htpp culture for change / improvement webinar...carolyn kozik, msn, rn executive director of...

HTPP CULTURE FOR CHANGE / IMPROVEMENT

WEBINAR

October 13, 2016

HOUSEKEEPING ITEMS

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Webcast will be recorded.

2

TODAY’S AGENDA/SPEAKERS

Hospital Success Stories

• Adventist Health – Carolyn Kozik, Executive Director,

Organizational Quality

• Good Samaritan Reginal Medical Center – Teresa

Herrera, Manager, Data Gov. & Analytics Services

• Legacy Health System – Aisha Furbach, VP Quality and

Patient Safety

Q&A and hospital sharing/roundtable discussion

3

ADVENTIST HEALTH - PORTLAND

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Adventist Medical Center

Adventist Health Medical Group

A faith-based, not-for profit, 302-bed acute care medical center and 38 clinics

Creating the Culture for Change

“Power of Teams”• Emphasis on improvement for the patient, not just financial

• Leadership by Executive Director, Organizational Quality

• Champions / teams for each of the 11 measures

• Two executive sponsors: CFO, then CNO (added 1 FTE for

EDIE)

• Rounding every 1-2 weeks when goal was not met

• Visual management of progress via AMC HTPP Dashboard

• Accountability:

» Goals tied to leader evaluation / merit pay

» Dept Head status meetings with “one up”

» Dept Head / President’s Council updates on metrics

» Governing Board updates.

10/13/2016 5 Oregon Association of Hospitals & Health Systems

10/13/2016 6 Oregon Association of Hospitals & Health Systems

10 of 11 benchmarks or improvement targets met

What went well?

Greatest Breakthrough:Preventing Readmissions

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Hospitalists & Case Mgmtcollaboration Discharge Process RPIW:

(Rapid Process Improvement Workout)

Discharge Phone Calls

Post-discharge care mgmt.Transitional callsTransitional visits

Predictive Risk Tool in EMR

Opportunities for Improvement

Leadership changes

Ensure robust orientation to HTPP

Frequent rounding with data outcomes

Focus switched due to bandwidth

Evaluate impact of other priorities (TJC,

restructuring)

Maintain frequent touchpoints

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Remember Power of the

Hardwire the improvement work of Year 2-3

Form new teams for

• Opioid Prescribing

• IT and Nurse Infomatics working on data pull

• NP educating physician team

• Clinic physician education

• EDIE/Frequent ED Utilizer Case Management

• PreManage for clinics for care plan partnering

• ED Care Manager/Social Services in ED (expand?)

– Care Plan Templates & Standard Work

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Plans for HTPP Year 4

Carolyn Kozik, MSN, RNExecutive Director of Organizational Quality

carolyn.kozik@ah.org503-251-6189

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CREATING A CULTURE FOR CHANGE

Good Samaritan Regional Medical Center

October 13, 2016

Teresa Herrera, MBASHS Manager, Data Gov/Analytic Services

therrera@samhealth.org

(541) 768-4596

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Service area map here

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SAMARITAN HEALTH SERVICES

• 342 Beds• Health Plans

• Medicare Advantage• IHN CCO• Commercial• Employee

• 5,300 employees Network-wide• 300 Employed Providers• 90 Primary & Specialty Clinics• GME Program• Regional Cancer Center• Regional Heart Center• Stroke & Bariatric COEs

Creating the Culture for Change

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SAMARITAN HEALTH SERVICES

Performance

Improvement

SHS Leadership

Providers & Operations

Quality Resources

IS/Informatics

(EHR)

Data/Analytics

GOOD SAMARITAN REGIONAL MEDICAL CENTER

What went well:

• HCAHPS: Red Discharge Folders

• Readmissions: Readmissions Taskforce

• SBIRT: Measure Tracking

• Med Safety: Diabetes Education Campaign

• EDIE Notification: PCP Assignment

• Chronic Disease Coordinator

Opportunities for improvement

• EDIE Provider Notification

• Readmissions

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SAMARITAN ALBANY GENERAL HOSPITAL

What went well:

• CAUTI- 2 YEARS!

• CLABSI- 3 YEARS!

• SBIRT

• HCAHPS

• ADE- Opioids

Opportunities for improvement

• EDIE- Provider Notification

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1. Keep the course!

2. Readmissions:

• Palliative Care Program

• Care Management System

• ED Case Managers

3. ED Utilization

• PCP Access

• ED Case Managers

• Opioids Rx Tracking

4. CAUTI

• Reducing Device Days

• Acuity/co-morbidities

5. Population Health Strategy

Underway

• Care Management Focus

• Hospitalization Follow-up

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GOOD SAMARITAN REGIONAL MEDICAL CENTER

Plans for PY4:

Key Takeaways:

• ‘The Patient First, Always’

• Collaboration

• Investment

• The Power of Data

• Keep it Simple!

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GOOD SAMARITAN REGIONAL MEDICAL CENTER

RED DISCHARGE FOLDERS

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(Follow-up Appointment

Card)

SBIRT TRACKING

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CLINICAL DECISION SUPPORT

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Pamela Aronson, RN MBA CPHQ, Director of

Quality Resources, Good Samaritan

• paronson@samhealth.org

• (541) 768-4761

Sheri Johnson, RN MSN, SHS Director of

Accreditation & Performance Improvement

• sjohnson@samhealth.org

• (541) 768-6977

Teresa Herrera, MBA, SHS Manager, Data

Gov/Analytics

• therrera@samhealth.org

• (541) 768-459610/13/2016 21 Oregon Association of Hospitals & Health Systems

GOOD SAMARITAN REGIONAL MEDICAL CENTER

OVERVIEW

Legacy Health’s roots

go back more than 100

years

One of the largest

private-sector

employers in the

Portland metropolitan

area

Legacy Health employs

more than 12,000 full

and part-time

employees10/13/2016 22 Oregon Association of Hospitals & Health Systems

OVERVIEW

Current service area extends north to Vancouver

and south to mid-Willamette Valley

Facilities include…• Legacy Emanuel Medical Center

– Randall Children's Hospital at Legacy Emanuel

• Legacy Good Samaritan Medical Center

• Legacy Meridian Park Medical Center

• Legacy Mount Hood Medical Center

• Legacy Salmon Creek Medical Center (WA)

• Legacy Silverton Medical Center (non-DRG)

…as well as clinics, labs, and other support services

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CREATING THE CULTURE FOR CHANGE

Built on the existing change culture

• Lean methodologies

• Process improvement and quality improvement experts

• Culture of Safety

Teams

• Centralized system-wide program support team

• Site-based resources to provide “at-the-elbow support”

• Bedside subject matter experts to identify, develop, test

and implement changes for improvement

Tools

• Program site for easy access to program materials

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HTPP YEAR 3

What went well

• Top-down commitment to adopting HTPP improvements

• Depth and breadth of program resources (e.g., system-

wide and site-specific)

• Agile response to adoption of new processes (e.g.,

SBIRT)

Opportunities for improvement

• Readmissions and Medication Communication continue

to be challenging

• Continued standardization of processes and tools

• Timely communication of program parameters and data

to inform approach

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PLAN FOR HTPP YEAR 4

Conduct basic evaluation to inform HTPP Year 4

efforts – feedback sought from leadership and

front-line staff

Utilize Quarter 4 of 2016 as planning period to

kick-off improvement work

Strengthen data-driven approach to identifying

improvements

Prioritize opportunities and efforts – not enough

resources or time to focus on every HTPP

measure equally across the system

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SUMMARY OF KEY LEARNINGS

Communicate early and often

Prioritize efforts and resources - “low hanging fruit

may already have been picked”

Team composition is critical

• Appropriate knowledge

• Appropriate authority

“Run the marathon, not the sprint”

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CONTACT INFORMATION:

Aisha B. Furbach

Vice President, Quality and Patient Safety

afurbach@lhs.org

(503)415-5941

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Q&A – ROUNDTABLE DISCUSSION

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CLOSING THOUGHTS

Remember Leadership support is vital

Do not let perfection be the enemy of good

Use what data you have and explain its

limitations

Assure your multidisciplinary team(s) have

input and buy in early

Provide regular status updates to Leaders

Celebrate your success!

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THANK YOU

www.oahhs.org

Barbara Wade, MS, BSN, RN,CPHQ, CPPS

Director Quality Improvement

barbara.wade@apprisehealthinsights.com