Diagnostic Accreditation Program Using Tracer Methodology to Conduct Internal Assessments Brenda Watson, RTR RTMR Accreditation & Research Development.

Diagnostic Accreditation Program

Using Tracer Methodology to Conduct Internal Assessments

Brenda Watson, RTR RTMR

Accreditation & Research Development Officer, DAP

Objectives

Understanding Tracer Methodology

Its Origins

Tracer Methodology and the DAP Survey Process

Tracer Methodology and its Role in Continuous Systems Improvement

Planning , Implementing and Evaluating Results


A systems approach to evaluation - Outcome

Observe and follow systems and processes of care

Focus on real issues, actual patients Follow the path of a system, specific care process,

patient/sample, high risk area (focus area), look for risk points

Allows for flexibility and follow-up on identified issues


Tracer Methodology intends to do more than just verify that an organization has documented its plans for how the delivery of care should take place

It functions to test those plans by looking at how patients move through the system and how those systems and processes relate to patients on a day-to-day basis

Objectives


Its Origins




Origins of Tracer Methodology

Roots in science- emerged in the early twentieth century

Used by scientific researchers:• Trace a substance• Study a sequence• Has led to scientific breakthroughs

Healthcare

The tracer methodology or tracer approach in Healthcare was introduced in the early 1970’s by Kessener and Kalk (1973)

The aims of the approach were twofold. Firstly, to evaluate the quality of care and secondly, to identify areas that need improvement through the use of tracers which are “representative” of those areas of patient care

Tracers most commonly used were individual patients, tracked through their patient record and systems, such as radiology

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

In January 2004, JCAHO redesigned their accreditation process by implementing Tracer Methodology

Shared Visions –New Pathways ®

“Tracing” the patient stay- from point of entry to post discharge and all points in between

Providing a real assessment of the organization

Objectives


Its Origins




DAP Quality Categories

Pre-Exam Exam Post-Exam

Leadership and Management, Human Resources, Safety, Patient and Client Focus,

Suppliers and Partners, Quality Improvement, Informatics

Inputs Process Patient Outcome

Pre-exam Exam Post-exam

Why the DAP Uses Tracer Methodology to Conduct Accreditation Surveys

Observe systems and processes -Provides a more realistic “moving picture” of how well things are operating

More time talking directly to healthcare providers and observing direct care Is a much more interactive and unscripted process

How the DAP Uses Tracer Methodology to Conduct Accreditation Surveys

Two tracers: System Tracer: Observes system-wide process Patient/Sample Tracer: Allows the process to be observed by

following the patient/sample

Detailed protocols: Scenarios to observe and prompting questions- “Look and listen”

Tracer Methodology and DAP

Accreditation Surveys

Ensures surveyor observations are directly connected to standards

Improves consistency in survey conduct

Shifts the accreditation-related focus from survey preparation, scores and a simple standards compliance exercise at a point-in-time to continuous improvement

Example of System Tracer

Human Resources Planning phase Skills competencies required Organizational chart indicating reporting relationships Individual human resources records Job descriptions- Match and updated Recruitment- selection of individuals and training/orientation

Interactive- Let’s trace a new hire

Objectives


Its Origins




Why use Tracer Methodology to Conduct Internal Assessments

Tracer methodology is a flexible, need-specific evaluation method that can be used in a variety of ways

Assist an organization in discovering any problematic practices, such as communication failures, documentation deficiencies, fragmented care and so on

Evolve as the needs and concerns of the organization change

Why use Tracer Methodology to Conduct Internal Assessments

Compares practice as to how it was designed

Tracers distinguish between documentation and action

Tracers to understand variation

Mitigate unwanted trends in systems and processes

Use tracer data to monitor for improvements

Objectives


Its Origins




Preparing to Use Tracers

Understanding your own organization in relation to tracers- knowing your organization, its strengths and its weaknesses is the most important factor when laying the groundwork: Culture Resources Scope Structure

Identify any current activities that can easily fit into the new approach

Preparing to Use Tracers

Tracers are inherently flexible in their usability- Goal same whether patient, process or system tracer, so how it is carried out and where it goes need not follow one particular style or pattern

There is no “cookie cutter” model

Preparing to Use Tracers: Training

Staff training is essential for optimizing the use of tracers:

Formal training Integrated into existing programs

Planning The Tracer Process

Determine what, where and when to trace:

A tracer can be conducted for a patient/sample, a process, a limited system-specific or a system-wide process

Identify focus areas: Processes of care, hand-offs, documentation, system breakdowns, etc.

Look from a variety of perspectives and involve a variety of staff

Planning The Tracer Process

Create a system for feedback of tracer findings

Create a plan for any improvement work that comes out of tracer work- re-tracing to verify and validate improvements

Conducting the Tracers

Interview Tips:

• Follow prompts but do not use a prepared list of questions

• Let the interview and findings guide your next question- Tailor questions to situation

• Use “I” statements

• Ask open-ended questions

• Listen

Using and Understanding the Data From Tracers

The data should provoke useful questions: Are we doing the right things? Are we doing the right things well? How can we improve the things that we are doing right and

wrong?

Prioritize the improvement work

Conducting Tracers to Verify and Validate Improvements

The tracer process should be cyclical in nature

In this final step of the cycle, your organization can conduct tracers to track the progress of completed work, enabling you to verify that improvements are taking hold, or that additional improvements need to be made

Conclusion

Unique opportunity for organizations to demonstrate how they deliver care on a daily basis

Some organizations might choose to use Tracer Methodology as a new method for bolstering or even replacing current quality improvement activities

Conclusion

Flexible and adaptive

Interactive

Areas for improvement will come to the surface

Cyclical -Trace to verify and validate improvements

Close study of how an organization delivers care on a daily basis

Can you see the value in using Tracer Methodology to conduct internal assessments at your organization?

References and Resources

1. Kessner DM, Kalk CE, Singer J: Assessing health quality: the case for tracers. N Engl J Med 1973; 288: 189-194

2. Tracer Methodology: Tips and Strategies for Continuous Systems Improvement, 2nd Edition. As available on: http://www.jcrinc.com

Thank you

Brenda [email protected]

Diagnostic Accreditation Program Using Tracer Methodology to Conduct Internal Assessments Brenda Watson, RTR RTMR Accreditation & Research Development.

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