Bob Luttman, Robert Luttman & Associates
(Briefly) Revisiting VMS Design Issues
Gateway Documentation - Normal Days
Gateway Documentation - Insert Days
Pushing Variance Data Up The Ladder
Moving Data Up the Organization: Balanced Scorecards and Variance Data
We will cover balanced scorecards in more detail later in this workshop. We also cover them in great detail in our Next Generation Quality workshops.
Variance data plays an important role in balanced scorecards. As I have been expounding for weeks now, they are the link between the process of care and the outcomes of care. As variance data moves up the organization it becomes part of the different feedback levels within the organization. These feedback loops are:
These feedback loops cover increasingly broader patient populations and problems. Each level "owns" different resources and, therefore, can implement different solutions. The feedback loops also work on different time scales from real-time at the bedside to (probably) quarterly at the institution level.
To see how these feedback loops relate to each other in handling variances consider a common problem: continuing care.
- At the bedside the care team is concerned about getting the necessary home health or institutional care for an individual patient. The concern is the patients needs, resources, and desires.
- At the pathway level the concerns broaden and now include the pathway itself. Is it too aggressive? Is something missing? Should we do something differently?
- At the population level the same questions are asked, but of the whole service or population. Why are we having trouble getting home health for ortho patients? Why can't we get rehab for neurosurgery patients? Is is our processes, or are the community based resources lacking?
- At the institutional level the issues and potential solutions are larger. The institution may decide to create, acquire, or develop the community based resources it needs.
Increasingly, a fifth level, the integrated delivery system, has emerged and variance data must now move to that level as well. This also opens the door to comparative variance data: what variances are occurring across the system, what solutions are available across the system?
Sometimes the problems are solved higher in the organization, at least not without digging deeper into the variances' causes.
