Thomas Kelley, MD Chief of Quality and Transformation Orlando
Health Leading the Way to Better Care: Floridas Quality
Journey
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Session Overview Describe how Floridas hospitals worked
together to significantly improve care while reducing costs across
the state. Identify the key lessons learned over the five years
Floridas hospitals worked together to reduce readmissions,
complications, and infections. Develop actionable steps for
collaboration around quality improvement in their own state.
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A Look Back: Florida Healthcare Quality Five Years Ago Florida
hospitals were the target of criticism for poor health outcomes and
high costs compared to hospitals in other states.
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A Look Back: Florida Healthcare Quality Five Years Ago
Performance based on: CMS Core Measures Infection Rates Mortality
Rates Patient Experience Management of Chronic Conditions
Performance based on: CMS Core Measures Infection Rates Mortality
Rates Patient Experience Management of Chronic Conditions Source:
Agency for Healthcare Research and Quality, National Healthcare
Quality and Disparities Reports
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Goal: Improve Care Together Reduce patient harm Tackle
high-impact areas Build a better reputation nationally and improve
our results Reduce costs Save lives, prevent complications, and
help patients return home sooner and stay home
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Collaborating to Improve Quality Under the leadership of the
239 member association, hospitals made a commitment to improve
care, save lives and lower costs through: shared successes and
failures the knowledge of experts the latest evidence-based best
practices a community of trust, communication and
collaboration
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Collaborating to Improve Quality Why did hospitals choose to
work through the Florida Hospital Association? Provided
opportunities for hospitals to work together verses independently
Dedicated staff; provided structure Resources to effect
improvement
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Readmissions 15% Surgical Complications 14.5% Blood Stream
Infections 41% Urinary Tract Infections 37% Floridas Results:
Making a Difference Statewide
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The Power of Collaboration: Reduce Readmissions Florida was
first state to use published potentially preventable readmission
rates for all hospitals. For the first time, hospitals had
meaningful data readily available. The Process Identified critical
information needed to transition a patient to different levels of
care. Worked with state agencies to modify existing patient hand
offs to ensure smoother transitions. Explored standardized
discharge orders and patient education. The Process Identified
critical information needed to transition a patient to different
levels of care. Worked with state agencies to modify existing
patient hand offs to ensure smoother transitions. Explored
standardized discharge orders and patient education. FHA
collaborated with: Agency for Health Care Administration Florida
Association of Directors of Nursing Florida Department of Elder
Affairs Florida Medical Directors Association Florida Orthopedic
Society
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The Power of Collaboration: Reduce Readmissions FHA also worked
with the states largest health plans to: understand plan services
to help keep people out of the hospital establish standard
methodology for measuring readmissions explore principles for
payment alignment What We Learned Data were critical to
understanding the problem and identifying barriers Multi-faceted
issue that requires sustained coordination and partnership among
hospitals, health plans and other caregivers What We Learned Data
were critical to understanding the problem and identifying barriers
Multi-faceted issue that requires sustained coordination and
partnership among hospitals, health plans and other caregivers
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Collaborative on Readmissions What Florida Did to Reduce
Readmissions Improved discharge instruction Improved handoff
communication Scheduled follow-up visits Evaluated end-of-life care
THE FACTS 107 participants statewide First to publicly report
readmissions rates by hospital First statewide readmissions program
THE FACTS 107 participants statewide First to publicly report
readmissions rates by hospital First statewide readmissions
program
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Orlando Health: Readmissions Results
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Improving Surgical Care: Florida Surgical Care Initiative
Largest statewide surgical collaborative in the nation 67 hospitals
statewide Piloted in partnership with Florida Hospital Association,
American College of Surgeons with support from Florida Blue Focus
on high-impact areas, including surgical outcomes for elderly
patients and surgical site infections The Process Hospitals
collected information on patients condition prior to operation
Qualified surgical reviewers tracked outcomes 30 days after
procedure Hospital staff called patients as a follow-up The Process
Hospitals collected information on patients condition prior to
operation Qualified surgical reviewers tracked outcomes 30 days
after procedure Hospital staff called patients as a follow-up
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Improving Surgical Care: Florida Surgical Care Initiative
Preventing Patient Harm Pilot extended with additional data
collection options Monthly educational meetings focus on topics
such as surgical site infections Continuous shared learning
opportunities THE FACTS 67 hospitals statewide Piloted in
partnership with Florida Hospital Association, American College of
Surgeons with support from Florida Blue THE FACTS 67 hospitals
statewide Piloted in partnership with Florida Hospital Association,
American College of Surgeons with support from Florida Blue
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Reduce Bloodstream and Urinary Tract Infections & Improve
Hospital Culture Focused on building culture of quality, improving
best practices and appropriate use of catheters On the CUSP: Stop
BSIs and Stop CAUTI THE FACTS The On the CUSP initiative launched
in 2009 Engaged 69 units in 35 hospitals in the CLABSI program
Engaged 21 units in 10 hospitals in the CAUTI program 16 NICUs
participated in the Perinatal Quality Collaborative Florida was one
of initial states to participate Partnership with HRET THE FACTS
The On the CUSP initiative launched in 2009 Engaged 69 units in 35
hospitals in the CLABSI program Engaged 21 units in 10 hospitals in
the CAUTI program 16 NICUs participated in the Perinatal Quality
Collaborative Florida was one of initial states to participate
Partnership with HRET
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Orlando Health: CAUTI Results
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The Tools: CLABSI Top Ten Checklist
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Orlando Health: CLABSI Results
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Floridas Quality Journey Phase II
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Eliminating Harm Florida hospitals are actively working on
improvement initiatives in ten focus areas through this
collaborative. Goal is to reduce patient harm by 40% and
readmissions by 20%. HRET-FHA Hospital Engagement Network THE FACTS
77 hospitals collaborating, sharing resources and best practices
Extensive education and training programs Strong leadership
engagement and support Topic specific listservs One-on-one coaching
and support Tracking monthly progress THE FACTS 77 hospitals
collaborating, sharing resources and best practices Extensive
education and training programs Strong leadership engagement and
support Topic specific listservs One-on-one coaching and support
Tracking monthly progress Harm Prevention 1,135 Cases of Harm
Prevented
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Orlando Health: HEN Results
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Ensure a Safe Reporting Environment & Foster Sharing
PSOFlorida provides an environment where hospitals and physicians
may submit data on medical errors and mistakes, learn
evidence-based best practices drawn from state and national patient
safety data and share insights with peers Learning and discussion
is facilitated through webinars, protected websites, newsletters
and research.
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Five Years Later: Weve Moved the Needle 23 Source: Agency for
Healthcare Research and Quality, National Healthcare Quality and
Disparities Reports 2011
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Lessons Learned It is possible to achieve statewide
improvement, in a state as diverse as Florida Focusing on improving
quality in specific areas of care can lead to meaningful progress
Quality care can cost less Collaboration among hospitals is the
additive that accelerates quality gains Culture is integral to
improving quality Data are critical to understanding the problem,
tracking progress Partnerships extend quality efforts and increase
learning Greater opportunity ahead by expanding collaboratives to
include pre- and post-acute networks
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Quality Remains the Top Priority Sustained Board of Trustee
Engagement Focused on statewide data to understand how Florida
compares to other states Identified champions to provide leadership
Refined advocacy role to emphasize quality and patient safety
Established a Quality Committee dedicated to promoting improvement
in clinical outcome strategies
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Partners
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Whats Ahead Florida Surgical Care Initiative (FSCI) Expansion
of FSCI Expanded data collection options Healthier Hospitals
Initiative New program with goal to embed sustainability into
culture and operations for improved health of patients, staff and
the community Partnership for Patients 77 hospitals statewide
Focused on 10 key areas Expanded to address patient and family
engagement and leadership development Refine data measurements
Expand number of hospitals participating Sustain improvement Refine
data measurements Expand number of hospitals participating Sustain
improvement
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Contact Information and Resources FHA Five Years of Quality
Report: www.fha.org/quality www.fha.org/quality Thomas Kelley, MD
Chief Quality and Transformation Officer, Orlando Health
[email protected][email protected]
Florida Hospital Association 306 East College Avenue Tallahassee,
Florida Phone: (850) 222-9800 Fax: (850) 561-6230 www.fha.org