Community Data & Resource Access Initiative

Amidst the COVID-19 pandemic and its aftermath, Fenway Health has been forced to manage care with limited resources. However, patients and communities still deserve the best possible care, especially when faced with adverse situations. Physicians at my organization regularly encounter challenging and out-of-the-ordinary situations during and after the pandemic. Unexpected and high-stress circumstances with uncertain outcomes characterize these situations. Unfortunately, the main result of such circumstances is suboptimal care, decreased chances of favorable health outcomes, and the possibility of readmission (Rosiles 1). This improvement achievement plan, called Community Resource Access & Community Data Initiative, creates foundational improvements to the current processes to improve COVID-19 prevention and treatment at Fenway Health using a data-centered approach. The project is directly linked and expands upon the breadth of data projects currently in place at Fenway Health designed for quality improvement.

This project builds on and works directly with community groups that gather and interpret data to understand how to serve populations better, most acutely impacted by the COVID-19 pandemic. This project also works with the state legislature’s health equity task force and the federal government’s health equity task force for COVID-19 (LaPointe).

Physicians may have to deal with combative patients, patient dissatisfaction, and malpractice lawsuits. The issue of patient dissatisfaction not only impacts the patients but also affects the organization’s strategic costs. It leads to the creation of more staff hours to resolve issues, the risk of non-compliance with regulations, reimbursing patients for errors, losing qualified physicians, and the eventual closure or decline of business (Fuentes).

Fenway Health needs to use data analysis to improve the likelihood of success in day-to-day operations under extreme emergencies. The organization can utilize internal data analysis and community efforts to find new ways to serve its communities better. Several reports share data analysis results from Fenway communities, including the Black Boston COVID-19 Coalition. These reports delve into the realities of disparities for their populations and suggest ways Fenway Health can improve its services (BBCC & Fenway Health). Making the most of these data-centric reports in the analysis would be beneficial. Even when a pandemic limits resources and care available, it is essential to prioritize physicians’ and patients’ fair access to health resources. This approach will ensure organizational success through Fenway Health’s most trying moments.

Project Benefits and Risks

The critical benefits of the project include reaffirming the organization’s commitment to addressing and improving outcomes for underserved communities of and around the Boston Fenway area. It also includes creating a more diverse, equitable, and inclusive workspace. The project will help to strengthen and develop the spearheading and improvement of the organization’s foundational five-year strategic plan and the racial equity action plan (LaPointe). As a data-focused community project at Fenway Health, the project commits to creating more engagement to sustain and develop new and current funding for health equity.

The critical risks of the project include reducing the work outside of this scope.

. Another risk is a dependency on the data. There should be awareness that overreliance does not accurately reflect the needs of other communities not currently included in this study. Similarly, a lack of data privacy when accessing data can result as a risk of utilizing data from community resources. Parallel to these risks is the risk of cultural resistance from the organization about the data during the implementation phase and from the communities where data is derived during the data collection process. These data-derived issues can result in miscommunication and a lack of confidence in community members during the implementation phase of the COVID-19 resource access initiative.

Another risk is utilizing data that is not accurate and developing analysis and the Quality Improvement Action Plan based on these inaccuracies. This results in overconfidence in the resources that develop these data. This can result from a lack of accountability from data sources and limited verification of reliable sources. This is especially relevant due to time constraints, the financial strain of the project, and a lack of care or planning during the project development phase.

Several other risks related to technological obsolescence, organizational complexity, and data compatibility can arise during a project. Firstly, the project may reveal outdated or legacy technology apart of the primary purpose of creating the project. This can result in delays in data analysis and require technological improvements to be implemented. Secondly, it may uncover hidden organizational complexities or interactions that could impact the project’s timelines, budget, or scope. Lastly, the project may identify issues with data compatibility, which could lead to delays in decision-making or require additional work to ensure compatibility between different data sources.

Measures of Project Success

A root cause analysis tool and a quality improvement action plan measure the project’s success from two angles. This tool template works to understand the areas of improvement based on the Root Cause Analysis and the factors for success (QAPI). This first tool factors a scale out of 10 to determine the project’s efficacy upon completion based on extensive evidence to justify results. The final score result of this analysis for this project is 9.17/10 above the required 8/10 for consideration as successful.

figure 1 (Rosiles 3)

Analysis results are demonstrated using a Quality Improvement Action Plan (AHRQ.gov). This Action Plan will be completed in an Improvement Action Plan Assignment.

Success versus Cost-Effectiveness

If, within the three-month (90-day) time window of this planning and implementation stage, the project cannot prove successful, the project will be scrapped to make room for other projects. Success will be measured by the ability to meet the project expectations’ standards, including the cost-effectiveness requirements.

The project can use available and relevant budgeting as part of its efforts. The resources allow for the project to access COVID-19 testing and racial justice budgeting (Fuentes). It can use resources like reports from parallel sponsored internal projects on the topics. The budget for this project is $100,000 divided by less than 15 employees currently employed at Fenway working on several projects looking to add this project for several hours a week for a 90-day preliminary period plus the possibility for long-term (managers, physicians, data analytics) and participants of new surveys not including physicians who participate in surveys. Should the budget exceed this amount, it will be in debt and considered unsuccessful. It is important to stay under budget considering how many people and the needs of the project considered.

Budget:

$131 million total budget

$5 million allocated to COVID-19 testing budgeting.

$1 million allocated for racial justice budgeting.

$100,000 for BBCC sponsored project.

$100,000 for this project (not to exceed this amount to be considered successful)

90-day Timeline:

Weeks 1–3 (Step 1): Inform and develop relationships with critical partners internally and within the community with data managers, department managers, and community groups. Gain support from executives internally. This will permit access to available data, analysis, and reports relevant to the next required steps for this project.

Weeks 4–8 (Step 2): Begin the implementation stages of the project. Utilize analysis to implement effective strategies for adequate resource access for the identified communities and the public. Document indicators of success versus cost-effectiveness from root cause analysis so far. Prepare for step 3 of this project.

Weeks 9–12 (Step 3): Determine whether the project will need to wrap up due to lack of success or continue to integrate with other services and develop into a more significant or longer-term project for health equity and COVID-19 response based on target identifications for success and cost-effectiveness.

Considering the available data, this project should take 90 days to complete. While some of the information is not subject to privilege for projects that assist the goals of the organization’s COVID-19 response team and racial justice plan. Data access will not require documentation that may incur minimal costs because it is internally derived at Fenway Health. Some of the analysis is available in report format, such as the BBCC’s project funded by Fenway Health titled, We Thought You’d Never Ask! Learning From Boston’s Black Community What Supports Its Health, Resilience & Wellbeing.

The project requires minimal cost because of the access to present projects that are similar in scope and subject matter related to health equity. Fenway Health’s budget is designed to require access from state and government entities and stakeholders that ensure support for these essential projects. Should this project become burdensome in some rare cases, it would signal an internal oversight error, and other projects would become burdensome by the budget design and related organizational structure. In this case, the project will be reviewed and limited along with similar projects in scope and subject matter in the process of an internal audit per the organization’s procedural standards.

Approach to Addressing Unanticipated Results

Mitigating and resolving unanticipated results is critical to the success of the quality improvement achievement project. Identifying and serving groups through analysis of more data projects inevitably uncovers unanticipated results. Some of these results include but are not limited to the risks described earlier under the Project Benefits and Risks section.

Preventing cultural resistance requires a commitment to the multiple projects involved from multiple parties to ensure ethical and sustainable results are met to prevent issues like cultural resistance, data privacy breaches, and data inaccuracy. During the data collection process, it is crucial to manage and guide data collection to anticipate the needs of those participants in surveys and tests (Kohn). In the implementation phase, carrying these concerns into the work is important by training personnel involved in handling data and interacting with patients and the public involved in the COVID-19 Resource Access & Community Data project.

To avoid technological challenges due to obsolescence organizational complexities such as interference with timelines, budget, and scope, and data compatibility, it is essential to position this project as overlapping with larger current projects taking place at the organization as an integral part of operations. It will help to have the guidance of executives and the support of support staff and managers to integrate any minor changes that this project will reveal as a consequence of its initiation and implementation.

Quality Analysis

During and after the COVID-19 pandemic, Fenway Health has had to manage care with altered resources. Patients and communities still deserve the best care, regardless and especially amidst adverse situations. Physicians at my organization during and after the pandemic regularly face challenging and out-of-the-ordinary situations where they face unexpected and high-stress situations with uncertain outcomes. The main result is that the impact on the patient can result in suboptimal care, a decreased possibility for a positive health outcome, and readmission.

For physicians, this includes dealing with combative patients, patient dissatisfaction, and sometimes leading to malpractice lawsuits. This issue of patient dissatisfaction costs the organization strategically by creating more staff hours to resolve issues, the risk of non-compliance to regulations, reimbursing patients for errors, losing qualified physicians, and the business’s eventual closure or declined success.

Fenway Health needs to use data analysis to improve its likelihood of success in its day-to-day operations under extreme emergencies. It can use the efforts of internal data analysis as well as community efforts to find new ways to serve its communities best. Some reports share data analysis results from communities of Fenway, including the Black Boston COVID-19 Coalition, who report on the realities of disparities for their populations and what Fenway can do next (BBCC & Fenway Health). It will be useful to make the most of these data-centric reports in this analysis. The organization needs to recognize the imbricated role that physician health plays in the quality of patient care when appropriate (Fuentes). Even when a pandemic limits the resources and availability of care, it is essential to include physicians’ health as a priority alongside patient health to ensure organizational success through Fenway Health’s most trying moments.

Method of Analysis

The root cause analysis (RCA) method is used for several reasons. In this case, root cause analysis involves data collection, staff interviews, and literature reviews. It allows a thorough examination of the complaints from patients and the parallel challenges to physicians during the pandemic (QAPI).

Data: Requirements, Access, and Statistical Analysis

Based on data requirements, access, and statistical analysis, key areas would improve quality standards for patients and physicians during the pandemic, after, and for future emergencies. The data that will be useful to understand how the clinic operates during the pandemic is to monitor performance by tracking key performance indicators. Specific to Fenway Health are infection and Covid-19 rates, medication errors, and opportunities to preserve its mission to serve the underserved populations in and around the Fenway area. Some of the data regarding anonymized patient health has already been analyzed through reports from Fenway and partnering community health organizations.

Other data might not be available or inaccessible. Some of this data that are likely not readily available is the information regarding physician performance. Including physician-related data will not be required to understand how to improve the patient experience. There is limited information regarding statistical analysis as well on the subject, only available to select privilege internally.

For statistical analysis, several methods can be employed for best practice. Pareto charts will be used in the identification process Control charts will be used to monitor the progress for success over time regarding patient satisfaction scores. Data analysts can implement knowledge of regression analysis to identify the patient outcome and readmission rates. Six Sigma can be employed to reduce the number of errors by identifying defects in Fenway Health’s processes.

Budget

The budget at Fenway Health would use current resources for this RCA and PIP. Fenway Health presently employs roles for risk management, quality improvement, Diversity, Equity, Inclusion (DEI), and data analysis at the organization. Fenway Health has an annual budget of almost $140 million annually. It accesses a grant of $50 million annually for the past and present years from MassDevelopment. It is a 501(c)3 non-profit organization.

Fenway Health ensures that it abides by its mission to offer healthcare for all individuals regardless of ability to pay. This is especially relevant for the data analytics projects it runs during the COVID-19 pandemic to understand better how to serve its mission and community populations better. It focuses on providing access to healthcare for historically marginalized populations of LGBTQIA+ identified individuals and racially marginalized communities, as well as the local populations of and around the Fenway area (Fuentes).

Fenway Health has the capacity for personnel, software and hardware, training, and additional hours to sustain a data analysis effort of this scope for quality improvement. It would also require consulting with the organization’s accountants to ensure compliance and funding is available and allocated appropriately. Additional funding would not be required. Because many of the roles needed to enact this change are currently in place, it would require a project management effort more than any budget requests. The software and hardware are already in place for similar projects and are ready to support this project. Therefore, there would be no additional costs for software and hardware.

Reasoning for Approach

The root cause analysis (RCA) method is used for several reasons. It is appropriate for these processes because it breakdowns the current systems contributing to complaint-related failure. The RCA ensures a framework for the Performance Improvement Project (PIP). The primary reason is to prevent the recurrence of similar events.

The RCA improves patient safety and quality of care in any time of need, especially the pandemic. It reduces costs by employing use of the current data analytics systems in place currently. It ensures regulatory compliance, which is especially important to Fenway Health's healthcare clinics. The RCA encourages and enhances organizational learning by promoting learning opportunities through active improvement based on the real impact of the COVID-19 pandemic.

Results of Analysis: Strategic Solution Guide

Overall, this project would reduce the number of dissatisfied patients and readmissions. It would utilize COVID-19 funding to provide additional services. The results of the analysis will show that customer complaints and physician performance altered in critical areas of service:

· Access to regular care

· Access to emergency care

· Access to special pandemic care

· Compromised quality of care

· Exacerbating inequities for marginalized patients and the public

The analysis will effectively defend and introduce the Strategic Solution Guide and Performance Improvement Project. The Strategic Solution Guide offers improvements to prepare for present, evolving, and future emergencies like the COVID-19 pandemic. The analysis encourages and reestablishes Fenway Health’s commitment to diversity, equity, and inclusion (LaPointe).

References

AHRQ.gov. (2015) Health Care Quality Improvement (QI) Action Plan Template.Agency for Healthcare Research and Quality. Retrieved on April 9, 2023, from https://www.ahrq.gov/evidencenow/tools/qi-action-plan.html.

BBCC & Fenway Health. (June 6, 2022). We Thought You’d Never Ask! Learning From Boston’s Black Community What Supports Its Health, Resilience & Wellbeing. Retrieved April 7, 2023, from https://fenwayhealth.org/covid-19-resources/.

Fuentes, A. (April 2, 2023). Interview on Fenway Health & COVID-19. Boston. Fenway Health.

Kohn, M. (April 3, 2023). MISM 6200: Introduction to Business Analytics. MSM Digital Transformation in Healthcare. Boston; Northeastern University.

LaPointe, E. (2021, December 20). A Message from CEO Ellen LaPointe. YouTube. Retrieved April 7, 2023, from https://youtu.be/CuASM-pcDiI.

QAPI. (2011). Guidance for Performing Root Cause Analysis (RCA) with Performance Improvement Projects (PIPs). QAPI.

Rosiles, S. (April 9, 2023). Quality Analysis Report: Fenway Health’s COVID-19 Response. MISM 6200. Boston; Northeastern University.