4/23/2012

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Category 6Operations Focus

April 16, 2012

William Conway, MDSr. Vice-President & Chief Quality Officer, HFHS

& CMO, Henry Ford Hospital

Panelists

William Conway, MD Sr. VP and CQO, HFHS & CMO, HFH wconway@hfhs.org

Linda Bargamian Project Manager, Management Serviceslbargam1@hfhs.org

Sharon Harpootlian

Bruce Muma, MD

Director, Medical Informaticssharpoo1@hfhs.org

CMO, HF West Bloomfield Hospitalbmuma1@hfhs.org

Lucy Young Director, System Quality Initiatives andHFH Performance Excellencelyoung1@hfhs.org

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Integration Across 9 Business Units

4 acute care hospitals – Henry Ford Hospital staffed by Henry Ford Medical Group– 3 Community hospitals supported by both employed and

private practitioners

Henry Ford Medical Group Henry Ford Physician Network Community Care Services Behavioral Health Services Health Alliance Plan

“The Henry Ford Experience” 7 Pillars of Performance

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Operations Focus

How do you design your work systems?

How do you design, manage, and improve your key organizational work processes?

What are your health care and process effectiveness results?

Work Systems & Key ProcessesWork System & Key Process – Focus on “Each Patient First”

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How do we design & Improve?HFHS Model for Improvement (MFI)

Model for ImprovementUsed broadly in our leadership system . . . .

From designing new worksystems HF West Bloomfield Hospital Patient-Centered Medical Home

To kaizen events . . . To front-line daily improvement

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Model For ImprovementTraining

MFI (PDCA & Change Management)– New Leader Academy– Leader Academy– Advanced Leader Academy– Physician Leader Academy

Lean Training– Henry Ford Production System

(2-day class)– Lean Boot Camp (1-day class)

Change Management– Influencer Model

“Just-in-time” Training for Teams

Designing a New Work SystemPatient-Centered Medical Home

Henry Ford Health SystemPatient-Centered Team CareSM

Advanced Access

Same Day Appointments

Self-CareKiosk / Web

AccessHealth Assessments

Preventive Care Scheduling

E-VisitsRN Visits

Population Management

Preventive Care RemindersCPG Reminders

Shared Medical Appointments

Clinical Practice Guidelines (CPG)

Chronic Disease Management

Protocol Management

Routine Common Illness

Mid-level Provider Visits

Stable Disease Follow-upMinor Urgent CarePreventive Care

Planned VisitsScheduled Physicals

Tests completed prior to appt.

RN Case ManagementComplex Chronic Disease Care

“Ambulatory Intensivist”Poly-pharmacy Management

Palliative CareHome Care for Frail Elderly

Care CoordinationSpecialty Care

1ST Floor

2nd Floor

3rd Floor

4th Floor

Am

bu

lato

ry

Inte

ns

ive

Car

e In

terv

en

tio

ns

Clin

ica

l Pra

ctic

e R

ed

esi

gn

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Pilot Locations

Depression Management

OPD Discharge

Using Multiple PDCA Cycles to Redesign a Work System

Standardize all operations

Chronic Disease Mgt (Autos, HAP, UAW)

Patient Focus Groups

PGIP(BCBSM)

MiPCT(CMS State)

Care InnovationSteering Committee

e-Visits

Designing a New Work SystemPatient-Center Medical Home

Patient-Centered Medical Home Process Change Workplan

Inventing - R&D Piloting Spreading Fully Deployed

Depression – Impact Model in PCTC

PCTC RN Care Management

Gestational Diabetes Diabetes Self Management Educ.

Childhood Obesity PCTC Tel-Assurance Pediatric MH Special Needs Patients

Smoking Intervention Program

Back Pain for BCBSM Diabetes Support Group Facilitation

Depression In Primary Care

Anti-coagulation clinics

Panel Managers Health Engagement Visits

E-Visits Weight Management

OPD Discharge Process DocSite to OptimEyes E-Messaging Wound Care

DocSite Performance Reports

HAP/HEDIS P4P bonus for staff

DocSite use during visit Cardiac Rehab

Quality Bonus Lipid Clinic E-Prescribing

Clinical Program Culture Change Process Redesign

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No Harm

System Priority

StrategicRetreat

6 Aims CMS & IHIInitiatives

Key Work Process: Care DeliveryNo Harm Campaign

Design,Manage, Improve

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Infection

EmployeeOther

Medication Harm

Procedural

Care Delivery

C-Diff

Coded

Complications

Falls

Pressure Ulcers

Back Injury

Sharps

Assaults

Renal Failure

Blue Alert

OB Harm

Hypoglycemia

Sources of

Harm

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.

Anticoagulation

Narcotics

Other

NSQIP

Pneumothorax

BSIs

VAPs

UTIs

Surgical Site Infections

Antibiotic Stewardship

Sepsis

Deep venous thrombosis

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

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Infrastructure to Share Learnings & Deploy Improvement

System Quality Forum

Care InnovationTeam

Other QualityInitiatives

No Harm Steering

Committee

Medication(Pharmacy Council)

Falls & Pressure Ulcers(CNO Council)

Culture Change(Quality Forum)

OB Harm (OB Collaborative)

Procedural Harm (NSQIP SystemCollaborative)

Glucose(CMO Council)

BSI, VAP, SSI,C-Diff, UTI

(Infection ControlCouncil)

SharePoint Site

Sharing metrics;Building accountability

Design, Manage,Improve

It’s About Process

AND

Culture Change

(Change Management)

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Change Management: Creating a Culture of Safety

Leadership– Safety rounds

Training & Awareness– Human Factors– Conflict Management

Simulations

Communications– Departmental Safety

Champions (450+)– Weekly Safety Huddles– Daily event debriefs

Collaboratives– ICU, ER, OR, OB

Huddles

Engage . . .Innovate . . .Reduce Harm

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Engage . . .Innovate . . .Reduce Harm

Culture of Safety Results

76 77

74

6259

34

81 82

7468

65

53

8083

79

7370

58

0

10

20

30

40

50

60

70

80

90

100

Mgt actions show safety is

a priority

We are encouraged to

speak up

I would feel safe as a

patient here

Lots of nurse doctor

teamwork

Clinical disagreements resolved well

Communication breakdown

leading to care delays rare

%

Culture of Safety Question

2006 - 2010 Comparison of Percent Favorable: (4 - Agree and 5 - Strongly Agree)

2006 2008 2010 AHRQ 75th Percentile 2010 AHRQ 90th Percentile 2010

N=15,767 N=15,683 N=16,566 N=10,407 N=10,994 N=10,994

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HFHS Overall No Harm Results

HFHS Combined Harm RateCombined Harm Rate HFHS Hospitals by Hospital

20

30

40

50

60

70

80

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep

-10

Nov

-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep

-11

Nov

-11

Rat

e p

er 1

000

Day

s

HFH Clint on Twshp Warren West Bloomf ield Wyandot t e All All w M/ C and t rauma

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Harm Reduction Segmented by TypeInfection Related Harm Rate HFHS Hospitals

2

3

4

5

6

7

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep

-10

Nov

-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep

-11

Nov

-11

Rat

e p

er 1

000

Day

s

Includes BSI, SSI, VAP, c-diff, UTI(599.0, 996.64)

ALL HFHS HospitalsProcedure Related Harm Rate

5

6

7

8

9

10

11

12

Mar

-08

May

-08

Jul-0

8S

ep-0

8N

ov-0

8Ja

n-09

Mar

-09

May

-09

Jul-0

9S

ep-0

9N

ov-0

9Ja

n-10

Mar

-10

May

-10

Jul-1

0S

ep-1

0N

ov-1

0Ja

n-11

Mar

-11

May

-11

Jul-1

1S

ep-1

1N

ov-1

1

Rat

e p

er 1

000

Day

s

Other Harm Rate HFHS Hospitals

10

12

14

16

18

20

22

24

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep

-10

Nov

-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep

-11

Nov

-11

Rat

e per

100

0 D

ays

Includes Renal Failure, DVT, Blue Alert and Misc codes

Medication Harm Rate HFHS Hospitals

10

15

20

25

30

Feb

-09

Apr

-09

Jun-

09

Aug

-09

Oct

-09

Dec

-09

Feb

-10

Apr

-10

Jun-

10

Aug

-10

Oct

-10

Dec

-10

Feb

-11

Apr

-11

Jun-

11

Aug

-11

Oct

-11

Dec

-11

Rat

e p

er 1

000

Day

s

Obstetrical Harm OB Bundle (In process) OB Result (outcome)

0%

20%

40%

60%

80%

100%

10Q1 10Q2 10Q3 10Q4 11Q1 11Q2 11Q3 11Q4

Compliance w all expected aspects of care during labor Induction

HFH HFWH HFMHHFWBH Total

0%

20%

40%

60%

80%

100%

10Q1 10Q2 10Q3 10Q4 11Q1 11Q2 11Q3 11Q4

Compliance w all expected aspects of care during labor Augmentation

HFH HFWH HFMH

HFWBH Total

0

0.5

1

1.5

2

2.5

3

3.5

Q1

2009

Q2

2009

Q3

2009

Q4

2009

Q1

2010

Q2

2010

Q3

2010

Q4

2010

Q1

2011

Q2

2011

Q3

2011

Q4

2011

HFHS System OB Birth Trauma

AHRQ Est. 90%ile

HFHS

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Quality Pays

Harm reduction produced a $10 million variable cost reduction over 4 years

Over 10 years, malpractice expense was cut by 60%, saving more than $26 million per year

27

Looking Forward Continue to identify key processes, owners and related

performance measures at all Business Units and in all work systems

Develop additional everyday in-process measures and drive accountability at every level

Continue to drive standard work – in clinical, administrative, and management processes

- Better deploy identified best practices across all Business Units and Work Systems

- Leverage our new EMR (EPIC) to drive standard practice

Leverage our annual Quality Expo to identify and spread best practices

- Update and share our annual No Harm Report

http://www.henryford.com/noharm

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Panel Discussion

William Conway, MD Sr. VP and CQO, HFHS & CMO, HFH wconway@hfhs.org

Linda Bargamian Project Manager, Management Serviceslbargam1@hfhs.org

Sharon Harpootlian

Bruce Muma, MD

Director, Medical Informaticssharpoo1@hfhs.org

CMO, HF West Bloomfield Hospitalbmuma1@hfhs.org

Lucy Young Director, System Quality Initiatives andHFH Performance Excellencelyoung1@hfhs.org

A History of Quality Improvement Q101 (first use of industrial improvement tools) 1989

Pursuing Perfection (IHI/RWJ) - Eliminating Suicide Project 2002

CMS demonstration on surgical site infections; tight Glucose Control Project

2003

MHA Keystone ICU Projects 2004

Chronic Care Initiative with HAP and Autos 2004

100K Lives Campaign – Mentor Hospital 2005

E-Prescribe 2006

Sepsis Management 2006

Care Redesign Centers (B6, F4, Medical Home) 2007

5M Lives Campaign – Mentor 2007

No Harm Campaign 2008+

Lean Lab Process Management 2009

Depression Management in Chronic Disease 2010

Patient Guided Care Redesign 2011

Care Coordination (leveraging Readmissions work) 2012

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National Best Practice Safety Innovations

HFHS Process HFHS Outcome Validation

Perfect Depression Care Model Up to 180 lives saved from 2002 to 2011

Codman Award (TJC) 2006 Nat’l Suicide Action Alliance (HHS) 2011

Sepsis Bundle and Deployment In the last 12 months 211 deaths prevented

New England Journal of Med., Kaiser, HCA, others

No Harm Campaign 16,360 fewer harm events over the past three years

AHA Quest for Quality Award 2010 VHA Patient Safety Leadership Award 2009

John M. Eisenberg Patient Safety and Quality Award 2011 (NQF and TJC)

Dialysis Catheter Antibiotic Lock Prevent 80 catheter infections annually Nat’l Kidney Foundation of MI Innovations Award 2011

NSQIP Execution and Deployment

1,000 fewer procedural harm events annually

American College of Surgeons National Initiative Consultants 2009-2011

Pharmacist Directed Anticoagulation Service

Out of Range Test ResultsDecreased by 80%

CMS Partnership for Patients Best Practice2009 ASHP Safety Award