Performance Indicators for Organ Procurement Organizations Richard Luskin Global Leadership Symposium May, 2016
The Restaurant Experience
The Restaurant Experience A Deeper Look
Which OPO is Performing Better? BarcApolis 10 Million Population DBD 200 DCDD 40 Total Donors 240 Donors/Million 24 LADelphia 10 Million Population DBD 185 DCDD 25 Total Donors 210 Donors/Million 21 1. BarcApolis 2. LADelphia 3. Both OPOs performing equally 4. Not enough information to determine
Which OPO is Performing Better? BarcApolis 10 Million Population DBD 200 DCDD 40 Total Donors 240 Donors/Million 24 LADelphia 10 Million Population DBD 185 DCDD 25 Total Donors 210 Donors/Million 21 1. BarcApolis 2. LADelphia 3. Both OPOs performing equally 4. Not enough information to determine
The Pool of Potential Organ Donors Varies Greatly by OPO Eligible donors* range from 22 to 66 per million population (OPO reported data) What explains this variation? NCHS US mortality data for 2005 Mapped these data to OPO service areas Defined a subset of deaths ( screened deaths ) In hospital Age less than 71 years No known contraindications (e.g. malignancy, HIV) *Brain dead, under age 71, no absolute contraindications
Possible Brain Dead Organ Donors per Million by US Region
Which OPO is Performing Better? BarcApolis 10 Million Population DBD 200 DCDD 40 Total Donors 240 Donors/Million 24 Medically suitable BD Potential 308 Medically suitable DCD Potential 80 Conversion rate = 61.8% LADelphia 10 Million Population DBD 185 DCDD 25 Total Donors 210 Donors/Million 21 Medically suitable BD Potential 200 Medically suitable DCD Potential 100 Conversion rate = 70%
Which OPO is Performing Better? BarcApolis 10 Million Population DBD 200 DCDD 40 Total Donors 240 Donors/Million 24 Medically suitable BD Potential 308 Medically suitable DCD Potential 80 Conversion rate = 61.8% Authorization rate = 65% Timely referrals = 85% OTPD = 3.10 LADelphia 10 Million Population DBD 185 DCDD 25 Total Donors 210 Donors/Million 21 Medically suitable BD Potential 200 Medically suitable DCD Potential 100 Conversion rate = 70% Authorization rate = 75% Timely referrals = 95% OTPD = 2.98
Measuring the quality of performance is multifaceted and requires an examination of all aspects of the process. It s like peeling the layers of an onion
Why do we need Performance Measures?
Why do we need Performance Measures?
Why do we need Performance Measures?
Why do we need Performance Measures?
Why do we need Performance Measures? Corollary: You have to know where you started.
Strategy Mapping Slide #29 from Jim Rice Q1: Where are we today? Q2: Where should we be going tomorrow? Q3: How shall we get there? Q4: Are we getting there?
Measuring success in organ donation Monday morning s presentations on the donation system in US, Spain, UK, China: What was the same in all four presentations? What was different among the presentations?
Measuring success in organ donation Monday morning s presentations on the donation system in US, Spain, UK, China: What was the same in all four presentations? What was different among the presentations? Performance measurement happens within the context of the local culture The measures one emphasizes are dependent on where you are today and where you are trying to go
Organ Donation European Quality System ODEQUS 14 European national organizations Hospitals in 11 European nations www.odequs.eu
ODEQUS Quality Criteria The standards one should use to measure performance. Quality Indicators The data points one should measure in order to assess performance against those criteria. Living donation DBD DCD
ODEQUS Deceased Donation 25 Quality Indicators 1. Donation process procedures structure 100% 2. Proactive Donor Identification Protocol structure 100% 3. Donation team fulltime availability structure 100% 4. Donation team members with ICU experience structure 100% 5. Dedicated time Key Donation Person structure 100% 6. a. Document key pts. of donor process structure 100% b. Document cause of no donation process 100% 7. Patient/Family Consent outcome 90% 8. ID of all possible donors in ICU process 75% 9. UDCD in hospital donor ID process 100% 10. Controlled DCD donor ID process 100% 11. Controlled DCD donation protocol exists structure 100% 12. Referral of DBD possible donors process 100% 13. Discarded organs documented process 100%
ODEQUS Deceased Donation 25 Quality Indicators 14. Evaluation of Brain Dead Donors process 100% 15. Donor management process 90% 16. Unexpected cardiac arrest outcome 3% 17. DCD organ donor preservation process 85% 18. Seminars on organ donation process 1 19. Documentation evaluation of potential donors process 100% 20. Brain death identification process 50% 21. Conversion rate in DBD donors outcome 75% 22. Conversion rate in uncontrolled DCD donors outcome 85% 23. Conversion rate in controlled DCD donors outcome 90% 24. Kidneys tx d from uncontrolled DCD donors outcome 80% 25. Kidneys tx d from controlled DCD donors outcome 90%
ODEQUS Deceased Donation 25 Quality Indicators Each quality indicator describes: Justification Dimension (efficiency, appropriateness, effectiveness) Formula for calculating Explanation of terms Population Data source Expected result Comments/references
Attributes of Performance Measurement & Quality Systems A tool to help do your work in the best way possible. An organizational commitment. Everyone is accountable, not just the Quality Department Happens within the local culture. Involves structure, processes, outcomes, training, people and data.
Quality is not an act, it is a habit. Aristotle