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December 1, 2016

Steve Reinhart, MBA

Director, Clinical Quality | HRET

THE POWER OF HIINOVATION

PROJECT BACKGROUND, SCOPE, & GOALS

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This activity is jointly-provided by SynAptiv and the Colorado Hospital Association

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CONFLICT OF INTEREST DISCLOSURE STATEMENT

I have no financial interest or other relationships with the industry relative to the topics being discussed.

• Overview of HIIN

–HEN 1.0 and HEN 2.0

–HIIN: where we are going & why it is different

• Assistance you get as a HIIN hospital

–Education

– Site visits and technical assistance

– Fellowship

–CDS reports

AGENDA

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Hospital type:

• General medical/surgical?

• Teaching?

• Rural/CAH?

HOW MANY OF YOU ARE JOINING US FROM…

Hospital size:

• CAH?

• Not CAH, <100 beds?

• Not CAH, 100-299 beds?

• Not CAH, 300+ beds?

HOW MANY OF YOU ARE JOINING US FROM…

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WHAT BEST DESCRIBES YOUR EXPOSURE TO HIIN/QI WORK?

A. We are familiar with HEN/HEN 2.0 and are a high reliability organization.

B. We are familiar with HEN/HEN 2.0 and are looking to take our hospital to the next level and free education, free resources and free assistance sounded like a good idea.

C. We are not familiar with HEN/HEN 2.0 and would like to learn more.

D. We are here because someone told us we needed to attend.

PARTNERSHIP FOR PATIENTS

The 40/20 goal set December 2011:

Keep patients from getting injured or sicker.• Reduce preventable hospital-acquired conditions by 40 percent.

–1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years.

Help patients heal without complication.• Reduce all hospital readmissions by 20 percent.

–1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

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Substantial progress thru 2014, compared to 2010 Baseline:

• 17 percent reduction in overall harm; 39 percent reduction in preventable harm.

• 87,000 lives saved.

• $19.8B in cost savings from harm avoided.

• 2.1M fewer harms over four years.

NATIONAL RESULTS ON PATIENT SAFETY

Source: Agency for Healthcare Research & Quality. “Saving Lives and Saving Money: Hospital-Acquired Conditions Update. Interim Data From National Efforts To Make Care Safer, 2010-2014.” December 1, 2015.

AHA/HRET ORIGINAL HEN RESULTS

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AHA/HRET HEN 2.0 RESULTS

HEN 2.0 HOSPITAL CHARACTERISTICS

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HEN 2.0 RESOURCES

HEN 2.0 RESULTS – COLORADO

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Topic

CO Hospital Results(Data submitted as of 9/1/2016) AHA/HRET

Baselinesubmission

Baseline rate

Mar – May rate

Relative reduction

Relative reduction

Catheter-Associated Urinary Tract Infection (CAUTI) 26 (100%) 0.87 0.75 -14.3% -4.1%

Central Line-Associated Blood Stream Infection (CLABSI) 26 (100%) 0.30 0.42 39.4% -11.2%

Early Elective Deliveries (EED) 17 (100%) 2.08 0.68 -67.5% -44.2%

Obstetrical Harm (OB Harm) 16 (94%) 19.54 10.08 -48.4% -49.2%

Falls 25 (96%) 0.51 0.58 14.0% -5.2%

Pressure Ulcers (PrU) 26 (100%) 0.80 1.22 52.9% -43.0%

Surgical Site Infections (SSI) 19 (100%) 1.48 1.54 3.8% -21.2%

Ventilator-Associated Events (VAE) 12 (100%) 0.41 0.24 -42.0% 13.8%

Venous Thromboembolism (VTE) 19 (100%) 5.93 8.29 39.7% -34.0%

Adverse Drug Events (ADE) 26 (100%) 1.44 1.26 -12.4% -11.7%

Readmissions 26 (100%) 5.33 5.21 -2.3% -4.0%

1 Relative reduction calculated by comparing baseline to quarterly rate Mar– May 2016

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Hospital leadership

Clinicians and front line staff (teams)

THE PATIENT

• Public-private partnership• Set 20/12 goal all cause harm

• Tool: HIIN• 16 contracts awarded

• Contracted with 32 state and regional hospital associations

• 1,700 + hospitals

• Ctr for Clinical Standards and Quality

• HIIN funded out of Medicare Trust Fund

HIIN: HOSPITAL IMPROVEMENT INNOVATION NETWORK

1. Improvement collaborative

2. Best-practice incubator (SNAP*)

3. Community of peers

4. Spread and sustainability

5. Learning cohort

– Quality improvement (QI)

– Clinical content

6. Similar to the original HEN project (2011-2014) and HEN 2.0 (2015-2016), regarding focus and bold aims.

7. Different regarding topic adjustments, standardized measures and accelerated timeframes.

HIINS: WHAT ARE THEY?

HOSPITAL IMPROVEMENT INNOVATION NETWORK

They are NOT a “Quality Dept. Project”

*Safety Network to Accelerate Performance

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HIIN: WHERE WE ARE GOING

• 20 percent Overall reduction in hospital-acquired conditions (baseline 2014)

• 12 percent Reduction in 30-day readmissions (baseline 2014)

“America’s hospitals embrace the ambitious new goals CMS has proposed,” said Rick Pollack, president and CEO of the American Hospital Association (AHA). “The vast majority of the nation’s 5,000 hospitals were involved in the successful pursuit of the initial Partnership for Patients aims. Our goal is to get to zero incidents. AHA and our members intend to keep an unrelenting focus on providing better, safer care to our patients -- working in close partnership with the federal government and with each other.”

Goals:

partnershipforpatients.cms.gov

2010 145 Harms/1,000 Discharges

2011 142 Harms/1,000 Discharges

2013 132 Harms/1,000 Discharges

2013 121 Harms/1,000 Discharges

2104 121 Harms/1,000 Discharges

New Goal

201997 Harms/1,000 Discharges

Two base years to reduce all-cause inpatient harm by 20 percent and readmissions by 12 percent.

1. Be in action to support your patients and their families by committing to this project.

2. Work to reduce harm across the board.

3. Learn together by sharing your hospital stories – successes and opportunities.

4. Data is the foundation of all improvement at the unit level, hospital level, state and national level.

5. Accelerate, align and amplify the work of the previous HEN projects.

BOLD AIMS FOR HIIN

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1. Alabama

2. Arizona

3. Arkansas

4. Colorado

5. Connecticut

6. Dallas Fort-Worth

7. Delaware

8. Florida

9. Georgia

10.Idaho

11.Indiana

12.Kansas

13.Kentucky

14.Louisiana

15.Maine

16.Maryland

17.Massachusetts

18.Mississippi

19.Missouri

20.Montana

21.Nebraska

22.New Hampshire

23.New Mexico

24.North Dakota

25.Oklahoma

26.Rhode Island

27.Tennessee

28.Texas

29.Virginia

30.West Virginia

31.Wyoming

HRET HIIN STATE PARTNERS

• Framing all HIIN work as a single, cross-cutting improvement initiative rather than series of discrete efforts

–Group a few interventions together (leadership, current/accurate data, physician engagement, culture of safety, PFE)

• Emphasize “doing” within the hospital rather than “attending” as the route to substantive progress

– Look at the improvement occurring within the organization

• Stressing rapid progress vs chance

– Focus on rapid change linked to process improvement

HRET’S APPROACH

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Organizational Engagement

– Leadership engagement

• Leverage HIT resources to promote improvement

• Making the financial case

• Monitoring and promoting improvement

– Physician Engagement

• Training and coaching to project leaders regarding how to effectively engage physicians

• Training and coaching for physicians on how they can champion improvement efforts

– Patient / Family Insights

• Provide guidance and coaching on how to leverage PFE insights to reduce harm

• Focused guidance on how PFE can directly contribute to avoid infections, prevent falls

HRET’S EMPHASES

Hands on Improvement Support

– Site Visits

• Well-planned and executed site visits

• Foster leadership support

• Facilitate physician engagement

• Provide a forum to receive practical advice on topics

– Coaching calls

• Focus on implementation challenges

• Allow hospitals to ask questions, get advice and encouragement

• Obtain improvement insights

– Panels

• Clinical and implementation experts

• Hospital staff

• Peer level sharing

HRET’S EMPHASES

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• Data System

– Simple, straight forward, user-friendly, non-duplicative

• Education and resources development

–Best practice dissemination

–Active engagement by participants

– Implementation challenges addressed

• Virtual support, tools and resources

–Easily accessible, relevant

–Website and LISTSERV®

• SMEs, IAs, Physician Advisors

• Site visits

HRET’S TACTICS

THE HRET HIIN STRUCTURE

Patients

and families

Hospital teams (YOU!)

SHA (Colorado Hospital Association) and QIN-QIO (Telligen) teams

HRET HIIN team

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CORE TOPICS – AIM IS 20 PERCENT REDUCTION

1. Adverse drug events (ADE)

2. Catheter-associated urinary tract infections (CAUTI)

3. C. difficile infections (C. diff)

4. Central line-associated blood stream infections (CLABSI)

5. Injuries from falls and immobility

6. Pressure ulcers (PrU)

7. Sepsis

8. Surgical site infections (SSI)

9. Venous thromboembolisms (VTE)

10. Ventilator-associated events (VAE)

11. Readmissions (12 percent reduction)

Note: patient and family engagement (PFE) and health care disparities (HCD) woven throughout all topics.

ALL OTHER FORMS OF HARM

1. Multi-drug resistant organisms (e.g. MRSA)*

2. Hospital patient safety culture*

3. Diagnostic error**

4. Airway safety**

5. Iatrogenic delirium**

6. Undue exposure to radiation**

7. Malnutrition in the inpatient setting**

*HRET will have a strong focus on MRSA and hospital patient safety culture throughout the project.

**HRET HIIN will provide support on the topics and encourages you to work on them, but Colorado is not requiring these.

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• Customized by hospitals’ needs:

– High-level and targeted.

– Didactic and interactive.

– Full-hour and condensed virtual events.

– Highly technical and practical implementation vs theory.

• Cross-cutting:

– UP

– PFE

– Disparities

• Topics will be prioritized based on our direction from CMS, you and your

project data (including a needs assessment).

• Data webinars

– Will cover how you can use project data and analytics to inform quality

improvement.

EDUCATIONAL OPPORTUNITIES

Creating Systems to Prevent Falls: Coming Together to Get Up!December 1 |11:00–11:50am MT

It is time to start teaming if we want to move the needle on falls. Nurses can’t do this alone. Hospitals have seen an unintentional shift towards restricting independent mobility to prevent falls when there is not a structured mobility program, resources and teamwork to mobilize patients safely and regularly. In this kick off Falls Learning Event for HIIN, we will look at safe mobility from the nurses’ perspective and build a case for increasing the influence of Physical Therapists on interdisciplinary teams to make it a reality. Please come prepared to react to the different perspectives being shared and bring your organization or unit’s needs, experiences, solutions and aspirations to share.

Audience: Executive Leadership, Interdisciplinary Falls Teams, Front Line Nurses, Front Line Physical Therapists, Nursing Leaders, Physical Therapy Leaders, Physicians, Physician Leadership, Patient Family Advisors.

Download the agenda and register today.

JOIN OUR UPCOMING VIRTUAL EVENTS!

http://www.hret-hiin.org/events/index.shtml

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JOIN OUR UPCOMING VIRTUAL EVENTS!

http://www.hret-hiin.org/events/index.shtml

HRET HIIN CAUTI Virtual EventDecember 6 | 10:00–10:50am MT

The technical changes needed to reduce catheter-associated urinary tract infections (CAUTI) are well documented. Over the past five years, evidence has mounted to support reducing the number of indwelling catheters placed, ensuring reliable aseptic placement, conducting daily review of catheter necessity according to indications, and removing catheters in a timely manner. Why then, are hospitals still struggling to reduce hospital-acquired CAUTI? In this initial HIIN CAUTI event, we will pose and discuss the “wicked questions” that address the complex adaptive issues that contribute to the current state, as well as hear strategies to address barriers to cultural and behavioral changes. Please come prepared for a lively discussion and to ask some “wicked questions” of your own!

Audience: Executive Leaders, Nursing Leaders, Front Line Nurses, Physicians, Infection Preventionists, Infectious Disease Physicians, Hospital Epidemiologists, Quality Directors, Patient Family Advisors, Nursing Assistive Personnel

Register today!

JOIN OUR UPCOMING VIRTUAL EVENTS!

http://www.hret-hiin.org/events/index.shtml

HRET HIIN Quality Improvement & Patient Family Engagement Fellowships Informational SessionDecember 8 |10:00 – 11:00 pm MT

Are you passionate about improving patient care but not sure how to go about it? Do you have a desire to increase patients’ autonomy and involvement in their own care? Please join HRET, Tanya Lord and IHI to learn more about the amazing opportunities to be a fellow with a quality improvement (QI) or patient and family engagement (PFE) focus! This event is held specially for HRET HIIN hospital staff members and quality workers who are interested in learning more and participating in the HIIN QI and/or PFE fellowships.

Download the agenda and register today.

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LISTSERV® COLLABORATION

• Subscriber-based email group.

• Each email group covers a different topic or group of topics.

• Ideal for:

• Peer-shared learning.

• Asking questions about barriers.

• Sharing data collection opportunities.

• Clarifications about measures or inclusion/exclusion criteria.

HIIN WEBSITE…IN DEVELOPMENT

www.hret-hiin.org

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FOR NOW, HEN 2.0 SITE IS A GREAT REFERENCE

Resources:• Click on

resources• Sort by topic

www.hret-hen.org

• QI: Foundations for Change Fellowship

– For new HIIN participants or those new to quality improvement.

• QI: Accelerating Improvement Fellowship

– For QI-trained HIIN participants or those who have been focused on quality improvement and patient safety for more than five years.

• PFE Fellowship

– For hospital staff and patient/family advisors seeking to support PFE at their institution and guide patient and family advisors on how to support QI and patient safety efforts.

Details for each include:

• Integrated learning across topics, QI and PFE fellowships.

• Deliverables throughout the fellowship to drive pace.

• Focus on peer-to-peer learning.

• Projects will highlight individual hospital progress toward HIIN project goals.

• Supported by virtual and on-site collaboration.

FELLOWSHIPS: QI AND PATIENT & FAMILY ENGAGEMENT (PFE)

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• Alarm fatigue

• Patient satisfaction

• Closing the referral loop

• Catheter reduction

• Rounding

• Adverse drug events

• Falls

EXAMPLES OF QI FELLOWSHIP PROJECTS FROM HEN 2.0

• Colorado Hospital Association will contact you to set up a mutually agreeable date and time for them to visit and review the project, data and your organization’s goals.

• During site visits:

–You will complete an action plan with your state partner.

• What to expect:

–Focused attention, support and guidance.

–Site visits are meant to set you up for success in HIIN.

SITE VISITS

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3 CO hospitals have taken the #123forEquity pledge

HEALTH CARE DISPARITIES

http://www.equityofcare.org/pledge/index.shtml

• Simple, straightforward and explainable!

• Capitalize on existing data where possible.

• Use standardized measures.

• Be responsive to unique needs.

• We have done this for 4+ years – the team has the experience and understanding to help support your hospital in gathering data.

MEASUREMENT PHILOSOPHY

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Reports available in the Comprehensive Data System (CDS)

CDS

Additional reports in CDS:

• All measures

• Custom data

• Current improvement

• Relative improvement

• Ad-hoc reports

CDS interpretation guide is available here.

CDS

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WHY DO THIS WORK?

41

10/5/10 – had lunch together

10/7/10 – stroke 10:30a

Rooms 903 > 1510 > 915

11/22/10 – died

11/23/10 – job offer

in Perf Improvement

Images from “Buddy Portugal: 47 Days – a Documentary” by Emily Portugal

WRAP UP

Thank you for joining us on this journey to improve care!

We ask that you:

• Strive for continuous improvement.

• Learn from and collaborate with your peers to achieve the goals.

• Embrace change.

–Change is hard at first, messy in the middle and beautiful at the end.

• Remember, this is NOT a Quality Department Project

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QUESTIONS?

Thank you – we look forward to supporting you on your HIIN journey