Upon returning from the IHI conference in Orlando, I’m reflecting on two different ways to view Question-Answer-Know-Act—the mechanism that Acesis uses to describe continuous improvement.

QAKA functions similarly to Deming’s Plan-Do-Check-Act or the Plan-Do-Study-Act cycle that IHI promotes. Change management requires the questioning of assumptions, gathering data to find answers, creating knowledge from that data, and taking actions to effect real change. Trust is gained through the collaborative transparency of the process.

Perspective 1: Acesis enables the improvement process

Each step of the process of continuous improvement is supported within the Acesis application.

Questions are developed as document templates with a built-in authoring tool.

Answers are obtained by using the templates to capture data in individual cases or through aggregation of data.

Knowledge is obtained through real-time analysis. This is different than a typical report generation process where reports are run monthly or quarterly. Dashboards with graphs and tables always show real-time data, integrated throughout the work process. In addition, individual cases are analyzed and expert judgement is rendered.

Actions become tasks that can be tracked to completion, along with the data appropriate to that action. Closing the loop with actions and actionable data means real change can happen.

Perspective 2: Acesis enables IMPROVING the improvement process

In the traditional enterprise software development world, each step in the development cycle (design, development, implementation, and change orders) takes 3-6 months. But the complexity of the real world is hard to predict and encode in software, so that almost immediately after progressing to the next step, you discover that the prior step needs changes. You end up with key fields missing, for example, or too much complexity in forms where it’s not needed. If it takes months to get changes from your IT department or vendor, you’ll likely not bother to change it.

Rapidly prototyping a process means you can create small pilots to test your assumptions and process, then make improvements as you go.

The Acesis platform lets you develop and initiate a new process in days, so that you can Know and Act within the week. For one recent customer, we received Word documents with hundreds of data elements late Friday, built templates on Monday, reviewed them with the customer on Tuesday, edited them on Wednesday, and the customer started live data capture on Thursday.

And once the new process is live and new improvements are identified, changes can be rolled out quickly, across departments – without requiring IT support.

It’s one thing for software to support a standard improvement process, but it’s another for software to quickly and easily enable you to improve the process itself. To my thinking, that’s a necessity.

• Perhaps you’re in the process of adopting a new initiative that you think can make a difference. How do you roll it out to your team?
• Maybe you have an innovative group of physicians or staff that have a vision for improving a specific measure. How can they organize and collaborate together on their unique project?
• You just went to a conference and picked up an abstract of a best-practice improvement process that would be great for your hospital. Now what?

Acesis can help you answer these questions and can begin to help you answer some of the meta-questions like, “Our reimbursements are vanishing… how do we survive?”

Here are some of the unique benefits of using Acesis for your unique Performance Improvement Projects:

• Take an existing improvement process and roll it out to your group immediately.
• Create or adapt any improvement process without IT support for customized workflows and multiple levels of security for each different role.
• Engage physicians and hospital staff with a collaborative rallying point for improvement.
• Use your specific improvement process of choice such as LEAN or Six Sigma.

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Acesis provides an ideal solution for creating, maintaining and distributing checklists.

Acesis provides Dynamic Checklists that are simple to create and efficient to use, saving clinicians time. Since no IT support is needed, clinicians can work with PI staff to develop checklists with questions relevant to the patient or procedure at hand. The design minimizes the need for ‘not applicable,’ improving the effectiveness of a checklist. With Acesis Dynamic Checklists, simple logic can be used hide or show checkboxes or whole sections so that checklist items are never not ‘applicable.’

Atul Gawande makes these points about the additional advantages of checklists:

• Identify potentially missed steps
• Identify risks through screening requirements
• Improve communication between all care-givers

Acesis checklists provide even more benefits:

• “Dynamic Checklists” maintain relevance to increase efficiency.
• Fully customized checklists apply to local institutional needs and an appropriate level of detail.
• Create a checklist and deliver immediately to iPad/tablet devices.
• Aggregated data can roll up for management dashboard views.

Pronovost recruited some more colleagues, and they made some more checklists…. The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.

- Atul Gawande, The New Yorker

Fully customizable
The Acesis platform with a built-in Authoring Tool, is the ideal solution within which to plan, develop, and deploy new checklists, tailored to local needs and desired emphasis.

Click the screenshots above for the following examples:

• WHO Surgical Safety Checklist
• Central Line Insertion Checklist
• Congenital Heart Surgery Checklist
• Adult Cardiac Surgery Checklist
• Radiology Procedure Checklist
• Ventilator (VAP) Checklist

Preparing for the Mortality and Morbidity meeting is a lot of work. Acesis makes that preparation easy by enabling you to coordinate and complete the reviews online. Then it can be used in the committee meetings to help guide the conversations and track follow-up actions in real-time.

Here are some of the unique benefits of using Acesis for Morbidity / Mortality Review:

• Automatically compile cases to create your M&M committee agendas.
• Easily design specific templates for each service line or specialty.
• Committee leaders can see the status of any case.
• Track cases to completion, making sure that recommendations and follow-up actions are completed.

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Acesis provides an always-accessible, cloud-based platform to ensure your events receive timely attention with prompt follow-up. Staff can easily track, analyze, and report on event-related data.

Here are some of the unique benefits of using Acesis for tracking incident/event reporting data:

• Intelligent routing and workflow of events, based on your real-world needs.
• Use classifications with which you and your hospital staff are already familiar.
• Involved parties can see the status/details of any case, when appropriate.
• Track cases to completion, making sure that recommendations and follow-up actions are completed.

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One way that hospitals are looking to get a leg up is by proactively calling back patients that have been discharged. Not only do the patients feel cared for, but hospitals and healthcare systems have a feedback loop to better identify and understand the systemic and operational issues that their patients are experiencing. And once issues are identified, for example, if you need to improve your response to patient call bells, Acesis can be used to coordinate and track the improvement effort.

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• Design directly in the system your unique decision tree flow for determining error type and course of actions needed.
• Move from data to actionable knowledge by assigning action tasks, monitoring their progress toward completion
• Track the results on dashboards. Perform analysis and reporting, all in a closed loop of continuous performance improvement.

Acesis forms adapt to your current process instead of forcing your physicians to adopt a new process.

• Apply your organization’s Safety Event Classification definitions and algorithms in order to determine the level of harm and event type. Customize your own classification system taxonomy for safety events, or build from your preferred industry sources.
• Incorporate your organization’s definitions of how you classify human errors, possibly as: skill-based, rule-based or knowledge-based. Define specific descriptions of failure types, either individual or systemic.

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Benefits

Performing Medical Review with Acesis provides the key benefits of credibility, objectivity, efficiency, and fairness.

Credibility

Objectivity

Efficiency

Fairness