Presentation Transcript

1. American Hospital Association (AHA)/ Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN)

   Florida & Alabama National Mini Collaborative & Improvement Leader Fellowship (ILF) Wednesday, April 16, 2014
2. AHA/HRET (HEN) Florida & Alabama: Mini Collaborative & Improvement Leader Fellowship (ILF) Lake Mary, FL– Summary Disclosure & Accreditation Statement - April 16, 2014 The planners and faculty of the AHA/HRET (HEN) Improvement Leader Fellowship (ILF) have indicated no relevant financial relationships to disclose in regard to the content of this activity. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical education through the joint sponsorship of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) and the Health Research & Educational Trust. ABQAURP is accredited by the ACCME to provide continuing medical education for physicians. The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 4.50 AMA PRA Category 1 Credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is an approved provider with the Florida Board of Nursing to provide continuing education for nurses. ABQAURP designates this activity for 4.50 Nursing Contact Hours through the Florida Board of Nursing, Provider # 50–94. CMEsolutions is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 4.50 contact hours (.45 CEUs). ACPE Program Number: 0274-9999-14-010-L04-P
3. Good Morning & Welcome! AHA/HRET HEN Team: Charisse Coulombe, MS, MBA, CPHQ (Vice President) Tennille Daniels, MPH, PMP (Senior Program Manager) Vikas Bhala, MPH, MBA (Program Manager) Cynosure Health: Bruce Spurlock, MD (President & CEO) The Institute for Healthcare Improvement (IHI): Jane Taylor, EdD Florida Hospital Association (FHA): Kim Streit, FACHE, MBA, MHS Alabama Hospital Association (AlaHA): Rosemary Blackmon Most importantly… your PEERS!
4. Objectives for our Time Together Review national and state outcomes and data submission, including Fellowship information Review state demographics Highlight state successes Consider fieldwork assigned for today Session-specific Collaborative and ILF objectives Make a call to action for state-specific areas of focus Leave today with new energy, ideas and relationships
5. Action, Energy, Ideas and Relationships Review the objectives for today Action re: state-specific focus… use our time together to create or update your “to do” list to accelerate progress of reducing harm and readmissions per the Partnership for Patient’s (PfP) 40/20 aims Energy, ideas, relationships… leave with these items in your tool belt. Review your checklist and see what can be implemented next Tuesday
6. Data Submission- Acute/CAH/Children’s Data Source: Comprehensive Data System 4/01/14
7. Overall Achievement of Targets- Feb 2014 Data Source: Comprehensive Data System 2/24/14
8. Overall Achievement of Targets- March 2014 Data Source: Comprehensive Data System 4/01/14
9. Overall Achievement of Targets- CAH Data Source: Comprehensive Data System 4/01/14
10. Overall Achievement of Targets- Rural (non-CAH) Data Source: Comprehensive Data System 4/01/14
11. Florida Achievement of TargetsFebruary 2014
12. Florida Achievement of TargetsMarch 2014
13. Alabama Achievement of Targets- February 2014
14. Alabama Achievement of Targets- March 2014
15. How do we Assess State & Hospital Achievements?How do we Connect the Dots? How do I best contribute for my patients? (Our motto for today…) Talk to your state leads in this room! Network with the subject matter experts today! Connect with your peers! Review the CDS reports (Individual Measure, Measure Comparison, All Measures reports, Hospital and CEO dashboards) to track your data and progress! PDSA!
16. Thank You! For the hard work you are doing to improve our nation’s healthcare system. For your active commitment to improve the care of patients and clients. For your leadership and history of success on health care improvement, innovation and spread.

17. Florida Hospital Engagement Network

    Making Patients Safer
18. Florida: State of the State 78 hospitals (72 returned, 6 new) 72 acute care hospitals (4 CAH) 2 rehab; 3 psych; 1 LTAC 171 Fellows representing 43 hospitals 72% are Junior Fellows More than 160 attended 2012-2013 in-person and virtual ILF meetings
19. Florida: State of the State Successes: Eliminating Deliveries before 39 weeks: ↓79.7% ALL maternity hospitals adopted “hard stop” policy Reducing Pressure Ulcers - ↓44.6% Partnering at all levels of the hospital Challenges Data submission 80% reporting data on each recommended measure 40% improvement on each recommended measure Need at least 8 months of data to evaluate
20. State of the State Increase Data Reporting At least one ADE measure (insulin, warfarin, opioids) VAE (IVAC &/or VAC) Falls- All Falls (NSC 4 measure) VTE- Pot. Prevent (VTE 6) or Post-op (AHRQ 12) Readmissions All Cause 30 day OB- total transfusions or ICU days w Preeclampsia Topics needing extra focus CAUTI CLABSI SSI Readmissions

21. Alabama Hospital Engagement Network

22. State of the Fellowship Number of Fellows: 54 Number of Hospitals Fellows Represent: 30 Number of Fellows added so far in 2014: 11 Number of Virtual ILF Meetings Attended to date: 31 Number of In-Person ILF Meetings Attended to date: 67
23. Alabama: State of the State Key Successes 30 hospitals returned for the option year out of 33 from last year Meeting 80 percent reporting / 40 percent reduction in 3 of the topic areas OB – 68% reduction SSI – 60% reduction EED – 73% reduction CAUTI and CLABSI both have 100% reporting Meeting 40% reduction in VAP (need 3 additional hospitals to report to meet 80% reporting goal) Increased overall reporting (across all hospitals and all applicable measures) to 79%
24. Alabama: State of the State Areas of Focus CAUTI – through HEN and CUSP/CAUTI project EED Working with state health department and Medicaid agency to develop regulations that require hospitals to have a hard stop, hopefully to avoid a payment penalty 68% with a hard stop, 87% with a 0 rate ADE Ramping up this year to increase percentage reporting Pulling a workgroup together on April 23 to look at what issues our hospitals have in reporting and reducing ADE Readmissions

25. The FL & ALMini-Collaborative

    Wednesday April 16, 2014

26. The Importance of Quality to Your Hospital’s Future

    Kim Streit, FACHE, MBA, MHS VP/Healthcare Research and Information Florida Hospital Association
27. Quality in the past Why Quality should be your highest Priority in terms of patient care, advocacy and payment reform Essential elements needed to build quality into your organization’s culture
28. Organizational Chart in the Past
29. Current State for Transformative Organizations Board of Directors CEO Quality Performance Improvement Physician Leader CQO IT IT Operations Nursing Ancillary Finance Support Transitions
30. Increased Emphasis on “Value” Affordable Care Act Value Based Purchasing Readmissions Penalty Hospital Acquired Conditions penalty Medicare Spending Per Beneficiary Medicare Advantage Star Ratings Network provider quality requirements New delivery system models (ACOs, bundled payments, medical homes)
31. How Quality Impacts the Bottom Line 31
32. Tying it to the Hospital Engagement Network Initiatives 32
33. Demands by Payers
34. Consumers want information
35. Essential elements to build quality into your organization’s culture Quality is aligned as a strategic goal Engagement at all levels (Board, physician, leadership, frontline) Structure (team),process (PDSA), data (accurate/timely) Quick action/continuous improvement Demonstrated physician leadership, EBP Patient/family engagement Solid program to Reward and Recognize (individuals and teams)
36. Hospital Engagement Network HEN provides the Tools, Resources, Support to do this work FHA Contacts: Kim Streit, kims@fha.org Sally Forberg, RN, CPHQ, sally@fha.org Phyllis Byles, RN, phyllisb@fha.org John Wilgis, RRT, john@fha.org Suzie Waddle, suzie@fha.org (Florida ILF Coordinator)

37. Leading and Engaging to Reduce Harm: The Skill Set You Need to be an Effective Change Agent

    Bruce Spurlock, MD President & CEO, Cynosure Health
38. Bricklayer #1 “Putting a brick on top of another... Isn’t that obvious?”
39. Bricklayer #2 “Building a wall for the west side of a church”
40. Bricklayer #3 “Creating a cathedral that will stand for centuries and inspire people to do great deeds”
41. What percentage of your staff are: Putting one brick on top of another? Building a wall for a church? Creating a cathedral?
42. Three Skills
43. Skill # 1 – Connect to the Core
44. First detailed data showing higher % of smokers among lung CA patients (1928) Congress mandates health warnings on cigarette packs (1965) Congress bans smoking on all domestic flights (1989) First Surgeon General report linking smoking and lung cancer (1957) Arizona passes first law designating separate smoking areas in public (1973)
45. MEANINGFUL BIG BELONG DIFFERENCE
46. Skill # 2 – Engaging the Engaged
47. In your mind, without talking, get an image of a person in your organization who is the last to adopt new practices – some call them curmudgeons
48. Adopters and Who to Persuade First Fertile Ground for Champions Where Champions Work Where Champions Work
49. Find Your Champions
50. Use Early Adopters to Create Change
51. Skill # 3 – Customize Communication
52. Customize the WAY You Communicate SHARE INFORMATION SHAPE BEHAVIOR General Publications flyers newsletters videos articles posters Personal Touch letters cards postcards Public Events Road shows Fairs Conferences Exhibitions Mass meetings Face-to-face one-to-one mentoring seconding shadowing Interactive Activities telephone email visits seminars learning sets modeling (C) 2001, Sarah W. Fraser Adapted from Ashkenas, 1995
53. Recap

54. Leading and Engaging to Reduce Harm

    The Skill Set You Need to be an Effective Change Agent Presented by Stacey Yuskas Demerski, RN, BSN, CPHQ
55. Palm Beach Gardens Medical Center Established in 1968 199 Licensed Beds, 921 Employees Over 29,000 ED visits in 2013 Acute care hospital Performed first open heart surgery in Palm Beach County Performs TAVR (Transcatheter Aortic Valve Replacement Performs Robotic Surgery Comprehensive cardiac care, orthopedics and joint replacement, diagnostic imaging, general surgery, outpatient surgery and 24 hour emergency care
56. Palm Beach Gardens Medical Center Awards & Distinctions Healthgrades 100 Best Hospitals for Stroke Care ™ (2012-2013) Healthgrades Five-Star Recipient for Treatment of Heart Failure 7 years in a row (2007-2013) Healthgrades Five-Star Recipient for Coronary Interventional Procedures 11 years in a Row (2003-2013) Leapfrog A rating Joint Commission Top Performer 2 years in a row AHA Get with the Guidelines Gold Plus Award for Stroke and Heart Failure Certified Primary Stroke Center Joint Commission Chest Pain Center Accreditation from the Society of Cardiovascular Patient Care
57. Leading and Engaging for Patient Safety Leadership Commitment Rounding Building relationships Identifying informal leaders Asking the tough questions Involving frontline staff one team member at a time Tell the story Sharing data and encouraging transparency Recognize and celebrate the “wins”
58. Leading and Engaging for Patient Safety Engagement = collective understanding Courage Trust Communication Teamwork Focus Sustainability
59. Let’s Take a 15 Minute Break
60. Executing the Concepts of Eliminating Harm Across the Board (HAB): A Comprehensive Approach to Leverage Electronic Health Records (EHRs), Gather Data and Apply Tools Wednesday April 16, 2014

61. Orlando Health

    Gabriela Ramirez, PhD, MPH
62. Steps for Effectively Using EHR Data for Electronic Clinical Quality Metrics (eCQM) Assemble Workgroup Document and Clarify Metric Specifications Identify Source(s) of Data Understand Documentation Workflows Extract, transform and load data for analysis Calculate and validate metric Continue to monitor documentation workflows
63. Workgroup Composition
64. Key eCQM Design Considerations Define Measure Type: Process, outcome. Unit of Analysis: Describe ie. unique patients admitted, unique patients discharged, unique orders. Measurement Period Length: Annual, quarterly, monthly, etc. Determine Measurement Timing Considerations: Describe ie. If there will be a lag for measurement. Define Measurement Formula: ie. Proportion, rate, ratio, continuous.
65. Key eCQM Design Considerations Inclusion and exclusion criteria need to explicit, documented, and retrievable. Exceptions to the process need to be identified and agreed upon. Documentation is needed so that data can be retrieved.
66. Tool for eCQM Documentation
67. Watch out for… Exclusions or exceptions also need to be granular and retrievable . Missing Documentation or documentation in other sections of EHR. Changes in workflow that will affect documentation. GIGO (Garbage in, Garbage out). All fields need to be granular and analyzable.

68. Brooks Rehabilitation Hospital

    Kelly Mullee, RN, JD Director Quality and Risk
69. Brooks Rehabilitation Hospital One of the busiest rehabilitation providers in the US 157 licensed beds 97% of all admissions come from acute care hospitals Primary goal is to provide medical care along with rehabilitation
70. Where We Are In Our Journey to Leverage Data From the EHR Pressure Ulcers Reports from EHR, but still very labor intensive. Struggle with consistency with CMS reporting and requires manual oversight
71. Where We Are In Our Journey to Leverage Data From the EHR CAUTI’s We’ve got this one! Data driven by CMS requirement
72. Where We Are In Our Journey to Leverage Data From the EHR Readmissions Executive Dashboards
73. Where We Are In Our Journey to Leverage Data From the EHR CLABSI’s Almost 1 year to get “Line Days Report” Really?
74. Where We Are In Our Journey to Leverage Data From the EHR Falls and ADE’s Data from Incident Reports
75. Why Is It Taking So Long? IT Overburdened (new technology, system updates, organizational growth) Hard to get Prioritized Ever-changing Technology Need to be Visionary
76. Clinical Informatics Council Comprised of Nursing staff, IT Manager, System Analyst Meet every 2 weeks Ways to use the EHR to be complaint with regulatory requirements (JC, CMS, etc) Constantly reviewing flow of documentation and opportunities to improve the EHR
77. Next Steps Increase reporting: CLABSI’s, Narcan use in Opioids, VTE’s Look for ways to use technology to lessen the burden on staff

78. Empowering the Frontline: A Hospital’s Perspective

    Wednesday April 16, 2014
79. Empowering the Frontline: A Hospital’s Perspective Monroe County Hospital Broward Health North H. Lee Moffitt Cancer Center
80. Smile for a group photo Break for lunch:We will begin promptly at 2:00 Pm
81. Lunch Break