14 Jan

What does DTA stand for?

  • Posted by Kevin Campbell
  • 8 Comments
  • asymptote

I remember it well: it was a brisk fall morning in 2007 and we had just learned of yet another problem related to CMS Core Measures that had caught us completely by surprise. A patient at our specialty eye hospital had, unbeknownst to those of us in Quality, had a heart attack during his stay and this meant information on the quality of the care he received was supposed to be submitted to CMS. Unfortunately, that didn’t happen.

We were a couple of years into focusing on our Core Measures performance, and a big part of that was tightening up the whole process around data submission. We put monitoring tools into place to alert us to issues, we added more people to the process of ensuring data quality and completeness, and we put pressure on our vendor to ensure they had their house in order. And yet, issues kept popping up.

Our eye hospital, where it was rare to even have a midnight census of one, had cared for a heart attack patient who received appropriate care but was unknown to the Quality department—we weren’t watching for Core Measures cases to occur at that hospital. This was no minor issue. A portion of the hospital’s Medicare reimbursement was at stake for failing to report the quality of this patient’s heart attack care.

Well-intentioned, competent people were putting hard work into improving the Core Measures process, and yet those efforts only did so much. Out of frustration, I dusted off high school algebra concepts and demonstrated my assessment of the situation on the whiteboard: hard work had definitely reduced the (forgive my language) suckiness of Core Measures, but there was an asymptote at “still too sucky” that seemed impossible to cross.

What’s an asymptote, you ask? Here’s a refresher: an asymptote is an imaginary line, or limit, that an equation approaches but never touches (much less crosses). Take the equation y = 1/x. As x gets larger and larger, y gets smaller and smaller but never reaches zero (1/1 = 1, 1/10 = .1, 1/1000 = .001, 1/1000000 is still ever-so-slightly above zero), hence the equation y = 1/x has an asymptote at 0. Core Measures, you’ll remember, had an asymptote at “still too sucky.”

This concept of an asymptote seemed to resonate with people, especially nerdy people like data analysts and doctors. So we decided to create a campaign, complete with buttons. But everybody knows an effective campaign needs a catchy slogan. We tossed around ideas like “Remove the Asymptote,” “Eradicate the Asymptote,” and “Mitigate the Asymptote through a Concerted Effort of Like-Minded Peers,” but none of those seemed worthy of the cause. Then a particularly astute member of the team—we’ll call her Sallie Boronis—said, “we need to defy the asymptote, like you would defy gravity.” She was right. An asymptote, like a law of nature, can either be accepted…or defied!

I could tell you that we had some grand purpose behind the Defy the Asymptote campaign, but that would be a lie like the one I told you about remembering the weather on the day we found out about the heart attack/eye patient. No, it was more about a fun respite from difficult work and sticking it to the enemy (asymptote) in our own way. But the response we got from the campaign was so positive that when it came time to name our fledgling healthcare consulting company years later, we had to incorporate defying the asymptote somehow.

So that’s the story behind the “DTA” in “DTA Associates”. At DTA we use defying the asymptote as a tongue-in-cheek way to describe how we can help with problems that seem like they can’t be improved. Maybe your asymptote is patient satisfaction scores that have plateaued, or physicians that aren’t “engaged” in improvement, or a situation where you’re making all these deposits into the EMR and can’t get any useful data back out, or quality improvement projects that are just plain stuck. Whatever your asymptote, if it falls into the category of healthcare strategy, quality and experience improvement, or the data necessary to accomplish those things, we can help!

DTA button alone

Now it’s your turn! Leave a comment and tell us what your asymptote is, and we’ll send you a free vintage DTA button like the one in the picture, except with your asymptote listed on it! (US and Canada only, we reserve the right to edit for space and appropriateness)

Post Comments 8

Posted by  Beth on
  • Feb 3 2015
 
I think a huge hurdle for data folks (which can include clinicians!) is the idea of data accuracy. I often hear the question, “How accurate is this data?” There are always challenges I have to account for: data is only as accurate as what’s been captured in the database, “garbage in is garbage out,” etc. I think there is an impulse to throw the baby out with the bathwater, though. I want to defy the accuracy asymptote, the idea that if data isn't 100% accurate, which it may never be, it can’t be trusted, understood, and used. Rather, I think it is important to ask ourselves: How good is good enough? Can the most offensive inaccuracies be overcome by better programming or training? If data has known issues, can it still be used directionally? Are the inaccuracies statistically significant? We should not shy away from honestly assessing the state of our data, but nor should we stop using our data if it is not “perfect.”
    Posted by  dta_admin on
    • Feb 5 2015
     
    Thanks Beth! You make some really good points. If we let perfect get in the way of good, we'll be paralyzed and we'll never get to improvement. We'll call your asymptote "Pursuit of Data Perfection". Watch for an email so we can find out where to send your button!
Posted by  Lynn Ehrmantraut on
  • Feb 4 2015
 
We find that many organizations struggle with HCAHPS results and improvement efforts, and as the organization nears the asymptote of the national benchmarks it gets even more difficult. While it is relatively "easy" to implement known evidence based best practices for scores below the 50th percentile, the challenge really begins when the % Always stalls out somewhere around the 75th percentile. This is where the hard work begins - because it is all about people, impacting thoughts that translate to actions and behaviors that have positive and lasting effect on the patient experience. Too often in healthcare we find that when budgets are tight, training is cut, training for staff, leadership development to help managers/leaders navigate the ever changing healthcare system. Our asymptote involves continuing to defy the inevitability of less than perfect scores - through the study of the interaction between Employee Engagement and Patient Experience...and in partnering with folks like DTA Associates to deliver this expertise in organizations who will join us in defying less than perfect results for our patients.
    Posted by  dta_admin on
    • Feb 5 2015
     
    Thanks Lynn! That's a great example of an asymptote. Watch the mail for your button!
Posted by  Ben Bache-Wiig on
  • Feb 11 2015
 
For Abbott Northwestern our asymptote had always been achieving high level performance on patient experience. As a large urban hospital with an older facility and a significant number of semiprivate rooms there was a sense that we were structurally unable to get HCAHPS scores greater than the 60th percentile. Over the last 3 years we made a series of interventions including facility upgrades, creative use of current space to get to all private rooms, introduction of care boards, bedside shift handoffs and adoption of behavioral standards and saw our performance break through the asymptote and move our performance to the 85th percentile nationally. Making the breakthrough took a change in our basic belief in what was possible.
    Posted by  dta_admin on
    • Feb 12 2015
     
    There's that patient experience percentile asymptote again! Defying that asymptote really does take a comprehensive approach, one that addresses the very culture of your organization. Thanks Dr. Bache-Wiig!
Posted by  Janet Wied on
  • Feb 13 2015
 
Working with a large medical group at Allina, our survey numbers are high at the organization level but the further we drill down to the individual clinic or provider-which is easy to do with CG-CAHPs, the numbers get smaller and smaller, so we too hear a great deal from providers about statistical significance and accuracy (although we only seem to hear that from those with lower scores!). We have spent a great deal of time slicing and dicing and compiling and explaining and then finally landed on "Every Patient Every Time". Talking about the data as one patient at a time, that every patient matters and the fact that it is about consistency and reliability has gotten us past the arguing and moving forward in almost all situations. Those that are not on board are getting smaller everyday. It is nice to be past those conversations and moving forward. Some of our biggest naysayers are now our biggest champions!
    Posted by  dta_admin on
    • Feb 16 2015
     
    We'll call that asymptote "Data Defensiveness" and send the button your way. Thanks Janet!