Partnering with You Continuing our Quest for Zero: OB

Transcription

1 Welcome, BETA OB Initiative Partnering with You Continuing our Quest for Zero: OB Tom Wander Chief Executive Officer Sarah Cohen Advanced Practice Strategies Heather Gocke Director, Risk Management & Patient Safety

2 BETA Healthcare Group Founded in 1979 Member owned and controlled Largest writer of hospital malpractice coverage in California Cover over 170 facilities, over 5,000 physicians 50,000 births and over 1.3 million ED visits

3 BETA Philosophy Patient Safety Strategies Improve Outcomes Drives Risk Reduction

4 BETA Invests Dollars Where They Matter Most *2013 Budget $5,000 $1,435 $2,157 $4,000 $3,000 $2,000 $1,000 $- $239 $2,261 $2,145 $221 $1,131 $2,790 $2,916 $3,579 $3,458* $ RM Expenses Rate Credits

5 BETA Claims By Hospital Location Claims Closed Between 7/1/2008 and 6/30/2013 # Claims Total Incurred Average Cost/Claim Claim/Year Cost/Year Emergency Room 776 $69,386,871 $89, $13,877,374 Inpatient 521 $47,865,521 $91, $9,573,104 Surgery 490 $17,356,396 $35, $3,471,279 Outpatient 350 $16,602,360 $47, $3,320,472 Other 144 $6,094,019 $42, $1,218,804 Obstetrics 137 $51,889,743 $378, $10,377,949 SNF 35 $3,183,669 $90,962 7 $636,734 Totals 2,453 $212,378,579 $86, $42,475,716 BETARMA and HealthPro combined Professional liability claims by closed date (7/1/2008 6/30/2013)

6 Why OB? Obstetrics 6% Other 6% SNF 1% Emergency Room 32% Obstetrics 24% SNF 1% Emergency Room 33% Outpatient 14% 6% of all claims Other 3% Outpatient 8% 24% of all dollars Surgery 20% Inpatient 21% Surgery 8% Inpatient 23% BETARMA and HealthPro combined Professional liability claims by closed date (7/1/2008 6/30/2013) Total claim count (ex companion) vs. total gross incurred for the period

7 9006 respondents; 4060 claims 42.3% reported one or more claims Average for all paid claims $510,473; Neurologically impaired infant $982, % electronic fetal monitoring 15.1% shoulder dystocia/brachial plexus injury 11.4% actions of OB/GYN residents ACOG Professional Liability Survey: to

8 Why are we sued? Top 10 Allegations by Severity Frequency Severity Improper Fetal Monitor Strip Interpretation 16 $13,089,915 Induction/Augmentation Issues 4 $11,543,883 Negligent Discharge 1 $10,704,737 C-Section: Delay in Ordering/Performing 14 $ 4,603,891 Intervention (Newborn) 9 $ 3,518,422 Improper Prenatal Care 10 $ 1,895,881 Uterine Rupture 1 $ 889,794 Failure to Diagnose Preeclampsia 5 $ 586,901 Delay in Maternal Intervention 6 $ 531,152 Shoulder Dystocia 17 $ 419,200 7/01/08 6/30/13 Closed Claims Total Gross Incurred (expense & indemnity)

9 Two-Tiered Incentive Program Tier 1 Foundation Common language Clinical knowledge Tier 2 Building Blocks

10 Tier 1: Clinical Knowledge Former Structure Advanced Practice Strategies (APS) (Healthstream) or comparable coursework* Year 1: All medical/nursing staff complete 10 modules EFM, Shoulder Dystocia, Operative Vaginal Delivery and SBAR Cost to facility $ per seat/per year (retail price $340)

11 23 of 36 Hospitals Met Tier 1 19 Hospitals Met Tier 2

12 BETA OB Claim Counts by Occurrence Claims Occurred Between 7/1/2007 and 6/30/ QFZ Number of Claims Year (7/1/YY - 6/30/YY) BETARMA and HealthPro combined Number of professional liability claims by date of occurrence (7/1/2007 6/30/2013)

13 Tier 1: Advanced Practice Strategies -GNOSIS BETA will sponsor full cost of GNOSIS for all BETA members and insureds* Easier accessibility: BETA portal will provide link to GNOSIS platform for end user $2,000 fee may apply if not implemented by March 1, 2014

14 What is GNOSIS? GNOSIS TM is an interactive elearning software that maps out a personalized and prioritized curriculum that is designed to improve performance efficiently. GNOSIS provides the tools to discover clinical proficiencies and areas of opportunity for clinical improvement. 14

15 GNOSIS : 2013 Approach Assessment + A Personal Coach ASSESS PERSONALIZE PRIORITIZE Evaluates knowledge and judgment for a tailored learning experience Identifies areas of strength and for improvement Eliminates the need to complete training in areas of proficiency 15

16 Script Concordance Measures Judgment Clinical scenario Scale for response more than one right answer 16

17 Why is this Important? The Risk is Currently Hidden from View A and C assessed as top and bottom performers; But both rated mid-level B and D assessed nearly identically; But rated significantly differently 17

18 Overview: How GNOSIS Works The PPM measures the areas of highest priority for clinical improvement Knowledge obtained from GNOSIS improves health outcomes Prioritized content generated from the results of the PPM Personalized score report and blind comparison to others at your facility Content Segments Self-directed education and review of the Learning Path segments 18

19 Establish and Educate: The Learning Path Measured from PPM Personalize Prioritize An individualized learning path is created with 3-5 minute content for timestretched clinicians Delivers data at the clinician, hospital, and system-wide levels to enable view of care delivery *PIAA 2011, CRICO 2012, Proprietary APS Customer Data

20 Apply: GNOSIS TM Reporting Knowledge and Judgment scores are separated and a custom Explain my Scores report is generated for each user The Graph shows individual scores and how they relate to others at the same facility (Grey bar is the 25%-75% and the --- line is the median)

21 Moving Forward New Requirement Tier 1 All medical/nursing staff complete APS Personal Proficiency Module (PPM) PPM analytics provides learner with personalized learning path Learner to complete PPM and modules identified in red zones to meet goal for QFZ

22 Submit BETA s Opt In How Do I Proceed? Designate administrator & backup* Include number of staff/providers Attend Implementation Orientation on November 8, 2013 at 1:00 pm Detailed timeline will be discussed Must implement by March 1, 2014 or be subject to a $2,000 fee payable to BETA Healthcare Group

23 Tier 2: Risk Reduction Strategies Culture of Safety Communication Elective Delivery Patient & Family Centered Care Hyperbilirubinemia Second Stage Management Measurement & Transparency Shoulder Dystocia Multidisciplinary Strip review Simulation and/or drills NCC Certified Nurses (RNC) Team Training-TeamSTEPPs Obstetrical Hemorrhage Perinatal Medication Safety Preeclampsia Vacuum Bundle

24 Team Training: TeamSTEPPs New Option

25 Team Training: TeamSTEPPs New Option Unit based readiness assessment Senior leadership support & attestation Develop in-house certified trainers in TeamSTEPPs principles Train all staff practicing in perinatal service area Measurement: Direct observation utilizing CAT s model

26 Measurement & Transparency New Option Participation in performance improvement Study outcomes through use of trigger tool screening Incident report data collated, trended & shared regularly at medical staff committee/staff meetings Unit adopts one-page Risk Scorecard designed to provide feedback A White Board communicates patient safety issues in real time to oncoming staff

27 Provide Staff Feedback on Performance

28 Make Learning Visible

29 Patient & Family Centered Care Readiness assessment Facility has adopted process around patients on improvement teams Emmi Solutions is adopted in OB area Patient satisfaction measure at 90 th percentile

30 Access documents and recordings at

31 Insert pictures of trophies

32 Submit Opt In to: Heather Gocke, B.S., RNC-OB, CPHRM, C-EFM Director Risk Management & Patient Safety

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