Dynamic Data: Using Numbers on Quality Outcomes to Drive Nursing Practice

Does having data on quality outcomes make a difference? It can, if presented and used the right way, says a team of nurses at Cleveland Clinic’s Hillcrest Hospital. Four nurses on the Hillcrest Magnet Steering Committee led a project to improve quality outcomes by providing access to key metrics and educating clinical nurses on how to use them. Nearly three years later, the regional hospital has seen improvement in all eight metrics it selected to track hospital-wide and at the unit level.

“Our part in improving those measures was making the data available and transparent, then getting it into the hands of nurses so they understand it,” says Katie Vriezen, MSN, RN, community outreach coordinator and a member of the steering committee.

Continuing the work of a Magnet committee

The project was an offshoot of the steering committee’s work toward Magnet® recognition, which Hillcrest Hospital achieved in 2014. While compiling stories to demonstrate exemplary professional practice, members of the committee ran into some stumbling blocks collecting supporting data. “Our data was not readily available, it was presented in multiple formats and a lot of those formats didn’t include any type of national benchmark,” says Vriezen. “And, most importantly, our clinical nurses didn’t have an understanding of all the data. They were only getting high level messages – messages like ‘too many people fall, and we should do better with falls.’”

So the steering committee embarked on a two-part project to empower nurses to improve quality outcomes. First, the members considered what data to use and how to present it in relation to national benchmarks. Second, they educated bedside nurses to read, analyze, understand and use data in their day-to-day practice. Vriezen worked alongside three other members of the committee: Toni Zito, MSN, RN, CPAN; Nancy DeWalt, RN, PCCN; and Tina DiFiore, MSN, RN, APRN, NNP-BC.

Standardizing and distributing data

The committee focused on four NDNQI® indicators (catheter-associated urinary tract infections, central line-associated blood stream infections, pressure ulcers and falls) and four HCAHPS patient experience outcomes (pain control, nursing communication, nurse friendliness and discharge readiness). “We set out to get this data and I realized that as a clinical nurse, I couldn’t access it without getting my nurse manager involved or digging into things,” says Zito, a perioperative educator at Hillcrest. “To make the data accessible, we needed a standardized format.”

The committee compiled and sifted through all the data reporting available at the time. They considered what they liked and didn’t like about existing reports, then made a list of criteria for a standardized data outcome reporting format. The criteria indicated that the template must be:

• Simple and easy to read
• Visually appealing with standard colors
• Consistent from unit-to-unit
• Report only quarterly data

A program manager in nursing support created the template, which is a line graph depicting Hillcrest’s data in one color and the national benchmark in another. The reports, which the hospital calls Magnet graphs, are published quarterly, posted on the nursing intranet site and given to each unit.

Educating nurses and making a difference

While the new graphs look fantastic, they need to be functional. The steering committee identified nurse champions to advocate for data usage and designed a three-month curriculum to educate them. Committee members met with the nurse champions at the beginning of each month to discuss why they should care about quality outcomes, how they relate to the Cleveland Clinic Zielony Nursing Institute’s Professional Practice Model, what the NDNQI and patient satisfaction scores mean, how to read the Magnet graphs and how to interpret hospital roll-up and individual unit data. The nurse champions then educated their unit staff.

The hard work of the steering committee, 50 nurse champions and clinical nurses, is paying off with quality outcomes improving in all eight metrics. And each unit has a success story to share. Take the post-anesthesia care unit: Hillcrest Hospital’s PACU serves the entire outpatient surgery center, from admission through discharge. Prior to the data usage project, the unit heavily emphasized starting operations on time – a key quality metric. “Unfortunately, all that rushing around to start OR cases on time led our patients to believe we could’ve been a little more friendly,” says Zito. “We were improving OR start times at the expense of the patient experience.”

The PACU nurse champions showed their unit nurses data on nurse friendliness scores compared to the national benchmark. The nurses didn’t want to be perceived as unfriendly, so they committed to improving the patient experience. The PACU’s nurse friendliness scores have risen steadily for six quarters and are up to 97.4.

“Nurses now use the data in their everyday practice,” says Zito. “If they don’t like a number, they jump on it. Data are no longer far-off numbers that someone tells them about. They own the data.” And this, in combination with interventional initiatives to improve specific outcomes, has made a difference.

Vriezen and Zito will discuss the data usage project and its results at the ANCC National Magnet Conference® in Atlanta. Their podium presentation, “Empowering Clinical Nurses to Improve Quality Outcomes,” will be held at 3:45 p.m. on Oct. 8.