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MHA: Strategic Quality What’s Up Wednesday | Lunch and Learn Your clinical quality, process improvement resource
Jessica Rowden, RN, BSN, MHA
Clinical Quality Improvement Manager
Housekeeping
Please ask questions
Press *1
Type questions in the question box feature of the webinar platform
Please fill out the evaluation
Give feedback
Offer suggestions of what would be beneficial to your organization
Be a featured hospital speaker!
April Lunch Menu Hors d’oeuvres
Refresher: Data/Website/Reports
Main Course Leading change and avoiding drift with PDSA
Hospital spotlight – St. Louis University Hospital
Transparency Update
HEN 2.0 Update
Dessert Upcoming Events
Refresher
HIDI: www.hidianalyticadvantage.com
– MOHEN – if you have not uploaded your data, touchbase with me
– HIDI is able to upload data from other HEN cohorts into Quality Collections for continuation of tracking; touchbase with me
– Analytic Advantage Reports available under the Quality Tab/SQI; touchbase with me if you have questions
SQI Website: http://web.mhanet.com/strategic-quality/
Leading Change and Avoiding Drift Focus on PDSA/PDCA
Making Change Happen
Critical thinking about the current system – flow chart the current system
Benchmarking – reach out to higher performers
Take the patient’s perspective – shed a different light on things that need to change
Using technology – bar code medications or hard stops in EHR
Creative thinking – think outside the box
Using change concepts (listed on the next slide)
Category Change Concept Questions to Ask
1) Eliminate Waste Eliminate things that are not used
Can you think of an activity or resource that doesn’t add value?
2) Improve Work Flow Find and remove bottlenecks
Is there some aspect of your processes where the work doesn’t happen as smoothly as it should?
3) Optimize Inventory Match inventory to predicted demand
Do you have too much or too little of the items you use or provide? Is your work held up because items are poorly organized or not available?
4) Change the Work Take care of basics Changing the work environment itself can make all other process changes more effective. Does the culture resist or embrace new ideas?
5) Producer/Customer Interface
Focus on the outcome What are the needs of the people you serve? Do they understand the value of your services? Do they have ideas for ways you can improve?
6) Manage Time Do tasks in parallel Can you cut down on the time it takes to do anything in the organization – whether it’s waiting times or the time to develop a new idea or project?
7) Focus on Variation Standardization (create a formal process)
What aspects of your systems vary and make your outcomes unpredictable?
8) Focus on Error Proofing Use reminders Can you make it harder for people in your system to make mistakes? For instance, can you make the information necessary to perform a task available in, say, a checklist – rather than in one’s memory?
9) Focus on the Product or Service
Listen to customers Is the service or product you provide a good one? Can it be better?
Observe the cycle in the OHNO CIRCLE
Drift Correction for Design Issues: Management by Improving Process
Pick your organization’s Top 3 Focus Areas
Compare baseline rates to current rates
Flowchart process as designed vs. reality
Go to the GEMBA
Spend some time in the OHNO circle
Model for Improvement & PDSA
“To help people”
Provide health with care
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
Pre-PDSA First Step - AIM
IDENTIFY:
What are we trying to accomplish?
What do we need/want to improve, and why?
Numbers increasing/decreasing
Survey focus
New quality measure
What to measure?
Relevant—really relates to the process
Meaningful—measure whole or part, timing
Available—use information that you can access with reasonable ease
Pre-PDSA Second Step – Measuring and Data
Identify if change in an improvement will maintain the efficient use of resources
Do you have favorable results without using more resources than necessary?
Is use of the resource helping?
Ensure that patients get evidence-based care
Work toward an HRO structure
Reduce variations in treatment
Understand the relationship between interventions and outcomes
Additional Benefits of Measurement
Measuring abstracts concepts such as “good” care
Communicate leadership goals to staff in clear terms that promote improved accountability from staff
Identify problems/evaluate solutions
Establish objective guidelines for delivery of care
Improve ability to comply with quality measures for value-based reimbursement
Pre-PDSA: Third Step – Making a Change
Now What?
What to do with what you measure
What do your initial numbers tell you?
How can you change practice to move the numbers?
How will you know what made the numbers change?
You know your baseline and have a theory….
HERE
THERE
Achieving sustainability requires planning on the front end
Make your process standard work
PDSA
Step 1: Plan Plan the test or observation, including a plan for collecting
data. State the objective of the test.
State the questions you want to answer and make predictions about what will happen and why.
Develop a plan to test the change. (Who? What? When? Where?)
What data will need to be collected?
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PDSA
Step 2: Do Try out the test on a small scale.
Carry out the test.
Document problems and unexpected observations.
Begin analysis of the data.
18
19
Problem Solving
Display Clear
Acknowledge
PDSA
Step 3: Study Set aside time to analyze the data and study the results.
Complete the analysis of the data.
Compare the data to your predictions.
Summarize and reflect on what was learned.
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PDSA
21
Step 4: Act Refine the change, based on what was learned from the test.
Determine what modifications should be made.
Prepare a plan for the next PDSA.
PDSA is an acknowledgment of failure,
but a victory in learning
Tips for testing changes
Have a C-Suite Champion
Stay a cycle ahead
Scale down the scope of tests
Pick willing volunteers
Avoid the need for consensus, buy-in, or political solutions
Don’t reinvent the wheel
Pick easy changes to try
Debrief on the results of every change
Drift
What is drift and why does it happen?
How do you know when you’re drifting?
Situational Awareness
DRIFT
Safety Across the Board
Design Levels for Reliability
Level One Intent, vigilance and hard work
• Common equipment (and other structural standardization)
• Standard orders sheets
• Personal check lists
• Feedback of information on compliance
• Awareness and training
Level Two Design informed by reliability science and research in human factors
• Design Concepts
• Standardization of processes
• Building decision aids and reminders into the system
• Taking advantage of existing habits and patterns
• Making the desired action the default (based on evidence)
• Creating redundancy
• Scheduling using proper operations theory
Level Three Design of integrated systems and high reliability organizations
• Sophisticated design of human interactions and working relationships
• Weick’s Attributes
• Preoccupation with failure (Prevent)
• Sensitivity to operations (Prevent)
• Reluctance to simplify interpretations (Identify)
• Deference to expertise (Identify/Mitigate)
• Commitment to resilience (Mitigate)
People Support Systems
Engage staff at all levels
Leadership support is crucial
Middle management support is the most crucial
Map out how the process improves efficiency, safety, benefits to patients and/or staff
Self Reinforcing
Publicize successes to promote pride in accomplishment
Spend purposeful time with staff – leaders at every level
Recognize early adopters at both the individual and team level. Promote the spread of adoption by sharing stories of success
Wall of fame
Award ceremonies
Learn from successes and failures. Don’t be afraid to be wrong
Once standard work has been established create and communicate ground rules to speak up when challenges are encountered
Assign high value to those who report errors/near misses
Hospital Spotlight St. Louis University Hospital
Reduction of Central Line
Infections
St. Louis University Hospital
• 72% decrease in central line infections from 2013 to 2014
• 69% decrease in central line infections from 2013 to 2014
CVC Review Process
• Daily review of all lines
• CVC Insertion Checklist
• Nurse managers complete a defect tool for all CVC infections
Other Tools and Resources
• CHG Bath Documentation
• CHG Bedrail Wipe down
• Identification of patients who tamper with lines
• CUSP Teams
• Increased use of mid line catheters
Physician/Resident Interventions
• CVC Physician Advisory Group
• Physician “Best Practice Alert (BPA)”
• Physician/Resident Certification • Blue Certification
• Gold Certification
Transparency Initiative Update
Transparency Launch
On Tuesday, February 17th MHA launched phase one of the price and quality transparency initiative
Objective
To support Missouri’s hospitals in continuing to provide safe, timely, effective, efficient and patient-centered care by sharing best practices
Where is the Data Stored?
The state aggregate price and quality data will be posted on MHA’s website, Focus on Hospitals.
2015 Missouri Quality Outcome Measures
Which Measures Are Included?
Twenty-one claims-based measures have been selected to highlight Missouri’s health care quality strategy
New measures with data uploads coming soon:
◊ SSI – Colon ◊ SSI – Abd Hyster ◊ Post Op Sepsis Rate ◊ C Diff
◊ MRSA ◊ Readmissions – COPD ◊ Readmissions –
Hip/Knee Replacement
How Can I Validate?
Concurrent to the release of state-aggregate data, hospitals will be able to access their hospital-specific quality data via HIDI Analytic Advantage® for internal review
Resources
MHA has developed a tutorial to assist quality staff with accessing and understanding their quality data
Transparency Timeline
Summer 2015- Data Use Agreements with non-marketing clause dissemination
January 2016- Hospital-Specific Dashboard release (for hospitals who sign DUA)
Upcoming Education
Missouri Quality Transparency Update
Tuesday, April 7. Noon-1 p.m.
Register here
Missouri Quality Measure Coding
Tuesday, April 21. 10-11 a.m.
Register here
Questions?
Dana Downing
Vice President of Quality Program Development
573\893-3700, ext. 1314
ddowning@mhanet.com
HEN 2.0 Update
HEN 2.0 Overview
We are adding a HEN 2.0 tab to our website:
http://web.mhanet.com/strategic-quality/
We will keep an weekly updated document of HEN happenings
For formal announcements, we will send an email to those organizations in our network as well as update our HEN 2.0 tab
Optional/additional topics
Severe Sepsis and Septic Shock
Hospital Culture of Safety that fully integrates patient safety with worker safety
Iatrogenic Delirium
C. diff including antibiotic stewardship
Undue Exposure to Radiation
Airway Safety
Failure to Rescue
HEN 2.0 Overview
10 core topics (all applicable topics are required)
Adverse Drug Events
CAUTI
CLABSI
Injuries from falls and immobility
OB adverse events
Pressure Ulcers
SSI
VTE
VAE
Readmissions
HEN 2.0 Hospital Expectations to Ensure Success
Once the project is awarded and begins, have your CEO sign a commitment that they will work on the aims of the PfP, especially CAUTI and readmissions
Have your QI HEN lead co-sign the commitment
Ensure your success in HEN 2.0
Participate in webinars and in-person meetings and utilize the tools and resources available to them to drive improvement in all target areas
Form a HEN team
HEN 2.0 Timeline
March 23
• MO submit final preliminary budget to HRET
March 28
• HRET submit RFP to CMS
Summer 2015
• CMS to award grant
• Formal letters of commitment will be sent to MO hospital CEOs
August 1
• Projected start date of HEN 2.0
Questions? Press *1 or type them in the question box
PDSA?
Drift?
St. Louis University Hospital CLABSI success story?
Transparency?
HEN 2.0?
7 Things to Start Next Week: Action Items
Sign up for the regional meeting in your area and for the Q101
Open invite to all applicable positions in your organization
Spend some time in the OHNO circle
Start the PDCA cycle on a change project
Make sure you are working on important issues – what matters to patients and families
Make staff leaders of system design and process improvement
Assess your organization, are you ready to become a HRO?
Review your organization’s transparency data
Discuss your organization’s HEN commitment with your CEO and leadership team
Join LinkedIn
Network with me, Jessica Rowden (and follow me on twitter @Jessica_Rowden)
We are building a MHA SQI group as another networking platform!
Upcoming Events, April & May
MHA Spring Regional Quality Workshop – Readmissions and Care Coordination: Aim Towards Outcomes
April 14 - Marriott West, 660 Maryville Centre Dr, St. Louis (Register)
April 15 - Drury Lodge, 104 Vantage Dr, Cape Girardeau (Register)
April 17 - Comfort Inn, 1821 N. Missouri, Macon (Register)
April 22 - Hilton Garden Inn, 19677 East Jackson Dr, Independence (Register)
April 24 - Hilton Garden Inn, 4155 South Nature Center Way, Springfield (Register)
May 20, 21 – Quality 101 Conference, Hilton Garden Inn, Columbia (Register)
Visit our website for additional events and links
OB Harm Regional Meetings, May & June
May 4 – SSM St. Clare, 1015 Bowles Avenue, Fenton, MO (Register)
May 6 – Southeast Hospital, 1701 Lacey Street, Cape Girardeau, MO (Register)
May 7 – CoxHealth 3801 S National, Springfield, MO (Register)
May 27 – Women’s and Children’s Hospitals, 404 Keene Street, Columbia, MO (Register)
June 2 – Saint Luke’s Hospitals of Kansas City, 4401 Wornall Road, Kansas City, MO (Register)
All meetings held from 10:00 a.m. to 3:00 p.m.
Visit our website for additional events and links
MHA:SQI - http://web.mhanet.com/strategic-quality/
Leslie Porth, PhD-C, MPH, R.N.
Division Vice President for Strategic Quality Improvement
Triple Aim
Population Health
Oversight of division (Quality Improvement, Quality Works,
Emergency Preparedness)
MONL
Alison Williams, R.N., BSN, MBA-HCM
Vice President of Clinical Quality Improvement
Dana Downing, B.S., MBA-H, CPHQ
Director of Quality Program Development
Patient and family engagement
National quality measures
Quality outcome transparency
Electronic clinical quality measures
MBQIP grant lead
MOAHQ
Jessica Rowden, R.N., BSN, MHA
Clinical Quality Improvement Manager
Clinical quality SME
Data management and analytics
HEN/AHRQ grant projects
TeamSTEPPS
Host of WUW|LNL
MOAHQ
MONL
Cheryl Eads
Executive Assistant of Quality Improvement
Provides support to the SQI team
Coordinates webinars, conference calls and meetings
Distributes correspondence and communication
Assists in maintaining reports
Lporth@mhanet.com 573/893-3700x1305
Awilliams@mhanet.com 573/893-3700x1326
Ddowning@mhanet.com 573/893-3700x1314
Jrowden@mhanet.com 573/893-3700x1391
Ceads@mhanet.com 573/893-3700x1382
Clinical quality SME
Oversight of Quality Improvement
Grant management
Collaboratives management
MONL
MOAHQ
Thank you for joining us
Please fill out the evaluation
Give feedback
Debrief: tell us what went well and what didn’t
Offer suggestions to help us improve
What topics would be beneficial to your organization
Be a featured hospital speaker!
See you next month, May 6 @ noon
On the menu: HRO principles and hear from a hospital’s journey to create a goal of zero harm for their organization
Resources are tight…what can we do
Visit Missouri Health Matters
Take action and be heard
Support Medicaid expansion
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