Quality Assessment with Visuals

Prompt: Your topic will be a study of readmission trends for SNHU Hospital. For comparison and informational purposes, you have been given a data set (Data Set Attached in Material File) representing readmission trends for the entire state of New Hampshire and SNHU Hospital. The third table in your data set shows where patients were readmitted after they were discharged from SNHU Hospital.

QUALITY ASSESSMENT with VISUALS

Data-Driven Approach: Summarize

Professionally summarize your topic of study, your approach, and how you will conduct your analysis. Be sure that your communication is appropriate for the given audience (executive leadership played by your instructor). Include value-based payments or how the quality indicator impacts finances.

Data-Driven Approach: Approach

Discuss why this data-driven approach is effective and appropriate for your quality assessment. Make the connection that data is going to be key here. What types of data might we want to look at? From the data set given, are there comparisons, benchmarks (Hospital Compare or with other hospitals) that can be made? Do we have a goal or threshold of where we’d like to be? What other info might be helpful for working towards improvements? Are the readmissions isolated to one service – all services?

Data-Driven Approach: Quality Assessment

Explain why a quality assessment is warranted regarding the key indicator described in the given information.

Quality Assessment: Collected

You have been provided with data regarding a key indicator for this project. Discuss how you believe the data was collected and compare that process to the one you would use to collect data if you were in such a position – in charged with the task. What data collection tools would you use? Why? Be sure to support your method with appropriate research.

Quality Assessment: Approach

Explain your approach to analyzing that data, comparing methods and tools to determine which you will utilize to accomplish your approach. You have studied Lean Six Sigma and Plan, Do, Study, Act (PDSA), along with others. Would one of these methodologies be suited for your approach? Explain why or why not.  Be sure to support your approach with appropriate research.

Quality Assessment: Benchmark

What benchmark* should be used for assessing level of quality based on the data and comparable institutions. (Note: You should conduct additional research of comparable institutions to complete this section.) Be sure to support your benchmark with appropriate examples and research. In other words, how have other comparable institutions performed regarding the key indicator? What does the data on other institutions suggest might be the goals of these institutions? Support your benchmark with appropriate examples and research. (Note the definition of “benchmark” below.)

* Benchmark: A benchmark is a piece of data used as a comparative. For example, in the last module, you looked at hospital data in your area and compared two hospitals to the national benchmark for several key indicators in the healthcare areas of complications and readmissions.

Quality Assessment: Threshold

What threshold* for meeting the specified benchmark regarding the key indicator should be used? How will you use this threshold? (Note the definition of “threshold” below.)

*Threshold: A threshold is the lowest level of acceptable performance for an organization. The threshold may be above or below the benchmark. For example, the national rate (benchmark) for hip-replacement complications may be 3.1%, but if your organization prides itself on being a leader in hip replacement, it may set a threshold of 2%. If, then, the organization notes that its hip-replacement complication rate is 2.5%, that would trigger a performance-improvement process because it has exceeded the organization’s threshold even though that rate falls below the benchmark. A different organization with a different focus may have a hip replacement complication threshold of 3.5%—above the benchmark.

Data Analysis: Variations

Determine whether variations in the data are common cause or special cause and explain what information you can gather from the data.

Data Analysis: Frequency Measures

Describe the data using frequency measures. In your description, be sure to include frequency distributions, ratios, and proportions when appropriate. What was the average number of readmissions over the eight months for SNHU Hospital? During which months was the actual number of readmissions higher than the expected readmissions for SNHU Hospital? What was the range of readmissions for SNHU Hospital? During which months did the highest readmission rates occur for SNHU Hospital? Which months had the lowest? Speculate why.

Data Analysis: Potential Risk Factors

Based on the data you have analyzed and the supplied information, what potential risk factors might need to be considered? In other words, what might be problematic for the institution moving forward, based on the data? What challenges might they face? Be sure to consider both internal and external factors that have an impact on readmissions.

Data Analysis: Visually

Professionally and visually communicate the data and the results of your analysis. Be sure that your communication is appropriate for the given audience (your instructor in the role of executive leadership) and includes appropriate graphics, tables, charts, and so on.

Recommendations and Conclusions: Recommendations

Make performance-improvement recommendations to the leadership of the institution for addressing any issues regarding your key indicator. Be sure that you utilize the previously analyzed data to support your recommendations. For example, you might consider what kinds of

performance-improvement methods or activities could be implemented to address potential risks and how to communicate your recommendations professionally.

Recommendations and Conclusions: Basic Quality Dashboards

Make recommendations regarding the implementation of basic quality dashboards for continuously tracking specific indices for ongoing monitoring and compliance. You could consider how the information regarding the key indicator could be effectively tracked and communicated to guide your response.