Download Insert Title

The presentation
will begin shortly.
Agenda
Welcome and Opening Remarks
Gary Yates, MD, President, Healthcare Performance
Improvement, President, Sentara Quality Care Network and
Chair, 2013 Quest for Quality Committee
Remarks from McKesson
Walter Reid, Vice President of Product Strategy and Marketing
Presentation from Meriter Hospital
2012 Citation of Merit Recipient
Presentation from UNC Hospitals
2012 Quest for Quality Finalist
Presentation from Lincoln Medical
and Mental Health Center
2012 Quest for Quality Finalist
Presentation from University Hospitals Case
Medical Center
2012 Quest for Quality Winner
Discussion/Q&A
Matthew Fenwick, Director of Program and Partnership
Development
Adjournment
Meriter Hospital
The American Hospital Association
Quest for Quality
Presenters
Kathy Werner, RN, MS
Director, Performance
Improvement
Geoff Priest, MD, EMBA
Chief Medical Officer
•
•
•
•
Madison, Wisconsin
448 Beds
Nonprofit
Governed by 19
member Board of
Directors
• Community based /
locally owned
Meriter's Mission
To heal this day
To teach for tomorrow
To embrace excellence always
To serve our communities –
For a lifetime of quality health care.
Meriter's Vision
Meriter will be a fully integrated health system that
exceeds the expectations of our patients and their
families, our physician partners and the
communities we serve.
Meriter’s Definition of Quality
H
Safe
ea
Effective
Make
Me
Better
Patient:
I need you to...
e
W
:
em
st e...
Sy b
r e to
ca ed
lth ne
Keep Me
Safe
Respect
Me
Patientcentered
Be There
When I
Need
You
Timely
Efficient
Equitable
Draft
Adopted
11/18/2008
12/05/2008
Meriter Safety, Quality and Service
Programs and Strategies
Safety
•
•
•
•
•
Patient Safety Committee
Just Culture
Crew Resource Management /
TeamSTEPPS®
Transitions in Care: “The Good Discharge”
and Bedside Shift to Shift Report
CMS “Partners for Patients” Teams: Falls,
OB Adverse Events, SSI’s and CLABSI
Effectiveness
•
•
•
•
“Chasing Zero” – Board Established Quality
Aims
Electronic Health Record – order sets,
BPA’s, templates for standardization, clinical
documentation improvement program
Outcomes Reporting – both internally and
publicly
Meaningful Use
Timeliness
•
•
•
•
“BEST” Nursing Rounds
Dedicated Emergency Response Teams
Accredited Stroke Center and Heart Hospital
Post Discharge Patient Follow Up Phone
Calls
Efficiency
•
•
•
•
•
Care Management
Unit Based Clinical Pharmacists
Employed Hospitalists (Adult and Pediatric)
Dedicated Intensivists
Bundled Payment Projects (Total Joint
Replacements – State Based and CMS)
Equity
•
•
•
•
Uncompensated Care / Community Needs
Manager
Hospitalist Initiated Street Medicine Program
– HEALTH
Community Partnerships
Support of Mission Based Programs
Patient Centered Care
• Healing Environment
24/7 Spiritual Care Providers
All Private Rooms /
Refurbished
Wireless Voice / Noise
Reduction
• NICU Family Council
• Formation of System Wide
Patient Advisory Council
• Service Excellence
Department
RN Patient Representatives
HCAHPS / NRC Picker
• Palliative Care / Statewide
Initiative
Top performing facilities – Rate Doctor (Pediatrics):
Meriter Medical Group, Madison, WI
Winner of the 2012 Innovative Best Practice Award:
Meriter Health Services, Madison, WI
Meriter Improvement Drivers
Ongoing Monitoring and Reporting
• Board of Directors and its Quality of Healthcare
Committee Oversight
• 90-day operating updates
• Monthly scorecards clinical units
• Crimson™ physician reporting system
• Nursing shared governance structure
• Medical staff OPPE and peer review
processes / Medical Care Review Committee
• Pay for performance
Meriter Improvement Drivers
Leadership Development and Accountability
•
•
•
•
•
•
Board retreats and education
Leadership development curriculum
Continuing education
AHA “QI Leadership Fellowship” program
Physician leaders – Intermountain Healthcare Training
Nursing shared governance leadership education
Performance Improvement & Patient Safety
Scope and Authority
A Sampling of Results
•
•
•
•
•
•
•
CAUTI’s
CLABSI’s
SSI’s
VAP’s
Mortality
Readmissions
Hospitalist Case Study
Rate per 1000 Device Days
Catheter Associated Urinary
Tract Infections
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
2 CAUTIs
last Quarter
10
7
9
8
6
6
4
3
5
3
6
7
4
2
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q
2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012
Central Line Associated
Blood Stream Infections
3.0
Per 1000 Device Days
2.5
3 CLABSIs
last Quarter
2.0
1.5
1.0
0.5
0.0
7
4
3
8
4
2
3
2
6
2
2
2
2
3
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q
2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012
Overall Infection Rate
Surgical Site Infections
3.00
2.50
2.00
16 SSIs last
Quarter
1.50
1.00
0.50
0.00
32
23
21
28
22
9
26
17
15
9
17
8
10
16
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q
2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012
Number of Infections
Ventilator Acquired Pneumonias
3
2
0 VAPs last
Quarter
1
0
1Q
2010
2Q
2010
3Q
2010
4Q
2010
1Q
2011
2Q
2011
3Q
2011
4Q
2011
1Q
2012
2Q
2012
Readmissions
30 Day Readmissions Any APR - DRG
Quarterly Rates Compared to Large Hospitals
Medicare Patients Only
16
14
12
10
8
6
4
2
0
3rd 2010
4th 2010
1st 2011
2nd 2011
Meriter
Cohort
3rd 2011
4th 2011
Linear (Meriter)
1st 2012
2nd 2012
Mortality
Mortality Rates Compared to Large
Hospitals - Medicare Patients Only
4
3.5
3
2.5
2
1.5
1
0.5
0
3rd 2010
4th 2010
1st 2011
Meriter
2nd 2011
Cohort
3rd 2011
Linear (Meriter)
4th 2011
Linear (Cohort)
1st 2012
2nd 2012
Adult Hospitalist Outcomes
Where to Next?
Raising the Bar
Meriter Health will be a clinically integrated system of providers and payers that
focuses on the highest level of health and well-being of its Meriter Community
Members by:
• Building on Meriter’s strength in “Patient Engagement,” while ensuring
access and clinical excellence;
• Developing a unique model of care delivery that focuses on chronic disease
management, wellness and prevention with a goal of lowering cost and
improving health;
• Integrating physician, insurance, clinical, and hospital operations towards
community member health;
• Partnering with other healthcare organizations that can add to our focus on
community member health.
This requires that Meriter be a vibrant and progressive health care system, with
a board and management that make decisions on behalf of the community and
its healthcare needs.
Our Brand Promise: Healthcare done right.
Meriter System Model of Care Components
System Model of Care
Clinical Data
Outcomes Mgmt
Wellness
Programming
Patient Centered
Medical Home
Patient Access
Technology
Workforce Roles
& Scope of Practice
“Better is possible. It does not take
genius. It takes diligence. It takes
moral clarity. It takes ingenuity. And
above all, it takes a willingness to try.”
- Atul Gawande, MD, Better: A Surgeon’s Notes
on Performance
Questions
Thank You!
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Quality Improvement
Lessons from the
2012 AHA-McKesson
Quest for Quality
Prize Recipients
Webinar
Larry Mandelkehr, Director of
Performance Improvement
November 13, 2012
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Overview
Who we are
Keys to success
• Our Commitment to Caring and the Carolina Care
Initiative
• Triads and Physician Service Leaders
Summary of our many improvement initiatives
26
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
UNC Medical Center - Who we are
• Located on the campus of
University of North CarolinaChapel Hill
• 804 beds
• 73,650 ED visits
• 37,750 inpatient discharges
• 28,750 surgeries
• 873,500 outpatient clinic visits
• Level 1 Trauma Center
• Level 3 NICU
• NC Jaycees Burn Center
• Magnet Designation
• Beacon Award for Critical Care
• Leapfrog Group Top Hospital
27
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Our Commitment to Caring
28
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Key Elements of Carolina Care
• Moment of Caring
• Hourly rounds
• No Passing Zone
• Words and Ways that Work
• Blameless Apology
30
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Carolina Care Rollout Overview
Carolina CareTM Implementation Oversight Committee
• CNO
• Nursing Directors
• Nurse Managers
Nursing Teams
• Nurses
• Nurses
Assistants
• Health Unit
Coordinators
Interdisciplinary
Teams
• Nurses
• Housekeeping
• Nutrition & Food
Service
• Plant
Engineering
• Other Support
Services
• Director, Environmental
Services
• Director, Food and Nutrition
• Data Analyst
Action Plans
• Assign process
owners
accountability
for specific
items
• Team approves
action plan
Unit Implementation
Led by Nurse
Mangers
• Nurse Manager
held
accountable for
improving
inpatient
satisfaction at
the unit level
31
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Implementing Carolina Care
Roll-out details
Simultaneous roll out on
all acute care units
Adapted for diagnostic
and support departments
Implemented as one hour
required in-person class
for all employees
8 Week Implementation Sequence
Monday morning Nurse Mangers’
meeting
Weekly focus areas
Bi-weekly nursing &
Interdisciplinary team meetings
Building action plans
Tracking performance measures
Daily huddles
Bright Ideas
Implementation Oversight
Committee
32
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Maintaining our Commitment
33
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
New Physician Service Role created
School of Medicine
Hospital
New roles
Dean, SoM
Accountability
Physician Leader
Accountability
Chief of Staff
Chair 1
Chair 2
Chair 3
CEO, HCS
President
Etc...
COO
Efficiency
Chief 1 Chief 2 Etc...
Service
Leaders
Quality
• Resident and attending oversight
• Tie to both SoM and hospital
• Clinical performance focus
– Quality / safety
– Efficiency/flow
– Clinical outcomes
– Customer service
– Clinical Documentation & Coding
SVPs Ops Nursing
Etc...
34
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
Physician Service Leaders partner with Nursing and
Care Management to form Clinical Care Team (CCT)
• Case manager drives
patient discharge process
from Day 1
• Ensures patient 'on track' for
timely discharge
Care
Mgmt
• Nursing and case
managers coordinate
for patient and family
needs to ensure timely
discharge
Patient
Nursing
• Nursing manages day-today care of the patient
• Works with patient on key
discharge goals
Source: BCG
• Physicians and case
managers partner to
estimate discharge date,
outline discharge criteria,
and monitor progress
Physicians
• Physicians work together
with nursing to
issue/complete medical
orders and to monitor
patient health status
• Physician Service Leaders
provide leadership and continuity
for clinical operations
• Attendings / residents lead
medical management of patient 35
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Safety
•
•
•
•
•
TeamSTEPPS team training
Just Culture
Adult and Pediatric Rapid Response Teams
Patient Occurrence Reporting System
Infection prevention programs & role of
infection control liaisons
• Prevention of complications
36
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Patient-centeredness
• Patient Family Advisory Board – initial focus
in Pediatrics & Cancer
• Partnering with Patients and Families
program
• Carolina Care - our own way of branding
care
• Commitment to Caring teams
37
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
38
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Effectiveness
• Annual Quality Expo – 90-100 posters
• Pediatric Residency Quality Improvement
Program
• Carolina Data Warehouse and NCTraCS –
data available to improve care and support
research
• Focus on HCAHPS- Hospital Consumer
Assessment of Healthcare Provider Systems
• Carolina Advanced Care Initiative
39
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Efficiency
• Six Sigma/Kaizen rapid response projects –
involvement of patients on teams
• Nursing Performance Improvement
“Roadshows”
• FMEA (Failure Modes & Effects Analysis)
projects
• Meaningful use of our electronic medical
record
40
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
41
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Equity
• Center for Latino Health
• UNC Community-Based Practice Network
• Employee feedback opportunities –
Employee/resident roundtables, “Glad you
asked”
• Ambulatory Care Excellence
• Employee Ambassador Program
42
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
What we do - Timeliness
• Transitions of care programs including
Carolina Care at Home and our many
readmission prevention initiatives
• Six Sigma/Kaizen projects
• Commitment to Caring
• Improvement in clinic access and cycle
times
43
PRELIMINARY DRAFT – FOR DISCUSSION PURPOSES ONLY – INFORMATION SUBJECT TO
CHANGE
UNC HEALTH CARE SYSTEM
44
Lincoln Medical and Mental Health Center
Quest for Patient Safety and Quality
Member of the NYC Health and Hospitals Corporation
Part of the Generations+/Northern Manhattan Health Network
CY 2011 STATISTICS
347………….Operating beds
24,829……….Inpatient discharges
4.07 days.…..LOS
444,300……...Ambulatory visits
163,110……...ER visits
2,319…………Deliveries
2,762…………Colonoscopies
8,960.............Mammograms
15………….Training Programs
THE BIG PICTURE
PATIENT SAFETY STRUCTURE
NYCHHC Board
NYCHHC President
Network /SVP
Executive Director
Network Patient Safety Committee
Patient Safety Officer
Corporate Patient Safety
Hospital Committees / HWPIC
QUALITY – IMPROVEMENT STRUCTURE
NYCHHC Board
NYCHHC President
Network / SVP
Executive Director
Regulatory Affairs /
Quality Management
Quality
Management
Risk
Management
Medical Director
HWPIC
Clinical
Departments PI
49
SAFE
•
Patient Safety Programs – develop and implement
best practices – reduce HAIs, DVTs, Falls, Harm from
Medications
•
Safety culture – TeamSTEPPS, Just culture, Safety
survey, address disruptive behavior
•
Teamwork – Invest in Simulation training
•
Developed programs to reduce radiation exposure
from diagnostic studies
•
Reduce errors in interpretations: Digital Mammo
CAD, SoftVue to reduce the likelihood of missing
small lung nodules
•
Specialized contingency teams: RRT, Stroke, BEST
EFFECTIVE
• Implement evidence based protocols –
Sepsis, CHF, AMI, Pneumonia,
Anticoagulation, Fall Risk reduction, Stroke
• Structured Care Management Program
• Interdisciplinary Palliative Care Team
• Active work on the 20 priority areas identified
in the IOM “Transforming Healthcare Quality”
and AHRQ Quality reports
• Developed and adopted multiple best
practices – SSCL, AC, Critical care bundles
• Data driven sustainable processes
PATIENT CENTERED
• Community Health Assessment
• Community Advisory Board and
Patient Advisory Council patient centered
approach with cultural sensitivity
• Focus High Risk - Fragile Populations /
Chronic disease management
• Patient Centered Medical Home
• Health Home
TIMELY
• Patient Flow – lean methodologies
Emergency Department
OR Efficiency
Inpatient
Ambulatory Care
Patient Navigators – DERS and Fast
Track
• 24 hour On Site Attending MD
EFFICIENT
• Lean Methodology (Breakthrough)
• Protocol Driven / Decrease Overuse
• Hospitalist System / On site Intensivist
• Case / Utilization management
• Dynamic Access to Data (EMR) – Ancillary
tests
EQUITABLE
• The Core of our Mission – only public
hospital in the South Bronx – a federally
designated medically underserved
community
• Focus on Cultural sensitivity / Language /
Literacy / LGBT Competency
• Improving Access
• Palliative Care
INFORMATION TECHNOLOGY
• Early Adopters - Davies Award
HIMSS (Healthcare Information and
Management Systems Society)
• Full CPOE
• Full Electronic Medical Records
• Clinical Decision Support
• Meaningful use
Achieving The New Healthcare Model
“The Triple Aim”
Improve the Health of
the Population
Coordinated
Transitions
Chronic disease/Care
management
Community Health
education/research
Health assessment
Enhance Patient
Experience (quality,
access, reliability)
Reduce (or at least)
Control Costs
Safety / Quality
Programs
Lean - Breakthrough
High Reliability
model
Service Excellence
Access Strategies
Case Management
Value Based
Purchasing focus
Cost containment
Lincoln’s great strides to achieve excellence
in quality and patient safety







Importance of Leadership –setting the vision
Robust Quality and Patient Safety Structure
Focus on Measurement is of Paramount Importance
Share data at all Institutional Levels to promote quality
and safety
Track Multiple Performance indicators benchmarked to
National data
Patient Centeredness: Determine all from the patient’s
perspective
Effective Teamwork and communications are critical for
ensuring high reliability
Confidential Quality Privileged
Prioritizing the Quality Agenda
at University Hospitals Case Medical
Center
Fred C. Rothstein, MD
President
University Hospitals Case Medical Center
November 2012
Agenda
1. Overview of University Hospitals (UH) Health System
2. Overview of UH Case Medical Center (UHCMC)
3. UHCMC Quality
• Our program in 2003
• Conceptual approach to program development
4. Our Focus
60
Agenda
1. Overview of University Hospitals (UH) Health System
2. Overview of UHCMC
3. UHCMC Quality
• Our program in 2003
• Conceptual approach to program development
4. Our Focus
61
Overview
Our Mission
To Heal.
To Teach.
To Discover.
62
Overview
A Diverse Integrated Delivery System
• 146 years of service to our community
• Over $2.5 billion annual operating revenue
• 9 hospitals
• 2,290 registered beds
• UHCMC is the primary teaching affiliate of Case
Western Reserve School University of Medicine
63
Agenda
1. Overview of University Hospitals (UH) Health System
2. Overview of UHCMC
3. UHCMC Quality
• Our program in 2003
• Conceptual approach to program development
4. Our Focus
64
University Hospitals Case
Medical Center
• The overriding purpose of Academic Health is to improve
the healthcare of our communities and of the larger
society in which we reside.
• It has been our guiding principle since 1866……
65
83 Wilson Street
May 1866
66
University Hospitals Case Medical Center
• Rainbow Babies & Children’s Hospital
• MacDonald’s Women’s Hospital
• Seidman Cancer Center
• Hanna House
• Lakeside
• Lerner Tower
67
68
Mission: To Heal
University Hospitals Case Medical Center - 2011
• Discharged 39,056 patients
• Performed 3,902 newborn deliveries
• Performed 30,799 surgeries
• 75,233 Emergency Room visits
• Over 4.3 million outpatient procedures
• 178 Intensive Care Beds (incl step down)
– 74 Adult plus 15 Step Down
– 58 Peds/Neonatal plus 31 Step Down
69
Mission: To Teach
• 878 Residents & Fellows in over 65 Programs
• 1,782 nursing students trained in 2010
• Over 800 medical students annually receive their clinical
experience at UHCMC
• Training Site for Allied Health Professionals
o APN/NP/PA
o Radiology & Pharmacy Techs
o CRNA/AA
70
Agenda
1. Overview of University Hospitals (UH) Health System
2. Overview of UHCMC
3. UHCMC Quality
• Our program in 2003
• Conceptual approach to program development
4. Our Focus
71
UHCMC Quality Program - 2003
No clear quality agenda
Quality “owned” by the Chief of Staff – lacked MD engagement
Inf. control, risk management, JCAHO “owned” by VP of Nursing
Limited joint defense & outsourced malpractice insurance
Senior management & Board meetings did not focus on quality
No management incentive plan related to quality
72
UHCMC Quality
Conceptual Approach to Program Development
1.
Clear definition of quality
2.
Senior administration & Board ownership
3.
Organizational structure
4.
Prioritization of quality goals
5.
Use of metrics to create change
6.
Shared learning & transparency
73
UHCMC Quality
1. Clear Definition of Quality
Patient
Safety
Publicly
Reported
Metrics &
Accreditation
Employee
Engagement
Patient
Experience
of Care
74
UHCMC Quality
2. Senior Administration & Board Ownership
• Senior leadership ownership
• UHCMC board focus on quality
• Role of the Board Quality Committee
• Immediate reporting of sentinel & critical events
75
UHCMC Quality
3. Organizational Structure
System Chief
Nursing
Officer
Chief Nursing
Officer
System Chief
Medical
Officer
Chief
Medical
Officer
Hospital
CMO
•
•
•
•
•
•
Hospital
CMO
Hospital
CMO
Hospital
CNO
Hospital
CMO
Quality Center
Peer Review
Credentialing
Continuing Medical Education
Complaint Management
Pharmacy & Therapeutics Committee
•
•
•
•
•
•
Hospital
CNO
Hospital
CNO
Hospital
CNO
Utilization Review & Management
RN Education & Certification
Joint Commission Readiness
Patient Satisfaction Surveys
Infection Control
Adverse Event Analysis
76
UHCMC Quality
4. Prioritization of Quality Goals
Infection
Procedure outcomes
Complaints
Patient satisfaction
Adverse events
Resource utilization
Medical malpractice
Joint commission
Publicly reported outcomes
Annual
Quality
Goal
Setting
77
UHCMC Quality
5. Use of Metrics to Create Change
• Targeted data elements that will modify
behavior
• Prioritization of quality goals
• Linkage to key strategic initiatives
• Benchmark our progress
78
UHCMC Quality
5. Use of Metrics to Create Change
• UHCMC Scorecards
 Superior quality
 Service excellence
 Employee engagement
 Financial performance & growth
79
UHCMC Quality
5. Use of Metrics to Create Change
UH Management Incentive Plan
Area
Goal
Weight
Financial Performance
Target
Max.
Core Measures
10%
Number at 90th percentile
Patient Safety
10%
Central line bloodstream
infections
Patient Satisfaction
10%
Inpatient units at 90th
percentile
System Operating
Margin &
Community Benefit
25%
Community Hospital
Discharges
5%
Superior Quality
Service Excellence
Threshold
Physician Group
Operating Margin
20%
Employee Engagement
Employee
Engagement
10%
Philanthropy
System Philanthropic
Attainment
10%
80
UHCMC Quality
6. Shared Learning & Transparency
• Medical malpractice insurance captive
–
–
–
Joint defense for hospitals and physicians
Contact with the plaintiff bar encouraging early
notification of potential litigation
Mandatory risk management education
• Focus on
–
–
–
–
Prompt incident reporting
Early disclosure
Early settlement when appropriate
Organization-wide sharing of “lessons learned”
81
UHCMC Quality Outcomes
2012 Quality Awards
• U.S. News & World Report ranked UHCMC in all 12 specialties
and in the Top 20 in four specialties, Cancer, ENT,
Gastroenterology, and Orthopaedics
• U.S. News & World Report ranked UH Rainbow Babies &
Children in all ten specialties and in the Top 5 in neonatology
and Top 10 in Pulmonology and Orthopaedics
• Best-in-Class for Board Diversity
• UH ranked second in nation for diversity by Diversity Inc.
• UHCMC received and “A” in The Leapfrog Group’s Hospitals
Safety Score
82
Agenda
1. Overview of University Hospitals (UH) Health System
2. Overview of UHCMC
3. UH Quality
• Our program in 2003
• Conceptual approach to program development
4. Our Focus
83
Our Focus
Institute of Medicine Aims
• Safe
• Timely
• Effective
• Efficient
• Patient-Centered
• Equitable
84
Safe – Surgical Safety Checklists
•
Series of critical safety steps
– Prompt verbal discussion for the surgical team
•
•
Increases communication and teamwork in OR
Decreases adverse events and improves patient outcomes
Pilot Results
OR Staff Survey
86%
Want it used for
self or loved one
78%
Worth the Time
Opportunity to
Voice Concerns
Improves
Communication
Improves
Teamwork
69%
81%
75%
85
Safe- Rainbow Mission Possible:
Seeking High Reliability in Safety
• Establish safety as the core value of the organization
• Set behavioral expectations and educate staff
– Personal commitment to safety, clear communication and
support of a questioning attitude
– Mandatory training of 2500+ employees in Error Prevention
• 200% Accountability
– Leadership methods
• Daily Check In; Daily Unit Huddle; Rounding to Influence; Senior
Leader Rounds
– Safety Coach program
• Unit based staff trained to coach and reinforce safety behaviors and
techniques
86
87
87
Safe- Incident Reporting
UH Wholly-Owned Hospitals
Incident Reporting
UH Hospitals
CY 2004 - 2012 @ 8/31
(Annualized)
2012 @ 8/31
889
79
593
49
+520%
2011
1024
2010
146
936
2009
116
792
2008
185
704
2007
151
578
2006
150
387
2005
361
2004
158
0
121
117
100
200
400
600
800
PCEs*
↑937% from 2004-2012 (Annualized)
1000
1200
1400
1600
Claims
↑22% from 2004-2012 (Annualized)
*PCE - Potential Compensatory Event
88
Effective – Chlorhexidine Bathing
Getting Started
•
•
•
Collaboration between the Quality Center, Nursing, Infection Control and Infectious Disease
Specialists took place for planning.
Education of staff in the bathing process for the towelette packages was conducted.
Examination of non-compatible skin care products and removal of these products from the stock of
the unit
Future Plans
•
•
Due to the remarkable outcomes, the daily CHG bathing was expanded to all four adult ICUs and
one surgical division.
There are plans to expand to oncology divisions.
89
Effective - Resident Education
•Purpose is to impart knowledge,
attitudes, and skills needed to
participate in quality and patient safety
at a large academic medical center
•Residents participate in a dedicated
four week long immersion experience
with UHCMC’s Quality Institute
•Received The Scholarship in
Teaching Award, CWRU, February
2012
• OHA Ohio Patient Safety Institute
Patient Safety Best Practice Award,
June 2011
•Presented at the Annual Patient
Safety Congress, May 2012
Resident EQUIPS
Pre-test
Reading materials
(To Err is Human, Infection
Control, Core Measure Details,
etc.)
Post-test
Introductory Session
Quality Center
Didactics
Departmental
PI/QA Meetings
Experience-based
Learning
(Quality, Risk Management,
Coding, Infection Control,
Utilization Review, Data, etc.)
(Medicine Quality Assurance,
Incident Reports, Patient
Complaints)
(Prepare QA cases, Hand
Washing Audits, Mock Joint
Commission Survey Audits, etc.)
Reflection and Feedback
• Added Family Medicine Residents to
the program in August 2012
•Completed 12 resident directed
process improvement projects for the
2011 – 2012 academic year
University Hospitals
5/25/2017
Year-long, ResidentDirected Process
Improvement Projects
90
Patient-Centered- Patient and
Family Councils
• Rainbow Family Advisory Council (FAC)
– Began in 1991
– A voice in the operations and policies of the hospital
– Quality Board representative
• Seidman Cancer Center FAC
– Involved in construction/design of new cancer hospital
• Adult Patient and Family Council
– Visitation policies
– Policies for family presence during resuscitation
91
Timely – Time is Muscle
• ECG interpretation
• Single-call STEMI
activation (TIM page)
• Provide real-time
feedback to EMS,
transfer center, ED
and cath lab staff
• Standardization of
algorithms
92
Efficient – EMR Order Sets
• > 800 order sets developed to guide best practice
• EMR Order Set Utilization
– Usage data being sent to medical staff leadership monthly
• System-wide EMR Prioritization process established to focus
efforts on decreasing variations in care
• Clinical Effectiveness teams developed by specialty to
continuously review and update order sets as practice changes
93
Equitable
• Ranked #1 in Equity on University HealthSystem Consortium
Quality and Accountability Study for past 3 years
– Measures race, gender, and socioeconomic status
• Equity demonstrated in indexes for mortality , LOS, and
Readmission rates
• Recognized nationally for Diversity
94
Questions?