, and how you can analyze their recommendations now.  Chances are they recommended at some point a PI person be hired to implement their findings (?)
    3) Getting back to #1), there may be an inherent conflict in this new position that needs further clarification.  What is the primary description of your job?  Were you hired to a) boost revenue (a business position in which clinical data is obtained), b) facilitate process improvement for the purpose of enhancing standards of care, or c) generate quality enhancements for the purpose of improving patient care?  Depending upon the answer, the staff in the OR will respond differently – and it is your responsibility to effectively manage these responses.  Do they know why you are there?  What is their perception of that?  Do you know why you are there?  These are the answers you need, because this is the first time someone has occupied this position.  There are naturally alot of unknowns, and before you go much further, get all this straightened out.  With your boss, write a very short business plan for what it is you are being asked to do in the next year.  This helps identify in writing what your boss wants of you, so that if you meet resistance along the way, you can go back to a document that was mutually created.  A new position like this is a target for alot of criticism, and a whole lot of history behind it.
    4)  Absolutely agree that you need a team.  This is not a good place to be on your own – harsh culture, big egos, and some very strong opinions on just about everything but the kitchen sink.   Before you move one more inch forward, work with your boss to assemble that team and get this into your written yearly plan.  I think a poster here may have provided some good info on assembling a team.
    5) Remember how vulnerable you are right now.  While you may feel confident, and competent, others are looking at you very carefully.  You are the first in a new position.  They don’t trust you yet.  Like all things involving nurses, you should consider spending a lot of time developing good relationships as you work toward your job-related goals.  As one poster mentioned, it is essential that you involve personnel in the decisions.  This comes with time and dedication.
    Good luck, Paul!
     
     

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