Transcript Broward Health Welcomes Nancy Paterson The Joint Commission

Broward Health Quality Improvement Plan
ACHPE 2015
Broward Health
Broward Health Medical Center
Broward Health Coral Springs
Broward Health Imperial Point
Broward Health North
2
System and Leadership
3
Five Star Values
1.
2.
3.
4.
5.
Accountability for Positive Outcomes
Valuing our Employee Family
Fostering an Innovative Environment
Collaborative Organizational Team
Exceptional Service to our Community
4
Strategic Priorities
Safety – provide quality and safe care to all we serve
Evidence-based practice – ensure evidence-based
practices are implemented and followed
Recruit- and retain high performing staff
Value – the differences in our culturally diverse workforce
and community
Improve profitability – by continually identifying way to
improve efficiency
Culture – promote a culture that consistently fulfills the
needs of our staff, physicians, patients, families, and the
community we serve
Excellence – strive to be the best and work to improve
performance that exceeds expectations
5
Broward Health Board Driving Quality
 Change in CEO to a physician leader
 Change in CEO compensation package
 Change in Executive and Management staff incentive
package
 Changing Employed Physician’s compensation package
 Changing general staff incentive structure
6
Performance Improvement
7
Safety/Quality Flow of Information
Board of Commissioners
(Governing Body)
Quality Assessment and
Oversight Committee
Corporate Environment of
Care Key Group
Corporate Patient Care
Key Group
Regional Medical Councils
Regional & Ambulatory Quality
Councils
Region Specific Performance Improvement
BHMC
BHCS
BHIP
BHN
Broward Health Quality and Patient
Safety Goals
CHS
8
Broward Health Board of Commissioners
Quality Assessment and Oversight Committee
 Outcome Indicators
 Mortality Rates
 Readmission Rates
 Patient Safety Indicators
 Catheter Associated Bloodstream Infections
 Catheter Associated Urinary Tract Infections
 Ventilator Associated Pneumonia
 Class II Surgical Site Infections
 Mislabeled Specimens
 Hospital-acquired Pressure Ulcers
 Early Elective Deliveries
 Falls
 Adverse Drug Events
 Door to Balloon Compliance
 Nurse Vacancy Rates
 Efficiency Indicators
 ED Throughput
 Risk Management and Environment of Care
9
External Benchmarking
Benchmarking:
 Adverse Outcomes
 Hospital-acquired infections
 Catheter Associated Bloodstream
Infections
 Catheter Associated Urinary Tract
Infections
 Ventilator Associated Pneumonia




Mortality
Readmissions
Cardiothoracic Surgery
Obstetric Hemorrhage Initiative
Agencies Include:










Society for Thoracic Surgery
Press-Ganey
Crimson
Avatar
Agency for Healthcare Research
and Quality (AHRQ)
National Database of Nursing
Quality Indicators (NDNQI)
American College of Surgeons
Commission on Cancer
Hospital Engagement Network
Health Services Advisory Group
Florida Perinatal Quality
Collaborative
10
Defining a High Reliability Organization
• Complex, high risk industry where mistakes can equal
great harm
• “ High Reliability Organizations are organizations with
systems in place that make them exceptionally
consistent in accomplishing their goals and avoiding
potentially catastrophic errors “ – Quint Studer
Chassin, M. R., & Loeb, J. M., (2013). High-Reliability Health Care: Getting There from Here. The Joint Commission. Retrieved from
http://www.jointcommission.org/assets/1/6/Chassin_and_Loeb_0913_final.pdf
11
Broward
Health Current
State
Leadership
Safety culture
Robust
process
improvement
TJC Reliability Model – Broward Health Progress
Minimal
Developing
Approaching
Quality activities focused on
regulatory requirements
Strategic importance of quality
improvement not recognized
Metrics for quality goals not
part of the strategic plan or
incentive compensation
Information technology
provides little support for
quality improvement
Physicians not actively
engaged in quality
improvement
Chief executive officer leads proactive
quality agenda
• Board reviews adverse events
• Organization sets a few measurable
quality aims
• Information technology supports
some quality and safety initiatives
• Physician leaders champion quality
goals in some areas
• Organization commits to goal of
high reliability for all clinical
services
• Organization aims for near-zero
failure rates in vital clinical
processes
• Some services demonstrate near
zero failure rates in some vital
clinical processes
• Information technology integral in
sustaining quality improvement
• Physicians routinely lead quality
efforts
No program to assess safety
culture
No assessment of trust or
intimidating behavior
Root-cause analysis limited to
most serious adverse events
close calls not recognized or
evaluated
Establishing safety culture accorded
high priority by leaders at all levels
• First measures of safety culture
deployed
• Beginning initiatives to encourage
reporting and analysis of close calls
• Safety culture is well established
• Measurement of safety culture is
routine and drives improvement
• Regular reporting of close calls
and unsafe conditions lead to
early problem resolution
No formal quality management
system
External requirements are
focus of improvement efforts
No commitment to sustainable
improvement
• Organizational commitment to adopt
strong quality improvement tools
• Training of selected staff beginning
• Improvement tools used to achieve
gains in quality and safety in addition
to routine business processes
• Robust performance improvement
tools used throughout the
organization
• Patients engaged in redesigning
care processes
• Mandatory training of all staff in
robust process improvement
• Proficiency in robust process
improvement required in career 12
advancements
TJC Reliability Model – Broward Health Progress
Key Broward Health Accomplishments/ Initiatives
•
•
Leadership accountability for quality and safety tied to
performance incentive
Transparency of clinical processes to Board of Directors through
Quality Assessment and Oversight Committee
Demonstration of system-wide low mortality rates
High level of compliance with ORYX and core measures
Physician leadership of quality committees and key quality
initiatives throughout Broward Health
System-wide CEO led patient safety and satisfaction rounds
•
•
•
•
Routine root cause analysis of near misses with corrective actions
Non-punitive reporting policy
Quarterly system-wide patient quality and safety meeting
Huddles to address quality and safety issues
•
•
Process improvement/ lean/ six sigma belt training available
Well established process improvement department and utilization
of lean / six sigma tools
•
Leadership
Safety Culture
Robust
Process
Improvement
•
•
•
13
Broward Health – Harm Star
14
Performance Improvement Objectives
2015
 Decrease fall rates to below the NDNQI benchmark
 Decrease mislabeled specimen rates
 Early removal of indwelling urinary catheters using the HOUDINI
protocol
 Decrease hospital-acquired infections through the HealthcareAssociated Infection (HAI) Prevention Collaborative utilizing the
Health Services Advisory Group (HSAG)
 Improve the management and outcomes of patients with sepsis
 Improve ED throughput to state averages
 Decrease HAPU rates to below the NDNQI benchmark
 Decrease readmission rates at or below the Crimson benchmark
 Maintain potentially preventable VTE at zero
 Continue journey to becoming a high reliability organization
15
2015
System-Wide Quality & Patient Safety Initiatives
 Outcome Indicators
 Mortalities
 Readmissions
 Infection Control Indicators
 CAUTI
 CLABSI
 VAE
 Surgical site infections
 C-difficile
 Compliance rates for influenza vaccine for staff and physicians
 Reduction of MDROs
 Efficiency Indicators
 ED throughput
 Decrease number of ED patients leaving without being seen 16
2015
System-Wide Quality & Patient Safety Initiatives
 Patient Safety Indicators








HAPU
Falls
Adverse Events
Early Elective Deliveries
Mislabeled Specimens
Adverse Drug Events
Management of Sepsis (new for 2015)
Potentially preventable VTE
17
2015
System-Wide Quality & Patient Safety Initiatives
 Participated in the Hospital Engagement Network (HEN)
project (2012 through 2014); Will be participating in HEN II
 Six Sigma Methodology implemented in all facilities
 Ongoing Six Sigma Training is being conducted
 System-wide Six Sigma Showcase was held in July 2014 to
present projects and share results and best practices
 The Advisory Board Company Crimson Continuum of Care
Program was implemented. This tool is used to identify
areas of opportunity as well as benchmarking.
Participating in AHRQ Patient Safety Initiatives to decrease falls and
pressure ulcers.
18
SAFETY CULTURE
• Key dimensions to improve quality and reduce harm:
– Setting Aims
PURPOSE:
Reduce the number of CLABSI in the
Adult Critical Care Units by 50%
between: July 1 and December 3, 2014
as compared to January 1 and
June 30, 2014
BHMC Run Chart of Central Line Infection Associated Bacteremia (CLABSI) in the
Critical Care Units: Rate per 1000 Line Days
8.00
7.00
6.92
Rate of Infections
6.00
5.00
4.32
4.00
4.00
3.86
3.86
2.40
2.00
3.10
3.02
3.00
2.00
2.81
R² = 0.2425
2.25 2.30
2.19
2.08
1.92
1.40
1.00
0.00
1.03
1.08 1.16
1.00
0.00
Jun-12 - Aug-14
1.14 1.08 1.12
0.90
0.00
1.24
IMPROVEMENTS:
Identified and Implemented process
changes in maintenance of central
lines: improved insertion/cleaning
methodology and periodic retraining of
nurses.
RESULT:
Rate of infection decreased from 1.5 in
Feb to 1.03 in Aug 2014.
19
SAFETY CULTURE
• Key dimensions to improve quality and reduce harm:
– Establishing and monitoring system-level measures
20
Catheter Associated Urinary Tract Infections
ICU
Broward Health
3.50
Rate per 1000 Catheter Days
3.00
2.50
2.00
1.50
1.00
0.50
0.00
2012
2013
2014
21
Medication Management
22
Medication Management Initiatives
 Types of technology used






Cerner Millennium
Smart pumps (Hospira Plum)
Barcoded medication administration
Pyxis
Epidural pumps/PCA pumps (Bbraun)
ePrescribing – February 2015
 95% implementation of Computerized Provider Order
Entry (CPOE) 2013
 Standardized order sets using evidence-based guidelines using
PowerPlan
 Population specific pharmacists
 Reduce likelihood of patient harm by better management of
anticoagulation therapy
23
Medication Management Initiatives
 System-wide policies and procedures
 Management of high-risk medications
 Look alike, sound alike medications
 Hypoglycemic protocol
 Insulin therapy protocol
 Heparin protocol
 Vasoactive titration guide
 Standardized concentration for drips
 Reporting of medication errors through RiskQual
Technologies Health Advisory Series (H.A.S) program
 Broward Health Complete
 Trials and research studies
24
Infection Control Key Initiatives
 Hand Hygiene Campaign
 Personal Protective Equipment
 Elimination of Hospital Acquired Infections (HAI)
 Central Line Associated Bloodstream Infections (CLABSI)
 Catheter Associated Urinary Tract Infections (CAUTI)
 Ventilator Associated Events (VAE)
 Surgical Wound Infections
 Multidrug Resistant Organisms (MDRO)
• C-difficile, VRE, CRE, MRSA
25
Infection Control Program
 CDC, APIC, AORN Guidelines
 Risk Assessment, Prioritization, Planning, Implementation,
and Evaluation
 Ongoing and annually
 Root Cause Analysis as needed
 Targeted surveillance
 NHSN definitions for reporting
 System-wide epidemiology meetings
 Standardization of plans, policies
 Standardization of products and best practices
 MedMined computer system for surveillance and antimicrobial
stewardship
26
Patient Safety
Delivery of Care Overview
27
UPDATE
Value Based Purchasing
28
Delivery of Care Initiatives
 Interdisciplinary Provision of Care Policies and Procedures
 The Journey to Interdisciplinary Rounds:







DSC Programs
Pain
Behavioral Health
Hospitalists (Pediatric and Adult)
Neonatologists
Intensivists
Journey to Top of Licensure Practice
 Interdisciplinary Communication Support





Electronic Plan of Care
Electronic Patient Education Record (Teachback)
Decision Support and Alerts
Various Screen Views to aggregate the process of care
Each hospital has prioritized a sequence of hourly rounding, bedside report and shift
huddles
 Focus on Standardizing Resource Systems
 Lexicomp®, Cerner Content, Lippincott, Ovid
29
Environment of Care
•
•
•
•
EoC
Function
Leaders
Regional
EoC
Committees
EoC Key
Group
Safety
Security
Facilities Services
Biomedical Engineering
• Administration,
Compliance, Facilities
Management, Safety
Services, Protective
Services, Emergency
Preparedness, Quality
Management, Risk
Management, Workers
Compensation,
Biomedical Engineering,
Behavioral Health,
Information Technology
• Administration,
Compliance, Facilities
Management, Safety
Service, Protective
Services, Emergency
Preparedness, Quality
Management, Risk
Management, Workers
Compensation,
Biomedical Engineering,
Behavioral Health,
Information Technology
QAOC
• Organization Leaders
• Board of Directors
• Quality
30
Abbe Bendell, RN, BSN, MBA
Vice President
[email protected]
31