The Oral Health team at Canterbury District Health Board understood the value of good information, but the dental system’s data structure was difficult to analyse and required an in-depth knowledge of the system.
They needed a better way to collate, analyse and view the information. The various performance metrics and clinical indicators that CDHB had developed were very manual or required special projects to deliver.
Oral health services for children are managed and delivered by District Health Boards (DHBs) across New Zealand. As part of normal clinical practice a wealth of information is captured about the patient and the service provided. In most DHBs this data is captured by Titanium, a point-of-care software application, and becomes the patient’s electronic dental record.
Utilising this information to improve the quality of child oral health services at the Canterbury District Health Board (CDHB) is the responsibility of Community Dental Service Clinical Director, Dr Martin Lee.
“The key driver for us is to improve what we are doing” says Dr Lee, “we follow the IHI’s Triple Aim Initiative which describes an approach to optimising healthcare performance by focusing on three dimensions, Improving Population Health, Improving Patient Experience and Reducing the cost per capita of Health Care”.
Dr Lee recognised that they needed to measure if they were to improve. “We needed access to information that would drive better performance in these key areas. We had limited reports and our ability to query and analyse trends from a dental services standpoint needed to improve”.
The point-of-care dental system’s data structure was not designed for easy querying, and thus it was difficult for others coming in to analyse the data as it was unfamiliar and required an in-depth knowledge of the system. “We needed a better way to collate, analyse and view the information we had. The various performance metrics and clinical indicators that we had developed were very manual or required special projects to deliver. They involved using Excel spread sheets and Access databases, which took a lot of time and meant our ability to push information out was unsustainable.”
The Oral Health team engaged the services of Montage – a Microsoft partner with a gold competency in Business Intelligence - to develop a solution that would address the key issue of making the Titanium data more accessible.
Montage in turn worked closely with Dr Lee, “Having a subject matter expert like Martin who not only understands the business but also has an in-depth understanding of the data is a huge asset in any Business Intelligence project” said Chip Felton, Principal Consultant at Montage.
Montage developed an ‘information layer’ using WhereScape Red data modelling software in conjunction with Microsoft SQL Server, as well as utilising Microsoft Reporting Services to publish the information out to the key stakeholders.
“They had all the technology they required” said Felton, “they just needed a team to manage not only the process of introducing a proven Business Intelligence framework but also to manage the requirements and expectations of the stakeholders”.
“Montage are the experts so it was good to have a team of people who could lead the project from start to finish. They had a good approach, understood our business and what we wanted to achieve.”Dr Martin Lee
Community Dental Service Clinical Director
Becoming a reflective practice by having access to key information on a daily basis and not requiring a special project to pull it all together has been a real game changer for the Oral Health team.
In the past, developing a culture of continual improvement was very difficult to do in a deliberate fashion, but the information that is now available is helping people to do a better job. Previously it was difficult to know how well the various clinical practices were doing; now they can see how well they are doing. “A colleague mentioned it’s created a Hawthorne Effect, in the sense that behaviours have changed with the increased visibility of information” said Dr Lee. “It’s driven people to take ownership and drive improvements, it’s more carrot than stick as people have an innate drive to want to do a good job”.
”The efficiency gains are numerous, a key example being the ‘Monthly Project Report’. This was originally a very manual process, it required all 112 staff to stop work for half a day a month to collate the information. The information was used for reporting and planning, but there was no easy way of linking it back to previous months or using the data to look at trends. With the development of an ‘information layer’ the process is now automated, and clinicians now spend this time treating patients”.
In another example, managing resources across the clusters was previously a difficult process - the information was accumulated so they had no way of seeing where the underlying issues were; now they have the ability to drill into the information so they can see the root cause of the problem.
The project wasn’t without its challenges. Managing the expectation of a diverse set of stakeholders, while at the same time delivering within the budget and schedule constraints requires close attention and communication.
Montage had provided the Oral Health team with a detailed scope and high level design document, which set out the ‘delivery’ and ‘information’ layer components envisaged for the Oral Health project.
“The project was certainly well managed and communicated” said Dr Lee, “we were provided with good detail so understood what we were getting from the start. My expectations were that it would be delivered on time and to specification and it was.”
The Oral Health team are now more effective because of the information that they now have. “We’ve got visibility where previously it didn’t exist, we’ve removed the laborious process of trying to get information out and we’ve got a framework that provides us with good information that allows us to continually to improve what we are doing, ” said Dr Lee.
“The project was certainly well managed and communicated. We were provided with good detail so understood what we were getting from the start. My expectations were that it would be delivered on time and to specification, and it was.”Dr Martin Lee
The Oral Health team are at the start of their Business Intelligence journey, they have a platform and framework which they can manage internally with occasional assistance from Montage.
“We have the capacity to do further analysis, it’s really the tip of the iceberg in terms of the information that we can now easily access. It took me awhile to really understand the value of the ‘information layer’ but now I get it. The data is now very accessible and this allows individuals to take ownership. We are developing an information culture within the organisation and people are making use of the information to improve their own services.”
The benefits and value gained from the ‘Oral Health Project’ is something that Dr Lee is keen showcase to the other DHB’s. “We’ve got similar challenges, and I like to think what we’ve managed to achieve here at the CDHB is something that can be replicated cost effectively across the country”.