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Transcript of Diagnostic Accreditation Program Using Tracer Methodology to Conduct Internal Assessments Brenda...
Diagnostic Accreditation Program
Using Tracer Methodology to Conduct Internal Assessments
Brenda Watson, RTR RTMR
Accreditation & Research Development Officer, DAP
Objectives
Understanding Tracer Methodology
Its Origins
Tracer Methodology and the DAP Survey Process
Tracer Methodology and its Role in Continuous Systems Improvement
Planning , Implementing and Evaluating Results
Understanding Tracer Methodology
A systems approach to evaluation - Outcome
Observe and follow systems and processes of care
Focus on real issues, actual patients Follow the path of a system, specific care process,
patient/sample, high risk area (focus area), look for risk points
Allows for flexibility and follow-up on identified issues
Understanding Tracer Methodology
Tracer Methodology intends to do more than just verify that an organization has documented its plans for how the delivery of care should take place
It functions to test those plans by looking at how patients move through the system and how those systems and processes relate to patients on a day-to-day basis
Objectives
Understanding Tracer Methodology
Its Origins
Tracer Methodology and the DAP Survey Process
Tracer Methodology and its Role in Continuous Systems Improvement
Planning , Implementing and Evaluating Results
Origins of Tracer Methodology
Roots in science- emerged in the early twentieth century
Used by scientific researchers:• Trace a substance• Study a sequence• Has led to scientific breakthroughs
Healthcare
The tracer methodology or tracer approach in Healthcare was introduced in the early 1970’s by Kessener and Kalk (1973)
The aims of the approach were twofold. Firstly, to evaluate the quality of care and secondly, to identify areas that need improvement through the use of tracers which are “representative” of those areas of patient care
Tracers most commonly used were individual patients, tracked through their patient record and systems, such as radiology
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
In January 2004, JCAHO redesigned their accreditation process by implementing Tracer Methodology
Shared Visions –New Pathways ®
“Tracing” the patient stay- from point of entry to post discharge and all points in between
Providing a real assessment of the organization
Objectives
Understanding Tracer Methodology
Its Origins
Tracer Methodology and the DAP Survey Process
Tracer Methodology and its Role in Continuous Systems Improvement
Planning , Implementing and Evaluating Results
DAP Quality Categories
Pre-Exam Exam Post-Exam
Leadership and Management, Human Resources, Safety, Patient and Client Focus,
Suppliers and Partners, Quality Improvement, Informatics
Inputs Process Patient Outcome
Pre-exam Exam Post-exam
Why the DAP Uses Tracer Methodology to Conduct Accreditation Surveys
Observe systems and processes -Provides a more realistic “moving picture” of how well things are operating
More time talking directly to healthcare providers and observing direct care Is a much more interactive and unscripted process
How the DAP Uses Tracer Methodology to Conduct Accreditation Surveys
Two tracers: System Tracer: Observes system-wide process Patient/Sample Tracer: Allows the process to be observed by
following the patient/sample
Detailed protocols: Scenarios to observe and prompting questions- “Look and listen”
Tracer Methodology and DAP
Accreditation Surveys
Ensures surveyor observations are directly connected to standards
Improves consistency in survey conduct
Shifts the accreditation-related focus from survey preparation, scores and a simple standards compliance exercise at a point-in-time to continuous improvement
Example of System Tracer
Human Resources Planning phase Skills competencies required Organizational chart indicating reporting relationships Individual human resources records Job descriptions- Match and updated Recruitment- selection of individuals and training/orientation
Interactive- Let’s trace a new hire
Objectives
Understanding Tracer Methodology
Its Origins
Tracer Methodology and the DAP Survey Process
Tracer Methodology and its Role in Continuous Systems Improvement
Planning , Implementing and Evaluating Results
Why use Tracer Methodology to Conduct Internal Assessments
Tracer methodology is a flexible, need-specific evaluation method that can be used in a variety of ways
Assist an organization in discovering any problematic practices, such as communication failures, documentation deficiencies, fragmented care and so on
Evolve as the needs and concerns of the organization change
Why use Tracer Methodology to Conduct Internal Assessments
Compares practice as to how it was designed
Tracers distinguish between documentation and action
Tracers to understand variation
Mitigate unwanted trends in systems and processes
Use tracer data to monitor for improvements
Objectives
Understanding Tracer Methodology
Its Origins
Tracer Methodology and the DAP Survey Process
Tracer Methodology and its Role in Continuous Systems Improvement
Planning , Implementing and Evaluating Results
Preparing to Use Tracers
Understanding your own organization in relation to tracers- knowing your organization, its strengths and its weaknesses is the most important factor when laying the groundwork: Culture Resources Scope Structure
Identify any current activities that can easily fit into the new approach
Preparing to Use Tracers
Tracers are inherently flexible in their usability- Goal same whether patient, process or system tracer, so how it is carried out and where it goes need not follow one particular style or pattern
There is no “cookie cutter” model
Preparing to Use Tracers: Training
Staff training is essential for optimizing the use of tracers:
Formal training Integrated into existing programs
Planning The Tracer Process
Determine what, where and when to trace:
A tracer can be conducted for a patient/sample, a process, a limited system-specific or a system-wide process
Identify focus areas: Processes of care, hand-offs, documentation, system breakdowns, etc.
Look from a variety of perspectives and involve a variety of staff
Planning The Tracer Process
Create a system for feedback of tracer findings
Create a plan for any improvement work that comes out of tracer work- re-tracing to verify and validate improvements
Conducting the Tracers
Interview Tips:
• Follow prompts but do not use a prepared list of questions
• Let the interview and findings guide your next question- Tailor questions to situation
• Use “I” statements
• Ask open-ended questions
• Listen
Using and Understanding the Data From Tracers
The data should provoke useful questions: Are we doing the right things? Are we doing the right things well? How can we improve the things that we are doing right and
wrong?
Prioritize the improvement work
Conducting Tracers to Verify and Validate Improvements
The tracer process should be cyclical in nature
In this final step of the cycle, your organization can conduct tracers to track the progress of completed work, enabling you to verify that improvements are taking hold, or that additional improvements need to be made
Conclusion
Unique opportunity for organizations to demonstrate how they deliver care on a daily basis
Some organizations might choose to use Tracer Methodology as a new method for bolstering or even replacing current quality improvement activities
Conclusion
Flexible and adaptive
Interactive
Areas for improvement will come to the surface
Cyclical -Trace to verify and validate improvements
Close study of how an organization delivers care on a daily basis
Can you see the value in using Tracer Methodology to conduct internal assessments at your organization?
References and Resources
1. Kessner DM, Kalk CE, Singer J: Assessing health quality: the case for tracers. N Engl J Med 1973; 288: 189-194
2. Tracer Methodology: Tips and Strategies for Continuous Systems Improvement, 2nd Edition. As available on: http://www.jcrinc.com
Thank you
Brenda [email protected]