Productivity measures point to funding needs, efficiency, and staffing changes

Make sure that the numbers tracked count for something

Generating productivity numbers on patient education programs, classes, and materials is not a worthless activity. Patient education managers have learned the data are valuable for a variety of reasons.

Each month, Louise Villejo, MPH, CHES, director of patient education at M.D. Anderson Cancer Center in Houston, issues a statistical report that shows the number of patient education materials that were distributed from various points including learning centers and those given out as part of a pathway.

The report also contains numbers on patient contacts at the learning center, in particular, classes such as side effects management, and computer-based education programs such as "Chemotherapy and You."

The number of people participating in focused interviews or focus groups is tracked as well as those attending health initiatives such as the Great American Smokeout or the Diabetes Fair.

New or revised materials added to on-line databases also are tracked.

"The numbers are valuable because they provide leadership some form of our productivity. A lot of what we do is program development and evaluation and that doesn’t always show up in the numbers that are kept but you have to show some kind of productivity and people like numbers," says Villejo.

Proof that staff are doing the job is revealed in many ways. For example, the data on the number of people using the learning center help show that the education department is responding to patients’ needs. This information is valuable during budget reviews in that it helps to justify the dollars spent on the service.

"Of course, numbers don’t tell the whole story, but they tell some of the story," says Villejo. Needs assessments and evaluations also are routinely conducted with patrons of the learning center.

Numbers on focus groups and interviews show that the education department staff continually are looking for feedback from patients, family, and staff.

Comparisons of the numbers can show that new, more efficient methods are working. For example, as more educational materials go on-line at M.D. Anderson, the numbers for on-line material distribution increase while the numbers of print materials being distributed decrease, says Villejo.

Numbers help prove worth

Numbers help Nancy Goldstein, MPH, patient education program manager at Fairview-University Medical Center in Minneapolis make sure that the one-on-one instructional services offered at the patient learning center meet the needs of patient and staff.

"Data help make sure the learning center meets the needs of different departments, is doing what it was designed for, and is worth the money. By showing that it is an effective program, I can justify keeping it in existence in tough financial times because I have data to prove that it makes a difference to patients," she reports.

Goldstein uses the data she tracks in a monthly process report to show the value of the instruction at the learning center. Also, they help her determine where improvements might be made.

To generate the numbers she needs, Goldstein tracks how many patients are referred from each of the patient care areas and clinics, how many patients were placed on a waiting list distinguishing between those who gave a day’s notice vs. a couple hours’ notice, how many appointments were not filled, and the number of cancellations. A monthly phone survey provides data on the value of the service to patients.

In the report, she identified several of her expectations for the service and uses the data collected to determine if the program meets them.

For example, one expectation is that 10 or fewer people remain on the waiting list without being offered an appointment for one-on-one instruction, not including unrealistic requests for an appointment within four hours of the call.

In December 2003, the data showed that the learning center met this expectation with five people remaining on the list, all of whom needed their appointment the same day the center was contacted.

Another expectation is that no more than 25 time slots are not filled with patient appointments or 38 or fewer hours accounting for the difference between one- and two-hour appointments. In the December report, 10 time slots or 11 hours were not filled.

These numbers help to justify staffing and can point to a need for more staff, says Goldstein.

The expectation for the patient and family satisfaction survey is that 90% of those contacted received the information they needed to care for themselves at home; found that the information was presented in a professional, caring manner; found the information understandable and written materials clear and easy to understand.

On-line proof

Sharon Sweeting, MS, RD, CDE, patient and family education coordinator at Jackson Health System/University of Miami Medical Center, has found that the numbers generated by a web counter on the organization’s web site can be valuable.

She is able to look at how many people are visiting the plain-language library of medical information on the web site, what pages are being hit, and how long people are spending on each page.

The popularity of this section, which has 250 of the health care institution’s most frequently used materials in both English and Spanish, made it possible for Sweeting to approach the webmaster to ask for a link to the education section on the homepage to make access easier. The traffic on the site also helps to show the value of the patient education materials being offered.

"The data put me on the business side of the organization because I can give the marketing department insight as to what products we need to enhance," she says.

In addition to looking at the numbers generated by the web counter, Sweeting tracks revenue produced from a charge-back system for patient education print materials that are issued to the organization’s units. When orders are filled, a budget code is used to bill that unit for printing costs or the costs of commercial materials.

The data reveal which materials are being used and justify the money allocated for the supply budget.

Tracking class attendance is one way that Sweeting determines whether a class is working or not. If attendance is low, she can audit the class to evaluate such factors as the presentation of the material, the cultural sensitivity of the curriculum, and the amount of information covered so that the necessary improvements can be made to make the class more attractive.

Focus on outcomes

While patient education managers agree that statistics for easily measurable things can be valuable, data collection must be tailored to the needs of each institution, says Fran London, MS, RN, a health education specialist at Phoenix Children’s Hospital. Also, they need to be combined with other measures.

"The most important measures of patient education relate to outcomes. A short-term outcome is, Did the person learn something?’ and a long-term outcome is, Did the health outcome improve as a result of learning?’" she says.

Outcomes are easily measured too, London notes. For example, to evaluate understanding after teaching an educator can initiate a conversation with the patient in which they discuss situations pertaining to the teaching.

To determine if a class improved health outcomes, see if those who attend have fewer readmissions or fewer emergency department visits than people in that patient population who do not attend, she adds.

Sources

For more information on productivity measures, contact:

Nancy Goldstein, MPH, Patient Education Program Manager, Fairview-University Medical Center, 420 Delaware St. S.E., Minneapolis, MN 55455. Telephone: (612) 273-6356. E-mail: ngoldst1@fairview.org.

Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1408. E-mail: flondon@phoenixchildrens.com.

Sharon Sweeting, MS, RD, CDE, Coordinator, Patient and Family Education, Dept. of Education and Development, Jackson Health System/University of Miami Medical Center, Miami, FL. E-mail: Ssweetin@um-jmh.org. Web site: www.um-jmh.org.

Louise Villejo, MPH, CHES, Director Patient Education, M.D. Anderson Cancer Center, 1515 Holcombe-Box 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: lvillejo@notes.mdacc.tmc.edu.