Duke University Hospital Sharpens Performance with SAS

• Accelerating the delivery of lab results.
• Increasing the number of beds available for intensive care patients.
• Sending patients home sooner once they’re healthy enough to leave.

Duke University Hospital is using SAS software to link performance targets and measurements with overall goals, communicate these targets to its 5,000 employees throughout the organization, scrutinize the results with advanced statistical analysis, and launch Six Sigma projects to promote further improvements.

Taking performance management to the next level
"We want to take our performance management program beyond reports of metrics and simple calculations of averages and percentages," says Bill Burton, the hospital’s director of performance services. "When you are dealing with clinical quality and other issues facing healthcare providers, it is critically important to understand why certain key performance indicators have changed since the previous quarter. That’s why we turned to SAS."

Duke University Hospital joins several leading U.S. healthcare facilities using SAS Performance Management for Healthcare to change their processes and to approach problems in fundamentally different ways. SAS helps hospitals improve the quality of the care they provide; strengthen their relationships with patients, employees, physicians and the communities they serve; and provide financial stability. These hospitals include Brigham and Women’s Hospital in Boston, Virginia’s Centra Health, Maine Medical Center, and Yale New Haven Health System of southern Connecticut.

Powerful analytics, user-friendly access
In 2001, administrators at Duke University Hospital launched a performance improvement program by adopting a balanced scorecard approach that focuses on four key areas: quality of care, patient satisfaction, financial performance, and employee training and satisfaction. These scorecards helped link hospital strategies and goals to key performance indicators (KPIs) that demonstrate the hospital teams’ progress toward meeting their goals.

Earlier this year, Duke University Hospital launched a Six Sigma program. This rigorous statistical analysis and systematic problem-solving approach breaks issues down into smaller components so that specific problems can be defined, results measured and improvements delivered within a matter of months. The Six Sigma effort at Duke University Hospital has already made significant improvements in a number of areas.

For instance, personnel in the hospital’s transfer center are loath to deny transfers from other community hospitals, but sometimes all the beds in the intensive care units (ICUs) are filled. A Six Sigma team examined the denials and worked side by side with individual clinical service unit teams to identify ways to reduce the number of denials. By increasing the availability of "step-down" beds for patients no longer requiring the full services of an ICU, expanding medical director oversight of the transfer process and implementing an electronic measurement tool that allows more accurate collection of data in real time, Duke University Hospital was able to reduce the number of denials due to lack of beds by 65 percent.

"We place a great deal of emphasis on living up to our reputation as a leading healthcare provider by doing everything we can to accept patients from referring hospitals whenever possible," Burton says. "It’s been gratifying to see how the work we’ve done to improve performance produces a positive, direct effect on patient care."

A higher level of sophistication
Traditionally, Duke University Hospital has relied on spreadsheets to create scorecards that measured and analyzed key metrics, including the number of denials due to the lack of available beds. While these scorecards have improved hospital performance in a number of areas, progress had slowed due to the limitations inherent in using spreadsheets. Scorecards don’t allow users to drill down and see the numbers feeding into the KPIs. Data flowing into the spreadsheets resides on disparate systems that are not linked. Scorecards report what happened without ascertaining why it happened. Also, scorecards must be updated by hand, a time-consuming process that can introduce errors.

By employing SAS Performance Management for Healthcare software as part of the hospital’s performance improvement efforts, the performance services team has advanced to a higher level of sophistication. Using Web-based scorecards at the hospital, clinical service unit and department levels, hospital personnel automatically update and analyze key measurements of performance, quickly alert users to measures falling short of pre-defined targets, and link performance initiatives to actual results.

"The scorecards provided by SAS show us what is working well and what requires improvement," Burton explains. "Six Sigma provides a framework for evaluating pertinent issues and making improvements, and then the scorecards come into play again with reports and analysis of the results of our Six Sigma efforts."

An overall hospital-level scorecard was first offered at the beginning of November, while scorecards for 10 different clinical service units are scheduled for implementation in January 2005. Individual patient care units will start seeing their own customized scorecards next summer.