CASE STUDY How Finger Lakes Health System Created a Culture of Quality Finger Lakes Health System Geneva, NY
FINGER LAKES HEALTH SYSTEM Geneva, NY VITALS Finger Lakes Health System Location: Geneva, New York Size: 142 beds How Finger Lakes Health System Created a Culture of Quality The shift from a fee-for-service to pay-for-performance model has caused hospitals to rethink what it means to be a quality-focused organization. The normally siloed departments of IT, quality, finance and administration have had to embrace a new culture of collaboration. Finger Lakes Health System in Finger Lakes, NY, set out to refine their focus, through education, collaboration and technology, and create a new culture of quality. The Triple Aim Challenge FLHS had two goals: To embraced the Institute for Healthcare Improvement s Triple Aim 1, and to simplify existing systems and processes. Achieving and sustaining these goals required an organizationwide cultural shift in perspective. One that made accountability for quality care, patient satisfaction, and financial performance a shared responsibility, with a sense of ownership in the hospital s overall success. It s a pretty tall order to have excellent quality and an exceptional patient experience at a low cost, explains Kathleen Reilly, Director of Quality and Performance Improvement at FLHS, and it s getting harder and harder to do that. We understand that culture shift is very complex, admits Reilly. It can t just be one little piece at a time. In essence, the entire health system has become a learning organization. The Solution The underpinning of culture change at FLHS was cross-collaboration up, down and across the org chart, led by a hands-on CEO and a fully committed Board of Directors. Taking a holistic, long-term view, and armed with the administration s commitment to change, Reilly and her staff identified six key areas where collaboration, education and technology would best drive this culture shift, and then created a plan to engage each area. 1 Breaking down silos Type: Health System Facilities: This hospital is comprised of two hospitals, four long term care facilities, three primary care centers, and several specialty and teaching centers in the Geneva, NY area. Reilly s team made a concerted effort to break down silos between departments, starting with quality and finance. Collaboration was initiated between the departments, resulting in ongoing improvement 2
around meaningful use measures. Reilly armed IT with a deeper understanding of the meaningful use requirements, which allowed them to more easily identify appropriate technologies to achieve their goals. Finger Lakes Health brought in Medisolv technology to support the ability for organization-wide access to data and accountability for quality improvement. Executives & BOD Culture & Coding Providers Nursing Quality IT Collaboration 2. Prioritizing programs FLHS had integrated several provider practices into its system to create a tightly knit care continuum for their patients and community. However, executives firmly believed that trying to be all things to all patients would not result in a successful business model. FLHS honed their programs to only those they could deliver with the best possible patient care, and with the most positive impact on their community. 3. Engaging providers Educating and engaging providers in performance improvement and cost containment starts early. Reilly s team created an orientation program that ensures every new provider receives in-person instruction on the organization s performance improvement efforts, including: Clinical Staff Why the program was developed Performance measures Care management Infection prevention Medication adherence Admissions practices Coding practices Current performance improvement projects We explain some of the ways they can help us [achieve the Triple Aim] and we encourage them to use us as a face-to-face resource, said Reilly. Also, we in the Performance Improvement department, attend all of the medical staff meetings. We understand that culture shift is very complex, admits Reilly. It can t just be one little piece at a time. - Kathleen Reilly 3
Kathleen Reilly's team created a dashboard of dashboards to simplify monitoring of key performance measure data. The effort has paid off. Reilly says involving providers on a recent clinical project resulted in invaluable feedback. The goal was to analyze patient flow and discharge to identify improvement opportunities. She credits physician input to the project s ultimate success. 4. Measuring what matters To avoid becoming overwhelmed with data, Reilly and her team began by focusing on monitoring and reducing hospital acquired conditions and readmissions. FLHS uses Medisolv s ENCOR quality management and RAPID predictive analytics technology to aggregate data from all domains into quality and performance dashboards that help identify risks of early readmission and hospital acquired conditions. To further simplify tracking, her team created a dashboard of dashboards that displays each quality indicator they ve chosen to monitor. Clicking on a topic, such as VTE Comparison, brings the user to that indicator s dashboard. Dashboards update in near real-time, providing relevant and actionable data. 5. Focusing on admissions and transitions FLHS has long been focused on reducing readmissions. Using Medisolv technology, the FLHS care management team uses data to predict the likelihood a patient will be readmitted, which then allows them to take preventative measures and deliver more timely care. Additionally, Finger Lakes participated in CMS s pilot Care Transitions program. Care Transition coaches worked onsite with FLHS managers and clinicians on successful discharges for patients likely to be readmitted, including follow-up home visits to determine medication adherence, and continued care through their primary care provider. 6. Benchmarking and analysis Reilly and her team use benchmarking to help them plan future improvement projects. Internal benchmarks help measure the progress of current programs, while external benchmarks are used to help set future goals. 4
Dashboard of e-measures and Abstracted measures displayed together. Abstracted measures are indicated in blue, electronic measures in yellow. The red and green trend arrows indicate the measure performance direction. The comparison dashboards in their ENCOR quality performance software displays abstracted performance measure data with electronic quality measure data, which allows Reilly s team to immediately identify performance gaps. Results In the three years that hospitals have been subject to value-based purchasing incentives, our hospital has performed above the national total performance score. Reilly notes the FLHS investment in Medisolv s quality solutions continues to pay off in receiving full reimbursements each year. We ve gotten all our money back and a little bit more. We have also been successful with not getting any hospital acquired conditions penalty, and we also received no readmissions penalty, and all of those things did not happen without a lot, and I mean a lot, of hard work. Conclusion Medisolv s software was the technology lynchpin that provided clean visibility of the hospital s quality performance. Data validation, integrity and integration help to close knowledge gaps, resulting in more timely, effective responses to sissues affecting patients, reputation and finances. We re fortunate to have a single platform within our health system focused on pay-for-performance measures with data for us to look at that s refreshed every day. says Reilly. Reilly notes that although FLHS is not an ACO, it is moving in that direction. As it does so, it is focused on the types of innovations that make the most difference in patient outcomes and taking advantage of the systems that help drive those innovations. Even so, the health system consistently scores above the national average in overall performance and has never received a penalty associated with hospital-acquired conditions or readmissions. 1 http://www.ihi.org/engage/initiatives/tripleaim/documents/beasleytripleaim_achejan09.pdf 5
The ENCOR Quality Reporting Software Solution has earned the exclusive endorsement of the American Hospital Association. www.medisolv.com info@medisolv.com 844-633-4765 10440 Little Patuxent Parkway Suite 1000 Columbia, MD 21044 Medisolv, Inc., provides a single platform for quality management and reporting for hospitals and their providers. Medisolv solutions are certified for reporting both electronic and abstracted measures to CMS and the Joint Commission, and integrate with the EHR data sources. Learn more about our ENCOR Quality Management & Reporting Solutions by visiting www.medisolv.com. 6