Set internal goals before measuring outcomes

First look at factors influencing case management

Getting started with an outcomes management program is perhaps one of the most difficult steps of the entire process.

That's why case managers must first look at internal factors influencing their case management program before ever starting outcomes management, says Judy Homa-Lowry, RN, BS, CPHQ, case management consultant and director of quality improvement for The Delta Group in Canton, MI.

Homa-Lowry says case managers should evaluate and address the following six areas before embarking on an outcomes management program:

* Strategic plan.

Know what your hospital's strategic plan says and how case management fits into the plan's overall objectives. This enables you to see where the organization is truly headed, says Homa-Lowry.

For example, physician recruitment is a common objective in strategic plans. Case management is an ideal support system for attracting physicians, says Homa-Lowry. Even though the strategic plans are developed by the hospital's senior leadership, your case management data are vital to them in planning many areas, she points out. "We share our data with the caregivers, but we often don't share it with our leadership, other than to say, 'We saved this much money,'" she explains.

Take the data to the top

Relay how you improved the system and the delivery of care. "They're waiting for you to bring [data] to them. They're not aware of the good job you're doing because it's not in their language," advises Homa-Lowry.

* Performance improvement plan.

Be specific with your data. "I would feel a tremendous amount of pressure if [length of stay and cost savings] were the only two variables I could use as a measure for success," notes Homa-Lowry.

Demonstrate the impact of your case man- agement program, not just in dollars, but in performance measures that make a difference to the patient. "We have not done this well in the quality field. We must quantify our data," says Homa-Lowry.

* Management of information.

Most case managers begin with baseline data when designing a critical pathway. They should do the same when designing an outcomes management process, says Homa-Lowry. "Using baseline information means you are measuring what's happening before you start doing anything. Without that, it becomes hard to measure improvement or success, and you may end up measuring some variances without any goals of what you're trying to hit or drive toward."

* Improvement priorities.

"It is tough to measure everything," says Homa-Lowry. And trying to do so can cause you to lose your focus, she adds. "Pick those areas that are truly priorities for the organization."

Gauge staff perception of focus

* Clinical competency.

Determine how your pathways are perceived throughout the organization -- do they help the delivery of patient care, or are they viewed as a method of competency? "Those who use a systems approach to quality say the minute you start using any type of tool for measurement of individual performance instead of for trends, patterns, or variations, you will have a hard time changing behavior," Homa-Lowry points out.

Furthermore, if used as a competency-measuring tool, the perception from physicians can then become negative toward your pathways and case management plans. "Instead of using the paths to look at individual competency, look at the system; does the system provide good care?"

* Internal benchmarking.

Identify best practices in your organization. "Before you can go outside and benchmark with other people, you need to know what you're internal benchmarks are. Then you know the amount of variation between you and the external organizations," says Homa-Lowry.

Keep in mind that all comparative data are not necessarily benchmarking data, Homa-Lowry cautions. "Comparing means you're just looking at how somebody else is doing, while benchmarking is demonstrated best practice. Sometimes we set standards using only comparative data without validating it with benchmarks." *