C20 These presenters have nothing to disclose Strategies to Address All Types of Harm Jack Jordan, Partnership for Patients, CMMI William Conway, MD Henry Ford Health System Sam Watson, Michigan Hospital Assoc. Keystone Center for Patient Safety Quality Net Baltimore & IHI National Forum Dec 2012 Objectives Share implementation process for a successful large scale harm reduction campaign Identify opportunities for smaller, critical access hospitals and hear perspectives from national leaders on safety improvement efforts 1
The Partnership for Patients Remains Focused On Our Aims 40% Reduction in Preventable Hospital Acquired Conditions 1.8 Million Fewer Injuries 60,000 Lives Saved 20% Reduction in 30-Day Readmissions 1.6 Million Patients Recover Without Readmission 3 Questions to Run on What actions can I take to broaden the ability of my hospital (or HEN) to impact the safety for all vulnerable patients? How can I apply these principles in my work to make the effort more effective? 2
Goals Aim 2010 Baseline Estimate 2013 Target 40% Reduction in Preventable HACs Injuries Prevented Deaths Averted (2011-2013) 20% Reduction in Preventable 30-day Readmissions Patients for Whom 30-day Readmission is Prevented (2011-2013) 145 HACs per 1,000 discharges 14.4 %, based on 32.9M admissions 119 HACs per 1,000 discharges 1.8 million 60,000 11.5%, based on 32.9M admissions 1.6 million 1 [1]Both admissions and readmissions are expected to decline. Because the relative improvements in these two numbers aren t possible to predict, creating a rate from them may produce variable results. 5 3
Partnership Translating for Patients the AIM Goals statement: to Action Four calls to hospitals Reduce harm across the board.it is a call for hospitals to produce reductions in every type of harm. Take a systemic approach. It is a call to transform the organization and its practices to eliminate all the causes of harm. Using every means at our disposal. Make your safety transparent to all.it is a call for hospitals to define themselves by their safety performance; define themselves to their employees, doctors, patients and the community. Make safety personal & compelling. Make every incident of harm a personal patient story that propels the institution to higher levels of performance. Leadership and Moral Imperative Actions and priorities are different for leaders Meta-level work to create environment A principle that compels a person to act Working on reducing harm is fundamentally different than a delivering supply office supplies or painting 40% reduction in harm motivates us in ways just going to work cannot. 4
Leverage Points to Enhance Ability to Work on Harm 12 leverage points on how to improve your organizations ability to rapidly reduce harm Presentation will include strategies and examples from the perspective of an outside organization (HEN), hospital leader and hospital middle manger Leverage Points for Improving Capacity to Reduce Harm 1. Provocation Triggering event to engage your organization 2. Leadership commitments Public, tracked and remembered 3. Regular review of progress Method to keep progress visible and maintain concern 4. Give Everyone a Role Help everyone from top to bottom see a role 5
Leverage Points for Improving Capacity to Reduce Harm 5. Develop recognition economy Find ways to recognize and make improvement visible 6. Create shared narrative Help everyone feel a part of something important 7. Relentlessly seek opportunities remain curious and enable people to constantly try ideas Leverage Points for Improving Capacity to Reduce Harm 8. Make harm transparent Share results broadly, encourage conversations 9. Streamline processes and hardwire change 10.Move work to front lines cascading goals, innovation units, safety champions 11.Infrastructure Recruit talent in improvement, make data available. 6
Leverage Points for Improving Capacity to Reduce Harm 12.Involve Patients at every possible level. a) In controlling their own care b) In design of care process c) In advising on program change d) In governance Questions to Run on What actions can I take to broaden the ability of my hospital (or HEN) to impact the safety for all vulnerable patients? How can I apply these principles in my work to make the effort more effective? 7
Experience Henry Ford Health System (HFHS) Southeast Michigan service area, 4 million population 24,000 employees Four acute med/surg and two behavioral health hospitals Henry Ford Medical Group 32 Medical Centers 1,200 Physicians/Scientists 1,500 Residents and Medical Students Health Alliance Plan Home Care and other Post-Acute Services 8
Harm is unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalization, or that results in death whether or not considered preventable. Medication Harm Hypoglycemia Anticoagulation Narcotics Other Blue Alert OB Harm Procedural Coded Renal Failure Deep venous thrombosis Complications Sharps Assaults Infection Pneumothorax BSIs Back Injury VAPs UTIs Sepsis Surgical Site Infections Falls C-Diff Pressure Ulcers Sources of Harm Other Employee Care Delivery 9
Results through Multiple Efforts 2012 Survey Results 10
Provocation 2007 board retreat identified Safety as the top priority Began quality topic and patient story at every board meeting Patient story spreads to senior leader meetings Leadership Commitment System Quality Forum monitors performance monthly CEO Chairs, System C-Suite Members A safety goal is 1 of 3 in leader bonus Culture of Safety score is a cascaded goal. 11
Leveraging our Core Competencies Put Everyone to Work Efficient Use of Resources Public Relations, Human Resources, Quality and Safety, Performance Improvement partnership Safety Champion network Delegate accountability and build on existing operational systems 23 Infrastructure to Share Learnings and Deploy Improvement SharePoint Site System Quality Forum Design, Manage, Improve Care Innovation Team No Harm Steering Committee Other Quality Initiatives Sharing metrics; Building accountability Culture Change (Quality Forum) Medication (Pharmacy Council) Falls & Pressure Ulcers (CNO Council) BSI, VAP, SSI, C-Diff, UTI (Infection Control Council) OB Harm (OB Collaborative) Procedural Harm (NSQIP System Collaborative) Glucose (CMO Council) 12
Seek Opportunities and Steal Ideas Institute for Healthcare Improvement (IHI) Campaigns Michigan Health & Hospital Association (MHA) Keystone Center ED, ICU, OR, OB Collaboratives American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Michigan Peer Review Organization (MPRO) infection reduction Recognition Annual Quality Exposition Internal Publication Board Caucus Team Awards 13
Process Improvement System Approach Learning Deploy Integration Harm Event Root Cause Analysis Hypothesis PDCA Multiple Small Tests of Change Spread Best practices Monitor Performance Leverage Synergies of Harm Reduction Share Results Broadly & Transparently Support by Business Unit By Nursing Unit Falls with Injury per 1,000 days HFH by Inpatient Unit, YTD September 2012 2011 Trips/Falls Employee Injuries by Business Unit Topic Teams 14
Organizational Performance Review System Level Monthly Review Business Unit Monthly Review By Location and team At all levels: remove barriers, celebrate, take corrective action For Example: System Perinatal Collaborative 15
Good 100% 80% 60% 40% Oxytocin Administration Bundle Compliance Obstetrical Harm 20% 0% 10 Q1 10 Q2 10 Q3 10 Q4 11 Q1 11 Q2 11 Q3 11 Q4 12 Q1 12 Q2 12 Q3 HFH HFWH HFMH HFWBH Total Neonatal Ideal Delivery Index Rule out NICU Sepsis/ Infection NICU stay NICU respiratory problems RDS Birth trauma Maternal Postpartum hemorrhage Maternal infection 3 rd or 4 th degree perineal tear Other obstetrical laceration Transfusion Bladder laceration High vaginal laceration 16
Actions Add OB agenda to No Harm Campaign Appoint System Collaborative Physician and site champions Joined MHA Collaborative Standardized protocols Extensive education including communication and culture Interdisciplinary rounds and debriefs Simulation training Expansion to perfect delivery initiative 17
Visit us at: www.henryford.com/noharm Then select: No Harm Campaign Summary MHA Keystone Center Hospital Engagement Network Contractor All Harm Prevention in Small Rural Hospitals Sam R. Watson Senior Vice President, Patient Safety and Quality Executive Director, MHA Keystone Center 18
MHA Keystone Center Vision: Health care that is free of harm The MHA Keystone Center uses evidence-based best practice in combination with cultural improvement to effect change in patient safety and quality. Cohesive commitment to top performance We can achieve broad scale improvement by working together; Patient Safety and Quality are Not Competitive the tide raises all ships. United voice to practitioners Support for evidence-based care Rigorous measurement Strategies for Small Rural Hospitals Provocation: Josie s Wall Leadership Engagement: Boards on-board Share the Progress Harm board Harm bubbles 19
Strategies for Small Rural Hospitals Recognition: Celebrate Share the Success: Tell your story, we learn from each other as much as from the experts Seek opportunities Local wisdom Strategies for Small Rural Hospitals Make Harm Transparent Open conversation about harm Move work to front lines At ongoing unit meetings the nurse managers reviewed articles related to urinary catheter usage and consequences including infection rates followed by discussion of the articles 40 20
Strategies for Small Rural Hospitals Take multiple opportunities to talk about Harm Safe Tables CAH Build Capacity Invest offer NPSF curriculum 41 21