Quality and Service Measures Across the ContinuumDuring the introduction for Sean Muldoon, MD the Senior Vice President and Chief Medical Officer for Kindred Healthcare’s Hospital Division, the audience got a hint of the difficulty involved when it was noted that Muldoon was given the choice of solving world hunger or getting three key metrics measured the same way in all Kindred facilities. Solving world hunger, it was noted, would be the easier task.

As he took the stage, Muldoon immediately focused the audience on his goal, “I want to talk about just one thing in the next 30 minutes. The future of the value proposition of Kindred Healthcare.” He started by focusing on Mary and examining how her experience would be measured in various settings currently. From Abacus to HCAPs, there were as many (or more) tools as there were settings. As Muldoon noted, they were “all measure differently, using different measures and scores.” He summed up his goal in one sentence, “No matter where you are, this is what you can expect.” He also made the point that “Strategically, we are becoming one enterprise of service.” To move that forward, there was a need to:

 

  • Measure and manage
  • Count and communicate
  • Promote and price

Muldoon wasn’t working alone. He was part of a group that was placed in charge of the integrity of the enterprise. The seven-member team included the clinical leader of each division: Tony Disser, Tammy Barker, Susan Sender, Matt Sivret, Glenda Mack, Mary Van de Kamp, and Sean.

Before the work could get started, the group needed to define the basics, starting with the language. He made the point that “measure” and “metric” are not the same thing, and even gave the audience a hint to help remember the difference (Measure=Words, Metric=Numbers). Making sure that everyone on the team meant the same thing with the same word was the first step to precision, accuracy and validity. Identifying the audience and their perspectives was next:

  • Patients: What can I do and what was it like?
  • Payors: What did I spend?
  • Physicians: How did it go?

Once that foundation was set, it was time for the group to select the measures. The group culled the list down to seven contenders. As he displayed the final choices, he asked the audience to vocalize their support of the seven as he read each one. Once again, the audience was given insight into the difficulties of choosing three as each measure gained some audience approval. Ultimately, the group chose those in bold (Satisfaction, Function, Readmission):

  • Infections
  • Medication errors
  • Costs and contribution
  • Satisfaction
  • Severity of illness improvement
  • Intensity of service improvement
  • Function
  • Readmission
  • Goal Achievement

Even with the measure selected, they still needed to define what they meant. Did the count for the 30 day readmission start at admission or discharge? How would they survey for satisfaction and what would the questions be? Further refining the measures is the first of several next steps, which are expected to take a year. Each of the next steps is driving this project from a pilot program to one that is rolled out to the entire organization. Muldoon summed it up as his presentation ended, “It isn’t several stories based on the setting, it’s one story across the continuum to find out how Kindred rates with three measures in place for all settings.”