Transcript Document

Creating an Effective Partnership for
HealthCare Quality and Safety
Quality and Safety Partnership
“The American health care delivery system is in
need of fundamental change. Patients,
doctors, nurses, and health care leaders are
concerned that the care delivered is not the
care we should receive. Yet the problems
remain. Health care today harms too
frequently and routinely fails to deliver its
potential benefits.”
Industry Change
• Evidence based guidelines for common diseases and
procedures
• Maturation of quality improvement models
– New developments and adaptation of techniques from other
industries (ISO9000, Six Sigma, TQM, etc.)
– Hospitals around the country have demonstrated these techniques
work
• Improved information technology makes data
collection and sharing possible
• Increasing # of states w/ public reporting systems
– Multi stakeholder interest in change
Forces of Change- Employer
• Escalating health care costs with double digit
insurance premium increases
– Employers concerned about their ability to provide
health care benefits with the economic slowdown
– Employers looking at benefit plan designs to
encourage consumerism. This requires reliable
quality and cost information.
– Employer/Payer demand for access to quality data
• Healthgrades
• Leapfrog
• SC Business Coalition
Forces of Change-Providers
• Reports of less than optimal safety and
quality practices
– 98,000 people die each year and many more are injured
from preventable mistakes made in hospitals (To Err is Human, IOM,
2000)
• Huge variation in clinical practice and
outcomes
– 50-60% of patients received recommended evidence based
care
– It is estimated that it takes approximately 17 years for
relatively definitive research on clinical practice (evidence
based health care) to become standard practice (Agency for Health
Care Research and Quality, 2002)
• Lack of comparative and best practice
information to guide internal improvement
SC Quality and Safety
Partnership- Historical Perspective
• IOM Reports- Magnitude of Patient Harm and
Aims for Improvement
• TJC- Pt. Safety Goals/Core Measures
• CMS P4R- HQA/Hospital Compare
• CMS- 8th Scope of Work/ Surgical Care Improvement
Project (SCIP)
• NQF- List of “Never Events”
• Leapfrog Group- Link to NQF Safe Practice Standards
• IHI- Pursuing Perfection/100K Lives/5M Lives Campaigns
• CMS- Evolution through P4P to P4V
SC Quality and Safety
Partnership- Historical Perspective
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SC Node- Link to IHI Campaigns/Initiatives
BCBS Hospital Recognition Program
Lewis Blackman Act
HIDA Act- HAI Public Reporting
PHTS ISO 9000 Project
American Heart Assoc.- Get w/ the Guidelines
SC Diabetes Initiative
Health Sciences SC- TDE Grant
SCHA- TDE Grant/QPS Advisory Council
Patient Safety- HIDA
• Tremendous public discussion over
hospital-acquired infections—IOM Report
• New SC law requires hospitals to report
infection rates semi-annually beginning in
2008; DHEC to issue annual public reports
beginning 2009.
• Two types of infections must be reported:
central line-related bloodstream infections
and surgical site infections.
“Every system is perfectly designed to
achieve the results it gets”
- Dr. Don Berwick
Compliance-Driven Quality Management
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Reactive in nature
Designed to meet standards
Clinicians often not engaged in process
Clinician leadership not essential
Indicators become the goal
Difficult to sustain clinical improvement
over time & across organization
Patient-Centered Clinical Effectiveness
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Proactive in nature
Evidence-based foundation
Clinicians actively engaged in process
Clinician leadership critical to success
Best and safest care as the goal,
indicators as markers of success
• Sustainable improvement over time and
across organization
Where Do We Go From Here?
“We can’t solve problems by using
the same kind of thinking we used
when we created them”
- Albert Einstein
Changing Course- A Confluence of
Important Events
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SMLC/Patient Safety Committee joint session
CEO/COO Leadership Retreat
SCHA Board Retreat
Quality Reporting/Transparency task force
TDE grant submission and approval
Quality Advisory Council formed by SCHA Board
Quality Council establishes framework and guiding
principles for quality and safety partnership
• Partnership vision/mission/goals approved by
SCHA Board
SC Quality and Safety
Partnership- Guiding Principles
• IOM Six Aims for Improvement- Patient care
that is:
• Safe- avoidance of unintended pt. harm
• Effective- evidence-based
• Patient-centered- focused on needs and
rights of the individual patient
• Timely- avoidance of delays & barriers
to patient care flow
• Efficient- elimination of waste
• Equitable- fair access to comparable
health care services for all
The Power of Engaged Leadership
and Governance
• Establish the mission, vision, and strategy
• Build an effective leadership system foundation
• Build will to make measurable systemic
improvement
• Ensure access to ideas and innovations
• Attend relentlessly to execution so that
improvements can be sustained and spread
• Establish and monitor system-level measures
• Aggressively embrace collaboration and
transparency
Visionary Leadership
“Far better it is to dare mighty things, to win
glorious triumphs, even though checkered
by failure, than to take rank with those who
neither enjoy much or suffer much, because
they live in the gray twilight that knows not
victory or defeat”
-Teddy Roosevelt
The South Carolina Partnership
for
HealthCare Quality and Safety
SC Partnership for HealthCare
Quality and Safety
SC Hospitals have an unprecedented opportunity to:
Take the lead in shaping the scope and direction of
the quality and safety agenda in SC
Shift from a competitive to a collaborative approach
as it relates to quality and safety
Re-establish the public trust in hospitals as the
community center for quality health care
Offer a viable alternative to legislative and regulatory
quality and safety mandates
Bring other health system stakeholders to the table
to define the future of health care in SC
SC Partnership for HealthCare
Quality and Safety
• Vision: That all South Carolina hospitals deliver
safe, high quality health care to each
patient, every time
• Mission: To establish a culture of continuous
improvement in quality and safety
across all hospitals statewide
SC Quality and Safety PartnershipKey Goals
• Promote a collaborative organizational
culture focused on quality improvement
and safety in all hospitals statewide
• Provide dynamic leadership and guidance
to the public and private sector in the areas
of safety and quality improvement
SC Quality and Safety PartnershipKey Goals
• Encourage hospitals and medical staffs to
adopt a systemic approach to patient
safety and quality improvement that is
board-directed, clinician-led, evidencebased, and data driven.
• Create an organizational framework that
supports active learning, knowledge
sharing, open communication & teamwork
SC Quality and Safety PartnershipKey Goals
• Institute a reliable data reporting system for
transparent dissemination of standardized,
understandable information on key quality and
safety indicators
• Promote strategic partnering with other key SC
health system stakeholders to maximize the
timeliness, efficiency & effectiveness of safety
& quality improvement efforts statewide
SC Quality and Safety Partnership
“ Unity is strength….when there is
teamwork and collaboration,
wonderful things can be
achieved”
-Mattie Stepanek
SC Quality and Safety PartnershipKey Components
• Explicit alignment of member hospitals statewide to
• Actively pursue continuous improvement in quality
and safety together based on
• Clearly defined and shared vision, mission, and aims
• Voluntary organizational commitment to participate in
the Partnership with
• Specific performance goals and measurements
• Inclusive of commitment to transparency and public
reporting of quality/safety data
Cultural Capability
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Organizational culture readiness assessment
Vision/mission/strategic plan alignment
Board engagement
Physician/clinician engagement
Commitment to internal & external transparency
Active leadership support for teamwork & open
communication
• Zero tolerance for disruptive professional behavior
Technical Capability
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Rapid Response Teams
SBAR communication process
Clinical protocols, checklists & order sets
Clinical care bundles- VAP; Sepsis
CPOE/EMAR/Bar Coding systems
Reliable data mgt. and reporting systems
Organizational Platform/Bridge
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ISO 9000
Six Sigma
Toyota Lean
TeamSTEPPS program
South Carolina Partnership
for
HealthCare Quality and Safety
“Alone we can do so little,
together we can do so much”
─ Helen Keller
SC Node- 5M Lives Campaign
Integration of 12 Initiatives
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Leadership Foundation- Board Engagement
Cardiac Care- Evidence-based AMI and CHF Care
Infection Control- Prevent MRSA, CLABSI, VAP
Surgical Care- SCIP, SSI Prevention
Medical Care- Prevent Pressure Ulcers
Critical/Emergency Care- Rapid Response Teams
Medication Safety- Medication Reconciliation
- High Alert Medications
SCHA Quality and Safety Partnership
Related Programs/Initiatives
• HIDA training sessions and NHSN reporting
system registration
• Expansion of ISO 9000 project
• TeamSTEPPS teamwork training project
• Lean Six Sigma Black Belt training program
• IHI Rural Hospital Alliance project
• Promoting Professional Behavior Collaborative
• Integration of AHA GWTG programs
• D2B Program/Database- ACC
Engage Leadership and Governance
The Goal:
Boards in all hospitals will spend at
least 25% of their meeting time on
quality and safety issues.
Boards will have a conversation with at
least one patient (or family member of
a patient) who sustained serious harm
at their institution within the last year.
What Does the Evidence Tell Us?
• Outcomes are better in hospitals where:
– The board spends >25% of its time on quality and
safety.
– The board receives a formal quality measurement
report.
– There is a high level of interaction between the board
and medical staff on quality strategy.
– Senior executive compensation is based in part on
quality and safety performance.
– The CEO is identified as the person with the greatest
impact on QI, especially when so identified by the QI
executive.
Vaughn T, Koepke M, Kroch E, et al. J of Patient Safety. 2006;2:2-9.
Six Things That Boards Can Do
 Set a specific aim to reduce harm this year and
make an explicit, public commitment to
measurable quality improvement (e.g., reduction
in unnecessary mortality or harm).
 Select and review progress towards safer care
as the first agenda item at every board meeting.
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Get data on harms and hear stories; put a “human
face” on data.
 Establish and monitor a small number of
organization-wide “roll-up” measures that are
updated continually and are transparent to the
entire organization and its customers.
Six Things That Boards Can Do
 Commit to establish and maintain an environment
that is respectful, fair, and just for all who
experience pain and loss from avoidable harm.
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Patients, their families, and staff at the sharp end of
error
 Develop the capability of the board.
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Learn how the “best in the world” boards work with
executive and MD leaders to reduce harm.
Set an expectation for similar levels of
education/training for all staff.
 Oversee the effective execution of a plan to
achieve the board’s aims to reduce harm,
including executive team accountability for clear
quality improvement targets.
Tapping the Boards Full Potential
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Choose board members w/ the “right stuff”
Educate the board
Use measures to focus board work on quality
Pursue perfection, not improvement
Pay more attention to culture
Exercise leaders powerful influence
Recognize and reward excellence
SC Quality and Safety Partnership“Existing Partners”
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PHTS- SC Node; ISO 9000 Project
CCME- SC Node; CMS 8th Scope of Work
DHEC- HIDA Program
BCBS- Hospital Recognition Program
American Heart Assoc.- Get with the Guidelines
SCMA/JUA/PCF- SC Node; PPB Project
SBME- PPB Project
AHEC- SC Node
SC Quality and Safety PartnershipKey Phase I Actions
• Establish formal Quality/ Safety Partnership with
individual hospital pledge to participate
• 5 Million Lives Campaign roll out via SC Node
• HIDA training and reporting system implementation
• Expansion of ISO 9000 Project
• Implementation of quality public reporting system
• Focus on “Board Engagement” initiative and “Moving
the Big Dots” template dashboard
ISO:9001-2000 Quality Management SystemPharmacy Initiative
• Joint PHTS/SCHA Quality & Safety Project
• Extension of Consortium Project- 6 SC Hosp.
• Self Regional will serve as mentor hospital
• Framework for linking cultural commitment to
quality/safety with targeted interventions
• Elimination of variability/reduction in errors
• Replication of desired patient outcomes when
combined w/ evidence-based practice
ISO:9001-2000 Quality Management SystemPharmacy Initiative
• Statewide ISO:9000 educational program
• On-site visits w/ each interested hospital
• Development of a process plan for ISObased QM system in Pharmacy dept.
• Active Senior leadership support at cultural
and technical levels
• Quality and Pharmacy directors as cochampions of the project
“We can drive the train, or we can wait until it runs over us.”
- Wisconsin CEO when asked, Why Public Report? Jan, 2000
Public Quality Reporting SystemGuiding Principles
• The system should be:
– Cost effective
– Voluntary and non-punitive
– Non-competitive in nature
• The information should be:
– Comparable across similar hospitals for benchmarking
– Readily accessible, user friendly and available in a timely manner
– Capable of instilling confidence in consumers through the ethical
distribution of reliable and valid data
• The measures should be:
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Evidence based
Coordinated with national initiatives
Relevant to hospital quality improvement efforts
Interesting/of value to various stakeholders
Supportive of other SC initiatives
Moving the Big Dots
“Not everything that can be
counted counts, and not
everything that counts can
be counted.”
-Albert Einstein
But what is reported, is changed!
Potential “Big Dot” Indicators
• Leadership -Rate/incidence of Avoidable Harm
-Occurrence of “Never Events”
-Inpatient Mortality Rate
• Cardiac Care – AMI/CHF Optimal Care Measures
and Mortality Rates
• Infection Control –Hosp. Acquired Infection Rates
• Critical Care – Inpatient Codes; VAP Rates
• Medication Safety – Medication Error Rate
• Surgical Care – Surgical Complications Rate
Moving the Big Dots- Real World
2005
 134 CLABSI
 2.0 codes/1000 d
 78 VAPs
 52 SSIs
 AMI mortality rate
of 12%
2006
 10 CLABSI
 0.9 codes/1000 days
 9 VAPs
 22 SSIs
 AMI mortality rate of
<5%
15 fewer deaths per
month than in 2005
Will these lines ever converge?
Will these lines ever converge?
It is possible . . . .
Quality
&
Safety
Health
Status of
South
Carolina
Covering the
Uninsured
South Carolina Partnership
for
HealthCare Quality and Safety
“Alone we can do so little,
together we can do so much”
─ Helen Keller