How Data-Driven Safety Culture Changes Can Lower HAC Rates Session #226, February 23, 2017 Holly O Brien & Abby Dexter Children s Hospital of Wisconsin 1
Speaker Introduction Holly O Brien, MSN RN Safety Program Manager Children s Hospital of Wisconsin Abby Dexter, MSPA, BS Director, Business Intelligence and Data Warehousing Children s Hospital of Wisconsin 2
Conflict of Interest Holly O Brien, MSN RN Abby Dexter, MSPA, BS Has no real or apparent conflicts of interest to report. 3
Agenda Who is Children's Hospital of Wisconsin? Explain the decision making process for prioritization of hospital initiatives. Deeper dive into roles and functions that support these initiatives. Delve into the details of a few safety projects to demonstrate how this plays out in real life. 4
Learning Objectives Identify governance principles and team structures that create a sustainable safety culture to support the reduction of hospital-acquired condition (HAC) rates Recognize how well-organized and trained frontline teams, empowered by accessible and actionable data, can reduce the rate of HACs Employ selective safety data to obtain buy-in and create champions among stakeholders from the C-suite to the sharp end Prepare to identify resources and priorities within a large healthcare system to create a successful framework for data-driven HAC reduction 5
An Introduction of How Benefits Were Realized for the Value of Health IT Treatment/Clinical 30% reduction in overall number of hospital acquired conditions 22 fewer patients were harmed 23% reduction in central line infections 74% reduction of pressure injuries 68% reduction in blood clots Savings equaled $1.6 million 6
Children s Hospital of Wisconsin believes it has a responsibility to prevent serious safety events and hospital acquired conditions (HACs). 7 7
Adds ~10% to hospital inpatient costs A $88+ billion a year issue for the nation 8 8
Children s Hospital of Wisconsin (CHW) Strives for Wisconsin children to be the healthiest in the nation. Consists of two hospitals, a surgery center, 26 primary care sites, a health insurance plan and a magnitude of community services for the state. One of the nation's top pediatric facilities ranked nationally in nine pediatric specialties. 9
Background 1. Hospital Acquired Conditions (HACs) are reported to the Centers for Medicare & Medicaid (CMS) for determining reimbursement. Pediatrics is excluded for now but probably not for long 2. The 110+ member Children s Hospitals Solutions for Patient Safety (SPS) Network strives to urgently reduce and eliminate serious harm for the children being cared for in member facilities. 10
The Problem and Opportunity The SPS Network identified 11 serious HACs for hospitals to focus on including: Adverse drug events (ADEs) Catheter-associated urinary tract infection (CAUTI) Central line-associated blood stream infection (CLABSI) Ventilator-associated pneumonia (VAP) Surgical site infections (SSIs) Venous thromboembolism (VTE) Peripheral intravenous infiltration and extravasation (PIVIE) Unplanned extubations While some CHW improvement teams had been in place for years (CLABSI, PI), little progress had been made. 11
The Turning Point 1. On joining the SPS Network in 2012, CHW adopted the SPS mission and goals for patient safety. 2. CHW launched a comprehensive initiative to reduce the incidences of HACs. CHW leaders knew major changes would be needed including creation of the right environment (culture), processes, and technologies to support their renewed efforts across the health system. 12
Results Strong organization wide commitment to reducing HACs. 5000 employees completed error prevention training. $1.6 million savings realized as a result of a 30% reduction in overall number of HACs. The most recent year over year comparison (2015 vs. 2014), reported 22 fewer patients harmed. Elimination of serious harm through reduction in several HACs. 23% reduction in CLABSIs / 74% reduction of PIs / 68% reduction in VTEs. VTE reduction driven through 90+% bundle compliance considered pioneering based on the lack of evidence in administering anticoagulants in small children. 13
The Elements of Our Strategy Clear vision supported through senior leadership commitment. Effective governance structure. Team-based approach. Data and analytics. Education and cultural transformation. 14
Clear Vision Supported through Senior Leadership Healthiest kids in the country Internal Integration Partnerships People Best place to work Destination programs Care closer to home Population health and payment innovation Service Excellent customer experience Quality Best and safest care Information and Performance Excellence Finance Balanced revenue and expenses 15
Effective Governance Structure istrategy Improve the way we work to optimize outcomes for the children and families we serve through the deployment of an electronic health record (EHR), evolution of the hardware/software/tools to support the stability and reliability of the operating environment and investments in business intelligence, enterprise data warehousing (EDW), and knowledge management. Analytics and Performance Intelligence Create infrastructure to further integrate and effectively leverage organizational information to improve decision quality and continuously improve our processes and services. Enterprise Performance Management Align across the pediatric enterprise by providing methods, tools and resources to manage performance for priorities through performance improvement, portfolio/project management, change management, and value recognition. Information Services and Technology Strategy Operations Improvement (EHR) Information Management / Performance Analytics Strategy 16
Team Based Approach Process Improvement Specialist / Safety Measurement identification and planning Process analysis and definition Application of improvement methodologies Project Manager Defining, managing and measuring work Scoping, planning and execution Status reporting and risk management ACE Analyst Data acquisition Data analysis Application design and build 17
Value Analytics Strategy Value Proposition Business event Data captured Intelligence delivered Action taken Action Time Time 18
Analytics Maturity Model We are here Establish a Culture of Data-driven Learning Establish Improvement Priorities Implement Basic EDW 19
Pressure Ulcer Compliance Develop Knowledge Assets More Efficiently Establish Advanced Analytics 1. Filters for easy analysis Establish a Culture of Data-driven Learning 2. Trends bundle compliance Establish Improvement Priorities Implement Basic EDW 3. Tabs for quick access 20
Pressure Ulcer Rate Establish Advanced Analytics Establish a Culture of Data-driven Learning Establish Improvement Priorities Implement Basic EDW 21
CLABSI Rate Establish Advanced Analytics Establish a Culture of Data-driven Learning Establish Improvement Priorities 22
Education and Cultural Transformation Driving organizational adoption of data and analytics Moving to automated, real time reporting. Access to Data Establish Advanced Analytics Education Eight HACs applications Establish a Culture of Data-driven Learning for the front line. Dedicated trainer. Relationship-centered approach one person at a time. Implement Basic EDW On Cultural Change Standardization and Transparency Standardized applications. Not used in a punitive fashion. 23
A Summary of How We Achieved Our Results A clear vision, leadership commitment, an effective governance structure, the availability of good data and analytics, an emphasis on education, standardization, and transparency were all critical to CHW s cultural transformation to improve patient and financial outcomes. Establish a Culture of Data-driven Learning Implement Basic EDW 24
Lessons Learned Strong leadership and a clear vision are essential. A multi-disciplinary, highly collaborative approach and education are required to overcome resistance and increase engagement. Establish a Culture of Data-driven Learning Routine rounds help maintain focus. Implement Basic EDW Timely access to reliable, actionable data facilitates progress. 25
Future Plans In pursuit of zero harm Establish a Culture of Data-driven Learning Implement Basic EDW 1. Continue progress on current HACs and focus on additional HACs. 2. Ongoing education. 3. Safety dashboard of all HACs metrics. 4. Sustainment plan safety coaches. 5. Realize an 80% decrease in the serious safety event (SSE). 26
A Summary of How Benefits Were Realized for the Value of Health IT Savings 1 Central line infection = $55K 1 Pressure Injury = $17K 1 Surgical site infection = $27K As of year end 2015 = $1.6 million saved 27
Questions Holly O Brien, MSN RN Abby Dexter, MSPA, BS hobrien@chw.org adexter@chw.org (414) 266-5703 (414) 337-7573 Safety Program Manager Director, Business Intelligence and Data Warehousing Please complete online session evaluation 28