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Reports Don’t Improve Outcomes | Navigating Outcomes Data & Measures

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“If” is a tiny word that has big implications and infinite possibilities. If you run every day, you’ll be able to run a 5K. If you read one book a week, you’ll be smarter. If you nail your work presentation, your boss will be impressed and give you a promotion.

And the behavioral health version – if all your clients show up for their appointments, they’ll improve and have better mental health.

But how do you turn your “if” into something you’ve achieved? By following a strategic plan and using the Data-to-Wisdom Continuum.

This 8 minute video illustrates a behavioral health agency using the Data-to-Wisdom Continuum to improve their no-show rates.

Watch the entire Reports Don’t Improve Outcomes eLearning course for a full understanding of reporting on your outcomes.

What is the Data-to-Wisdom Continuum?

The Data-to-Wisdom Continuum is the process by which meaningless data points from the past help drive meaningful actions that will result in better delivery for current and future clients.  It is the foundation for discovering deficiencies in your business process, and systematically improving them. There are four stages:

  1. Data – collecting individual data fields that by themselves, are relatively meaningless and represent the past.
  2. Information – combining data fields from the past in the form of a report.
  3. Knowledge – drawing conclusions from your information and acting in the context of your strategic plan.
  4. Wisdom – predicting positive results to the business and taking additional action for continuous improvement.

Let’s follow Carrot Clinic as they apply the Data-to-Wisdom Continuum

For the purposes of this example, we are going to assume that the organization has an electronic health record that enables them to visualize their data.

Carrot Clinic, a fictitious outpatient mental health clinic, set a strategic objective to positively impact their behavioral health outcomes by increasing the number of client visits. Carrot Clinic believes they will achieve their objective by reducing their no-show rate. This objective, a component of their strategic plan determined the data they would collect – the number of patient no-shows and the reason for the no-shows. They want to use outcomes measures to find their answers.

The Data Stage

Carrot Clinic asks their clinicians to follow-up on missed appointments and see if they can find out why the client didn’t come.  They create a field in their EHR for clinicians to capture no-show reasons. After the field is created, they begin the process of collecting data on the reason an appointment was missed.

Discrete data can be easily categorized into a classification. It ensures consistency and fidelity of data.  Examples include drop-down lists, true/false questions, multiple choice, selection boxes, etc.

To ensure that the data collected is discrete, Carrot Clinic wants to create a drop-down list of reasons someone might miss an appointment.  They ask their therapists and clinic directors why they think clients miss their appointments. It proves to be a good starting point, and they create the following drop-down list:

  1. Forgot Appointment
  2. No Transportation
  3. Scheduling Conflict
  4. Other

Carrot Clinic believes that by decreasing the number of appointment no-shows, they will be able to increase treatment effectiveness and improve the client’s outcomes.

The Information Stage

After six months of collecting data Carrot Clinic has a total of 200 no-shows. This confirms their notion that many clients were missing appointments. Now they begin a breakdown of the reasons why. 

First, they noticed that the largest percentage of the no-shows is the result of clients forgetting their appointment. Forgetting the appointment equals all three other options combined. You can see the breakdown in the graph below.

Avoiding the Chasm

To avoid falling into the Chasm, Carrot Clinic needs to make sure they don’t stop here.

If they continue tracking these metrics without taking any actions to improve them, they’ll fall into the Chasm. 

Taking no action is resorting to collecting data for data’s sake. It won’t help them improve, and it isn’t fair to those who they’ve asked to collect the data in the first place.

The Knowledge Stage

Now, Carrot Clinic begins asking questions of the information.  And the big question is…why is it that clients are missing appointments?  One of Carrot Clinic’s suggested insights was correct – Forgot appointment is the biggest culprit, making up over half of the no-shows.  The next largest percentage is no transportation, followed by the other field, and the scheduling conflict.

Carrot Clinic decides to implement a phone call reminder system to see if they can reduce the number of appointments missed due to clients’ forgetfulness.  They take this approach because they want to act on the largest deficiency first and make the biggest impact on the largest number of clients.  The phone call reminder system will be an automated dialer that will remind the client of their appointment in advance. 

After six months of using the automated dialer, Carrot Clinic runs the same report again – only this time they can see that the overall number of no-shows has been reduced by half. With the drop in the overall no-show rate, there is also a drop in the percentage of appointments that were missed because of clients forgetting about them.

Carrot Clinic realized that if action is taken at the client level, the number of appointments missed will be reduced. They now know that getting clients to show up for their appointment is something that can be improved, because they did it. 

The Wisdom Stage

The next largest deficiency is a lack of transportation to appointments, so now Carrot Clinic will try different things around transportation. They have a few options:

  1. Institute a transportation plan as part of treatment to have clients plan how they will get to appointments.
  2. Provide bus vouchers for individuals that could use them.

They are confident that either action will yield positive results in their outcomes data because they know that clients will attend their appointments if the clinic can help them reduce the obstacles.

Draining the Swamp

Methodically taking actions to reduce the largest deficiency is known as draining the swamp.  The largest deficiency will stick out above the swamp line, but when it’s reduced a new largest deficiency will stick out above the new swamp line.  When actions are continuously taken against the deficiencies that are having the largest impact, outcomes are systematically improved and your strategic goals and objectives are achieved.

Once you have used the Data-to-Wisdom Continuum to reduce deficiencies across all your business areas, then you can revisit your strategic plan, and begin the process again.  We hope that this course has provided you with valuable insight into how you can use the data captured in your EHR to not just measure your outcomes, but improve them. 

After acting on the forgot appointment and no transportation deficiencies, Carrot Clinic will now turn their attention to the scheduling conflict deficiency as that is the next one. Once they eradicate the remaining deficiencies, they’ll apply the Data-to-Wisdom Continuum to other areas of their business.

By relying on their strategic plan and the Data-to-Wisdom Continuum for guidance, Carrot Clinic will turn every “if” into something they’ve achieved. And so can you.

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