nationwide children s sheilah harrison september 2011 n.
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Nationwide Children’s Sheilah Harrison September 2011. Quality Improvement in Health Care. Presentation Overview. My Journey Nationwide Children’s Hospital (NCH) Background Quality Goals Quality Improvement Services Heart Center Quality Improvement Coordinator Key Measures

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Quality Improvement in Health Care


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    1. Nationwide Children’s Sheilah Harrison September 2011 Quality Improvement in Health Care

    2. Presentation Overview • My Journey • Nationwide Children’s Hospital (NCH) • Background • Quality Goals • Quality Improvement Services • Heart Center • Quality Improvement Coordinator • Key Measures • Quality Improvement Tools • My Observations on Health Care • Personal Goals to Achieve Success

    3. My Journey • Credentials • B.S. Industrial & System Engineering (BS I.S.E.) • Project Management Professional (PMP) • Industry Exposure • Internship at OSU Medical Center • Supervisor in Retail Warehousing • Supply Chain Engineer in Telecommunications • Medical Device Manufacturing • “Offshoring” Financial Processes • Chemical Supply Chain Project Management • Medicaid Project Management in Government • Health Care Quality Improvement

    4. Nationwide Children’s Hospital • ~1000 Medical Staff • 7200+ Employees • 124 Specialties on Main Campus • 28 Outpatient Care Centers • 18,472 Discharges • 18,873 Surgeries • 914,456 Outpatient Visits

    5. NCH Quality Goals Hospital Acquired Infections • Eliminate Preventable Harm* • Event Reporting System • Non-Punitive Huddles • Preventable Harm Indices • Focus on Numerator Surgical Site Infections Serious Safety Events Medication Errors Pressure Injuries Non-ICU Cardiac Arrests Falls * A condition/event has the potential of being placed upon the Hospital’s Preventable Harm Index (Index”) when the condition/event occurs as the result of a variation from a “best,” and/or “expected” practice.  Such variation of practice does not necessarily equate to a standard of care definition.

    6. NCH Quality Improvement Services (QIS) • Organization consists of: • Service Line Coordinators • Clinical Quality • Decision Support • Accreditation • Patient Satisfaction and Grievances

    7. Quality Improvement Tools

    8. Quality Improvement CoordinatorHeart Center • Monitor and Report on Patient Safety Measures • Manage 10 Blue Chip Goals • Support 40 Others • Facilitate Interventions for Improvements to Patient Care   • Assist Heart Center with migration to standard for measuring quality • Introduce quality tools and terms • Control Charts • Aim statements / Key Driver Diagrams • Baseline data

    9. Key Quality MeasuresThe Heart Center • NCH Quality Strategic Goal“Do Not Harm Me” • Central Line Associated Blood Stream Infections • Adverse Drug Events • Prevention of Pressure Ulcers > Stage II THE HEART CENTER STRATEGIC QUALITY GOALS • Improve Chronic Care of High Risk CHD Infants • Optimizing Nutritional Needs for Patients with Congenital Heart Disease • Reduce Mortality and Morbidity in CHD Patients • Blood Conservation in the OR • Anticoagulation Protocol for Post Stage II Hybrid Patients • Create Seamless Hand-offs • OR to Cardiothoracic ICU • Cardiothoracic ICU to Step-Down Unit • Non-Invasive Cardiology Lab to Inpatient Units

    10. My Observations of Health Care • Organizational charts • Hard to obtain • Have numerous dotted lines • Absence of clinical project management • Accountability is distributed • Physician support is familiar requirement • Comprehensive patient charts but challenges with trend analysis

    11. Personal Goals to Achieve Success • Largest endeavor is to seek trust from staff • Need to create allies that have focus on quality • Need to admit my skill deficiencies • Need not turn away opportunities to help others • Creating strong relationships with physicians • Ensure ideas and tasks have owners • Educate staff with Project Management tools • Address Change Management • Identify areas where data collection can be automated • Model new processes with strawmen

    12. Example Communication Dr. Smith: So, I have some questions about the Anti-Coagulation protocol for post-Comprehensive Stage II patients.  I hardly understand the subject matter, but I want to spur conversation among you, Dr. Jones, and any others, so we can further improve our Aim/Driver Diagram.  I think Dr. Jones talked with you about one or more of these questions, but I haven’t heard the conclusion. Should we specify when it is important to monitor fractionated Xavs unfractionated Xa? Should we add TEG evaluation as a key parameter in this document? What information does the D-Dimer count provide, particularly if we do add TEG evaluations? Thanks! Sheilah Harrison, PMPQuality Improvement Coordinator | Heart Center | Nationwide Children’s HospitalTel: 614-722-3198sheilah.harrison@nationwidechildrens.org

    13. Quality Improvement in Health Care QUESTIONS?