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Creating an Effective Partnership for HealthCare Quality and Safety


'The American health care delivery system is in need of fundamental change. ... Mattie Stepanek. SC Quality and Safety Partnership- Key Components ... – PowerPoint PPT presentation

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Title: Creating an Effective Partnership for HealthCare Quality and Safety

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
  • Maturation of quality improvement models
  • New developments and adaptation of techniques
    from other industries (ISO9000, Six Sigma, TQM,
  • Hospitals around the country have demonstrated
    these techniques work
  • Improved information technology makes data
    collection and sharing possible
  • Increasing of states w/ public reporting
  • 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
  • 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
  • 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
  • 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
  • IHI- Pursuing Perfection/100K Lives/5M Lives
  • CMS- Evolution through P4P to P4V

SC Quality and Safety Partnership- Historical
  • 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 infectionsIOM 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

Compliance-Driven Quality Management
  • 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
  • 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

Where Do We Go From Here?
  • We cant solve problems by using the same kind
    of thinking we used when we created them
  • -
    Albert Einstein

Changing Course- A Confluence of Important Events
  • 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

SC Quality and Safety Partnership- Guiding
  • IOM Six Aims for Improvement- Patient care that
  • 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
  • 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

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
  • -Teddy Roosevelt

The South Carolina PartnershipforHealthCare
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 Partnership- Key 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 Partnership- Key Goals
  • Encourage hospitals and medical staffs to adopt a
    systemic approach to patient safety and quality
    improvement that is board-directed,
    clinician-led, evidence-based, and data driven.
  • Create an organizational framework that supports
    active learning, knowledge sharing, open
    communication teamwork

SC Quality and Safety Partnership- Key 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 Partnership- Key Components
  • Explicit alignment of member hospitals statewide
  • Actively pursue continuous improvement in quality
    and safety together based on
  • Clearly defined and shared vision, mission, and
  • 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

(No Transcript)
Cultural Capability
  • 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
  • Zero tolerance for disruptive professional

Technical Capability
  • 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
  • ISO 9000
  • Six Sigma
  • Toyota Lean
  • TeamSTEPPS program

South Carolina PartnershipforHealthCare Quality
and Safety
Alone we can do so little, together we can do
so much
- Helen
SC Node- 5M Lives CampaignIntegration of 12
  • 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

SCHA Quality and Safety Partnership Related
  • HIDA training sessions and NHSN reporting system
  • 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
  • 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 gt25 of its time on quality and
  • The board receives a formal quality measurement
  • 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. 200622-9.
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.
  • 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.
  • Patients, their families, and staff at the sharp
    end of error
  • Develop the capability of the board.
  • 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 boards aims to reduce harm,
    including executive team accountability for clear
    quality improvement targets.

Tapping the Boards Full Potential
  • 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
  • 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 Partnership- Key Phase I
  • 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

ISO9001-2000 Quality Management System- Pharmacy
  • 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

ISO9001-2000 Quality Management System- Pharmacy
  • Statewide ISO9000 educational program
  • On-site visits w/ each interested hospital
  • Development of a process plan for ISO-based QM
    system in Pharmacy dept.
  • Active Senior leadership support at cultural and
    technical levels
  • Quality and Pharmacy directors as co-champions 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 System- Guiding
  • The system should be
  • Cost effective
  • Voluntary and non-punitive
  • Non-competitive in nature 
  • The information should be
  • Comparable across similar hospitals for
  • 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
  • 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 lt5
  • 15 fewer deaths per month than in 2005

Will these lines ever converge?
Will these lines ever converge?
It is possible . . . .
Health Status of South Carolina
Quality Safety
Covering the Uninsured
South Carolina PartnershipforHealthCare Quality
and Safety
Alone we can do so little, together we can do
so much
- Helen
  • This is the true joy in life, to be used for a
    purpose you consider a mighty one, to be a force
    of nature, rather than a feverish, selfish clod
    of ailments and grievances complaining that the
    world will not devote itself to making you happy

  • -George Bernard Shaw