Bob Luttman, Robert Luttman & Associates
(Briefly) Revisiting VMS Design Issues
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VMS Design Issues Revisited
First, we will briefly present those issues we discussed last week. As you recall, we discussed three groups of issues:
- Statistical Issues: Variance analysis is plagued by multi-collinearity: the lack of statistical independence among the variances. One cause of multi-collinearity is the cascade effect, a variance today will cascade down through the pathway causing variances in related tasks and outcomes. Working around these problems is complicated by small sample sizes and time oriented issues, most notably the Halo Effect: what changes you make for one population may improve care for another.
- Operational Issues. The biggest operational issue is that the traditional documentation model was not designed with variances in mind, it is a static document that cannot adapt to patient care dynamics. Documentation cannot extend past the planned LOS, variance data is collected on separate documentation, intrateam communication regarding variances is not supported.
Every process is perfectly designed to produce the outcomes that it does.
Paul Batalden
In other words: to change outcomes you must change the process.
- Legal Issues. Talk to your lawyers about your specific issues. However, for the most part, a good variance system is a legal asset. The variance system should tell your story in your voice: clearly, concisely, and openly. Better than the plaintiff telling the story.
The biggest issue, though, is the So What Question. Variance data should be actionable and compel action. This means looking at variances - better: your whole pathway - through the outcome lens. What is causing the outcomes you are seeing?
To open the outcome lens we had to create a new way of looking at variances, and a new variance type. Then we created a new pathway format to capture the data. And reduce nursing documentation.
To see how, click here.
