BOARD OF DIRECTORS WORKSHOP QUALITY & SAFETY. Thursday, May 3, :00 p.m.

Transcription

1 BOARD OF DIRECTORS WORKSHOP QUALITY & SAFETY Thursday, May 3, :00 p.m. Lee Memorial Health System Board of Directors

2 AGENDA BOARD OF DIRECTORS WORKSHOP: Quality & Safety BOARD OF DIRECTORS OFFICE FAX: DOCTORS WAY #190 FT MYERS, FLORIDA CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER May 3, :00 PM Gulf Coast Medical Center Boardroom (Medical Office Building) Doctors Way, Ft. Myers, FL CALL TO ORDER (Stephen Brown, M.D., Board Chairman) The Board of Lee Memorial Health System, doing business as Lee Health, Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations, including but not limited to Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc. WELCOME AND OPENING COMMENTS (Therese Everly, BS, RRT, Board Secretary) LEE MEMORIAL HOSPITAL GOLISANO CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL 1. QUALITY AND SAFETY PLAYBOOK (Scott Nygaard, MD, MBA, Chief Operating and Medical Officer) 2. BALDRIGE (Scott Nygaard, MD, MBA, Chief Operating and Medical Officer) LEE PHYSICIAN GROUP LEE CONVENIENT CARE BOARD OF DIRECTORS CROSSWALK-STRATEGY, CMS AND TRUVEN (Scott Nygaard, MD, MBA, Chief Operating and Medical Officer) STRATEGIC SCORECARD (Scott Nygaard, MD, MBA, Chief Operating and Medical Officer) DISTRICT ONE Stephen R. Brown, M.D. Therese Everly, BS, RRT DISTRICT TWO Donna Clarke Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen CMS STAR CURRENT AND FUTURE PERFORMANCE (Scott Nygaard, MD, M.B.A., Chief Operating and Medical Officer) (Marilyn Kole, MD, M.B.A., Vice President, Clinical Transformation) (Alex Daneshmand, DO, M.B.A., Vice President Quality and Patient Safety) (Marcelo Zottolo, MS, System Director, Process Analytics) SAFETY UPDATE (Alex Daneshmand, DO, M.B.A., Vice President Quality and Patient Safety) 7. DISCUSSION 8. NEXT STEPS & CLOSING (Therese Everly, BS, RRT, Board Secretary) DISTRICT FIVE Jessica Carter Peer Stephanie Meyer, BSN, RN 9. ADJOURN (Stephen Brown, M.D., Board Chairman) Lee Memorial Health System Board of Directors

3 WELCOME (Therese Everly, BS, RRT, Board Secretary) Lee Memorial Health System Board of Directors

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5 LEE HEALTH BOARD OF DIRECTORS QUALITY WORKSHOP Presented by: Scott Nygaard, MD MBA May 3, 2018 The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

6 Agenda 1. Quality and Safety Playbook 2. Baldrige 3. Crosswalk Strategy, CMS and Truven 4. Strategic Scorecard 5. CMS Star Current and Future Performance 6. Safety Update 2

7 QUALITY AND SAFETY PLAYBOOK Presented by: Scott Nygaard, MD MBA

8 Why We Are Here Our Mission To be a trusted partner, empowering healthier lives through care and compassion Our Vision To inspire hope and be a national leader for the advancement of health and healing Our Values Respect Excellence Compassion Education

9 Our Strategic Priorities

10 Job 1: Improving Care for our Patients We are not working BECAUSE of the scorekeepers (LeapFrog, CMS Star, Truven Top 15 Health Systems, HCAHPS, CG CAHPS,etc): JOB 1 to improve the quality of care, patient experience and value we provide to our patients and community (Professional Promise) The recognition is a result of OPERATIONAL EXCELLENCE External validation is important (True North) Celebrate our accomplishments Many different measurement systems, far in excess of what human being is capable of digesting Choosing what matters most Fewer things done exceptionally well will make a bigger difference to those we serve. 6

11 Rationale for Benchmarking 1. External benchmarks give us direction (Truven Top 15 Health Systems, LeapFrog, CMS Star, etc) 2. Data versus opinion: Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof. John Kenneth Galbraith 7

12 TRUVEN Top 15 Health Systems Value 25 year history dedicated to the development of objective measures of leadership and evidence based management in healthcare Identifies those health system leadership teams that have most effectively aligned outstanding performance across the organization and achieved more reliable outcomes Honorees set the standards for excellence nationally Utilizes a balance scorecard approach including: Care Quality, Patient Safety, Use of Evidence Based Medicine, Patient Perception of Care and Operational Efficiency 8

13 TRUVEN Top 15 Health Systems Value Provides health system boards with critical insights into long term improvement Only objective, public data sources are used for calculating study metrics. Facilitates uniformity of definitions and data Statistical analysis by epidemiologists, statisticians, physicians and former hospital executives 9

14 Key Differences In 2017 Award Winners Saved 66,000 more lives and caused 43,000 fewer patient complications Followed industry recommended standards of care more closely (97.3% versus 95.8%) Released patients from the hospital a half day sooner Readmitted patients less frequently and experienced fewer deaths within 30 days of admission Had nearly 18% shorter wait times in their emergency departments Had over 5% lower Medicare beneficiary cost per 30 day episode of care Scored nearly 7 points higher on patient overall rating of care 79% of winners are health systems in the Top 100 Hospitals 10

15 2018 Winners Large Health Systems (total operating expense of more than $1.75 billion): 1. Mayo Foundation (Rochester, Minnesota) 2. Mercy (Chesterfield, Missouri) 3. Sentara Healthcare (Norfolk, Virginia) 4. St. Luke's Health System (Boise, Idaho) 5. UC Health (Aurora, Colorado) 11

16 Key Differences 2018 Award Winners The key performance metrics that showed the most significant outperformance compared to non winning peer group health systems include: Fewer in hospital deaths (14.6 percent) Fewer complications and infections (17.3 percent and 16.2 percent, respectively) Shorter length of stay (0.4 days shorter) Shorter emergency department wait times (40 minutes shorter per patient) Lower spend (5.6 percent lower costs per episode, which includes combined in hospital and post discharge costs) Higher patient satisfaction, as measured by HCAHPS (2.3 percent higher) 12

17 Quality Program Approach A good plan executed now is better than a perfect plan executed next week. General George S Patton 13

18 Improvement Opportunities The key to success is to employ a disciplined, strategic focus that balances all four quality domains and targets high impact, high value projects that will affect a large portion of an organizations patient populations. John Byrnes, MD 14

19 7 Elements For Quality 1. Measurement 2. Clinical Quality Improvement 3. Patient Medication and Environmental Safety 4. Patient and Staff/Physician Satisfaction 5. Performance Improvement LEAN % Accreditation Readiness 7. Epidemiology and Infection Control 15

20 Measurement Data Governance the organizing framework for establishing strategy, objectives and policies for corporate data. Data Stewardship an ethic that embodies the responsible planning and management of resources. In the realm of data management, data stewards are the keepers of the data throughout the organization. Data Management is the set of functions designed to implement the policies created by data governance. Data Architecture encompasses the conceptual, logical and physical models that define a data environment. Data Quality includes standards and procedures on the quality of data and how it is monitored, cleansed and enriched. Traditional data quality includes standardization, address validation and geocoding, among other efforts. 16

21 Measurement Data Administration includes setting standards, policies and procedures for managing day to day operations within the data architecture, including batch schedules and windows, monitoring procedures, notifications and archival/disposal. Data Security includes policies and procedures to determine the level of access allowed for both source level data and analytics products within the organization. Data Life Cycle data should be managed from the point it enters your organization until it is archived or disposed of when it is no longer useful. 17

22 Clinical Quality Improvement 1. Year 1 Charter 10 QI teams (Clinical Consensus Groups) 2. Years 2 5 Charter an additional 5 teams per year 3. Focus on the following opportunities Reduce complications and mortality Reduce readmissions and LOS Reduce costs Optimize P4P where appropriate Truven Top 15 health systems where linked 18

23 Epidemiology and Infection Control 1. Reduce Hospital Acquired Infections: CAUTI, CLABSI, MRSA, C Diff, VAP and others Surgical Site Infections (SSI) Surveillance Data Base 19

24 Patient and Medication Safety 1. High Reliability Organization Safety Culture Transformation and Serious Safety Events 2. Leapfrog Survey and Grade plus Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) 3. National Quality Forum 4. Institute for Safe Medical Practices (ISMP) 5. National Patient Safety Goals 6. Focus on the medication administration process 20

25 Board of Directors Improving the quality and safety of care in the United States is a public health emergency, and boards have a big responsibility in that regard. David Nash, MD, MBA You have a responsibility to have oversight for the quality of the organization. 21

26 THE BALDRIGE CRITERIA FOR PERFORMANCE EXCELLENCE: PROCESS TO RESULTS The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

27 W. Edwards Deming Statistician who taught statistical process control to leaders in Japan after WWII By improving quality, companies will decrease expenses as well as increase productivity and market share started the era of Total Quality Management If you do not know how to ask the right question, you discover nothing. 23

28 Deming s 14 Points 1. Create a constancy of purpose for improvement 2. Adopt the new philosophy 3. Cease dependence on inspections 4. End the practice of awarding business on price alone 5. Improve constantly and forever 6. Use training on the job 7. Institute training and retraining 24

29 Deming s 14 Points 8. Institute leadership 9. Drive out fear 10. Break down barriers between departments 11. Eliminate slogans and exhortations 12. Eliminate management by objectives 13. Remove barriers to pride of workmanship 14. Take action to accomplish the transformation 25

30 Excellence Leapfrog Healthgroup Top Hospital Truven Health Top 15 Healthy System Governor s Sterling Award (State) Baldrige Performance Excellence (National) Prevention of Harm is Discussed Openly Focus on Early Prevention Patient Experience at 90% of the Nation Financial Reward is an output of the culture 26

31 Malcom Baldrige Improvement Act Of 1987 Mid 1980s, U.S. leaders realized that American companies needed to focus on quality in order to compete in an ever expanding, demanding global market Secretary of Commerce Malcolm Baldrige was an advocate of quality management as a key to U.S. prosperity and sustainability Malcolm Baldrige National Quality Improvement Act of 1987 was to enhance the competitiveness of U.S. businesses Scope expanded to health care and education organizations in

32 What Is Baldrige About? Improving organizational performance using an objective, evaluation Accelerating improvement results Gaining an outside perspective Focusing on results that matter Energizing your workforce Learning from the feedback report 28

33 State Baldrige Programs The Florida Sterling Council is the sole provider of Florida s Governor s Sterling Award (GSA) endorsed by the Governor, the National Baldrige Program, and the State Alliance Organizations that aspire to the Baldrige Award must first become role models through their official state program 29

34 Baldrige Operating Model 30

35 7 Areas of Focus: 1. Leadership 2. Strategic Planning 3. Customer focus 4. Measurement, Analysis and Knowledge 5. Workforce Planning 6. Operations Focus 7. Results A Study by Truven Health analytics links hospitals that adopt and use Baldrige criteria to successful operations, management practices and overall performance 31

36 Baldrige Is a Holistic Management System A flexible systems approach non prescriptive Uses the latest validated management practices Supports many tools ISO (International Organization for Standardization) Lean Balanced Scorecard Strategy Maps 32

37 Baldrige Healthcare Honorees Adventist Health Castle, Kailua Hawaii South Central Foundation, Anchorage, AK 33

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39 Strategic Plan, Star Ratings and Watson Health Crosswalk Watson Health evaluates large, medium and small health systems Results correlate with the Baldrige Award winners¹. 1. New Study Finds that Baldrige Award Recipient Hospitals Significantly Outperform Their Peers, National Institute of Standards and Technology. October 25,

40 FYTD 18 STRATEGIC SCORECARD UPDATE Presented by: Scott Nygaard, MD MBA The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

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42 Exceptional Patient Experience Strategic Priority Key Performance Indicator Desired Direction Meets Goal Exceeds Goal Current Status Tracking Reporting Period RIGHT CULTURE Exceptional Patient Experience Patient Experience (Systemwide rollup of "Overall Rate" top box) Higher is Better 74.1% 76.8% 74.0% Does not Meet FYTD Feb 38

43 Right Care Strategic Priority Key Performance Indicator Desired Direction Meets Goal Exceeds Goal Current Status Tracking Reporting Period RIGHT CARE Patient Impact (National Healthcare Safety Network nursing units, NHSN) Lower is Better Excellent Health Medicare Payor 30-day Readmission Outcomes Lower is 15.5% 14.6% Better Rate (Lee Health facilities only) 16.9% Does not Meet Does not Meet 12 mos ending Jan 2018 FYTD Jan 39

44 Patient Impact by Condition 40

45 Patient Impact by Condition 41

46 Patient Impact by Condition 42

47 Coordinated Care Model Strategic Priority Key Performance Indicator Desired Direction Meets Goal Exceeds Goal Current Status Tracking Reporting Period RIGHT TIME & PLACE Coordinated Care Model Increase the LPG Primary Care Patient Base Covered Lives Higher is Better Higher is Better 10,500 12,600 9,901 85,105 92, ,003 Does not Meet Better than Goal 12 mos ending Feb 2018 As of February 2018* * Next Gen ACO includes initial attribution of 25,311 lives, which may decline 10-15% due to loss of eligibility. 43

48 Right Cost Strategic Priority Key Performance Indicator Desired Direction Meets Goal Exceeds Goal Current Status Tracking Reporting Period RIGHT COST Year over year freestanding outpatient net revenue growth (2017 vs 2018) Strong Financial Results Operating Margin % Higher is Better Higher is Better 10.0% 12.0% 10.1% 4.5% 5.0% 4.1% Meets Goal Does Not Meet FYTD Feb FYTD Feb 44

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51 CMS 5 STAR RATING UPDATE Presented by: Scott Nygaard, MD, M.B.A., Chief Operating Officer Marilyn Kole, MD, M.B.A., Vice President, Clinical Transformation Alex Daneshmand, DO, M.B.A., Vice President Quality and Patient Safety Marcelo Zottolo, MS, System Director, Process Analytics The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

52 Strategic Plan, CMS Star And Truven Watson Health evaluates large, medium and small health systems Results correlate with the Baldrige Award winners¹. 1. New Study Finds that Baldrige Award Recipient Hospitals Significantly Outperform Their Peers, National Institute of Standards and Technology. October 25,

53 Glossary Terms CAUTI Catheter Associated Urinary Tract Infection CLABSI Central Line Associated Blood Stream Infection PE/DVT Pulmonary Embolus/Deep Vein Thrombosis Cdiff Clostridium Difficile SSI COLO Surgical Site Infection after Colorectal Surgery NHSN National Healthcare Safety Network 49

54 BOD CMS 5 Star Dashboard NOTE: These are the goals for each of the HAIs we setup at the beginning of the fiscal year and that the BOD and SEC approved. These are the only set of goals and align with operational goals and KPIs, patient impact and BOD 5 star dashboard. The percentiles vary by HAI because they depend on our performance during FY17. Here is the parallel to stars: 1 star = <20 th percentile 2 stars = 20 th to 40 th percentile 3 stars = 40th to 60 th percentile 4 stars = 60 th to 80 th percentile 5 stars = 80 th percentile or higher

55 CAUTI CMS 5 Star (Truven Top 15) Key Points: FY18 March performing better than the 80 th percentile of the nation. Two consecutive months with no (NHSN) infections system wide Best performance in at least 18 months 77% reduction FY18 Mar compared to FY15 51

56 CAUTI: Plans To Sustain 5 Star Ongoing: Operational timeline for guideline Go live being set Nursing education for Go live preparing for launch Decreasing utilization of devices in Operating Room ongoing Completed: Evidenced based guidelines developed/approved through Medical Staff: Dec Epic Urinary culture order requirements Go live: December 2017 Epic indications revised for insertion/continuation Go live: April 24 th CAUTI prevention algorithm available to all staff: April 9 th 52

57 CLABSI: CMS 5 Star (Truven Top 15) Key Points: FY18 March performing better than the 80 th percentile of the nation. Three (NHSN) infections system wide FYTD 83% reduction FY18 Mar compared to FY15 53

58 CLABSI: Plans To Sustain 5 Star Ongoing: Operational Go live for guidelines Bundle 1: April 30 th Audits to begin post go live Post go live Team calls to initiate 2 weeks post go live Completed: Guidelines completed and Medical staff approved: Dec 2017 Epic indications revised for insertion/continuation Go live: April 24 th Nursing education completed by April 30th 54

59 CLABSI Operational Plan 55

60 CDIFF: CMS 4 Star (Truven Top 15) Key Points: FY18 March performing at 4 stars (between 60 th and 80 th percentile of the nation. Not achieving goal set at 80 th percentile or better 63% reduction FY18 Mar compared to FY15 56

61 CDIFF Plans To Achieve 5 Star Ongoing: Go live for guidelines: June/July 2018 Antibiotic Stewardship Workgroup removing specific medications automatically listed on order sets Hand hygiene workgroup activated to help improve HAC s Completed: Guidelines completed and Medical Staff approved: March 2018 Epic changes to educate providers about PCR testing Epic previous C diff results visible when C diff is ordered Epic hard stop to require 3 indications for any orders Calls to physicians/advanced providers when repeat ordering is identified Decreased Levaquin use through Pharmacy and Antibiotic Stewardship (PCR Polymerase chain reaction) 57

62 MRSA: CMS 3 Star (Truven Top 15) Key Points: FY18 March performing at the national average (3 stars) 5 infections in Q1, 4 infections in Q2 system wide 58

63 MRSA: Plans To Advance To 5 Star Ongoing: Infection Prevention has recommended the following Action Plan: Implement universal chlorhexidine gluconate (CHG) bathing Avoid routine transfers of MRSA infected patients Do blood cultures only when clinically indicated 59

64 SSI COLO: CMS 2 Star (Truven Top 15) Key Points: FY18 March performing at 2 stars 2 infections system wide in February 63% reduction FY18 Mar compared to FY15 60

65 SSI COLO: Plans To Advance Rank Ongoing: 1:1 meeting with surgeons initiated: February 2018 Adding PSI and PE/DVT data to surgeon 1:1 meetings: April 2018 Re designed coding review of cases and corrections in NHSN: April 2018 Anesthesia education for ASA scoring/use of ERAS protocols/ Glycemic control in OR Surgical Site Infection guidelines in process CCG presenting May 29 th to PLC Data transparency PLC task force with IT data governance forming to engage physicians in data transparency to improve outcomes Completed: Guidelines completed for standardization in Surgical Services SMSQC sent SSI information/education to Colorectal surgeons March 2018 Redesigned Infection Prevention SSI determination with IP s/ct/ip Directors/Surgeons review 1:1 meeting with surgeons to review infections: Dr. s Abou Lahoud, Doan, Neale, Ravipati, All LPG surgeons, Kowalsky, Bloomston, Zolfoghary, Manibo PSI Patient safety Indicators PE/DVT Pulmonary embolus/deep vein thrombosis PLC Physician Leadership Council SMSQC System Medical Staff Quality Committee 61

66 CMS PE/DVT: 4 Star (Truven Top 15) Key Points: FY18 February performing at 4 star level (above 60 th percentile) Zero PE/DVTs in February, 11 PE/DVTs system wide 43% reduction from FY15

67 PE/DVT: Plans To Advance To 5 Star Ongoing: PE/DVT workgroup starting April 2018 Pre billing case reviews process redesigned: April 2018 Initiating surgeon review of cases 1:1 Exploring opportunities with new Epic upgrade to 2018 Validation of data from Crimson to 3M required Completed: Chart reviews for cases from December 2017 current: completed Pharmacy engaged in reviews to identify opportunities to trigger surgeons real time Early identification of cases within 1 week of event through Coding versus 45 days

68 Readmissions: CMS 1 Star (Truven Top 15) 64

69 Impact on Fiscal Year 2018 Readmission Rate Projected Impact on FY 2018 Performance If Project Pilots Initiate by May 2018 Projected Impact on FY 2019 If Full System Strategy Deployment by October % 65

70 Readmissions Program Timeline April May June July August September October November December READMISSION RISK SCORE System Wide PHARMACY MED TO BEDS LMH HPMC GCHSWF GCMS CCH PHARMACIST MED RECONCILIATION Partial capacity system wide Full capacity system wide MYCHART TELEMEDICINE VISIT LMH COMPLEX CARE CENTER LMH GCHSWF FOLLOW UP APPOINTMENTS All Moderate and High Risk Medicare Discharges

71 LEE HEALTH SAFETY PROGRAM Presented by: K. Alex Daneshmand, DO, MBA, FAAP Vice President of Quality and Patient Safety Officer The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

72 Safety Journey at Lee Health Current: Where Are We? Future: What Does it Look Like? Action: How Do We Get There? 68

73 Current Perception of Safety 2017 Safety Perception from Agency for Healthcare Research and Quality 69

74 Current Safety Status: Where Are We? 70

75 Current Safety Status: Where Are We? All Harm Can Be Prevented 22% Safety and 22% Mortality 71

76 Current State: Leapfrog Hospital Grades 72

77 Future Safety: What Does It Look Like? In Becoming a Highly Reliable Organization 73

78 Future Safety: What Does It Look Like? Becoming a Highly Reliable Organization 1. Preoccupation with Failure: Regarding small, inconsequential errors as a symptom that something is wrong; finding the event early regardless how small they are 2. Sensitive to Operations: Paying attention to what s happening on the front line 3. Reluctance to Simplify: Encourage diversity in experience, perspective, and opinion 4. Commitment to Resilience: Developing capabilities to detect, contain, and bounce back from events that do occur 5. Deference to Expertise: Pushing decision making down and around to the person with the most related knowledge and expertise 74

79 Future Safety: What Does It Look Like? 1. Preoccupation with Failure: Increasing Good Catches in the System Prevention at the front line In Becoming a Highly Reliable Organization 2. Sensitive to Operations: Early intervention Signals (Sepsis and Patients at risk) Detection of unsafe behaviors 3. Reluctance to Simplify: Listening to learn and prevent Create processes that are easy to do 75

80 Future Safety: What Does It Look Like? In Becoming a Highly Reliable Organization 4. Commitment to Resilience: Create systems that are interconnected and have a check and audit system Bring Alignment to Safety under the same umbrella Patient Safety Environmental Safety Employee Safety Security 5. Deference to Expertise: Use experts in building this system at the ground level Let the ground level build what works best for them and provide them expert support 76

81 Action: How Do We Get There? Predictive System This is how we prevent the next safety event That is how we do business around here Proactive System Safety values is addressed by leadership and drives continuous improvement Calculative System We have systems in place to manage all hazards Reactive System Safety is important and we evaluate every major safety event Pathological System We pay attention as long as we don t get in trouble Modified from Prof. Patrick Hudson, Univ. Leiden 77

82 Action: How Do We Get There? Building trust through transparency Set up accountability for leaders that require closing the loop of communication on safety issues Create an Environment for Ownership to Excel Align our safety goals around excellence in care Make safety personal to all of our employees and patients Partner with patients and their families in keeping them safe Create early detection system Trust and support our front line system in building processes that place redundancy in keeping patient safe Set up the bar higher on our safety expectation and reporting safety events 78

83 Professional safety includes: Industrial hygiene and toxicology Scope Broadening Design of engineering hazard controls, fire protection, ergonomics System and process safety Safety and health program management, accident investigation and analysis Product safety, construction safety, education and training methods Measurement of safety performance, human behavior, environmental safety and health Safety, health and environmental laws, regulations and standards. 79

84 Patient s Safety Story 80

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86 APPENDIX

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88 Discussion Lee Memorial Health System Board of Directors

89 NEXT STEPS & CLOSING (Therese Everly, BS, RRT, Board Secretary) Lee Memorial Health System Board of Directors

90 ADJOURNMENT DATE OF THE NEXT REGULARLY SCHEDULED MEETING PLANNING BOARD, TRAUMA DISTRICT AND FULL BOARD OF DIRECTORS THURSDAY, MAY 17, :00 P.M. Gulf Coast Medical Center- Boardroom Medical Office Building Doctors Way Ft. Myers, FL 33912