htpp culture for change / improvement webinar...carolyn kozik, msn, rn executive director of...
TRANSCRIPT
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.
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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
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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
(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
• (541) 768-4761
Sheri Johnson, RN MSN, SHS Director of
Accreditation & Performance Improvement
• (541) 768-6977
Teresa Herrera, MBA, SHS Manager, Data
Gov/Analytics
• (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
(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