Thomas Kelley, MDChief of Quality and Transformation

Orlando Health

Leading the Way to Better Care: Florida’s Quality Journey

Session Overview

• Describe how Florida’s hospitals worked together to significantly improve care while reducing costs across the state.

• Identify the key lessons learned over the five years Florida’s hospitals worked together to reduce readmissions, complications, and infections.

• Develop actionable steps for collaboration around quality improvement in their own state.

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.

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

Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports

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

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

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

Readmissions

15%

SurgicalComplications

14.5%

Blood StreamInfections

41%

Urinary TractInfections

37%$15.9 MILLIONCOST SAVINGS

$6.67 MILLIONCOST SAVINGS

$25 MILLIONCOST SAVINGS

Florida’s Results: Making a Difference Statewide

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.

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

The Power of Collaboration:Reduce Readmissions

FHA also worked with the state’s 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

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

Orlando Health: Readmissions Results

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 patient’s condition prior to operation

• Qualified surgical reviewers tracked outcomes 30 days after procedure

• Hospital staff called patients as a follow-up

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

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

Orlando Health: CAUTI Results

The Tools: CLABSI Top Ten Checklist

Orlando Health: CLABSI Results

16

12

8

4

0

Month

Numb

er CL

ABSI

s

2011 2012 2013 2014CLABSI by FY

Mean=7.6 Mean=7.1Mean=4.4

Mean=6.7

Florida’s Quality JourneyPhase II

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

Harm Prevention

1,135 Cases of Harm Prevented

Orlando Health: HEN Results

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.

Five Years Later: We’ve Moved the Needle

23

Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports

2011

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

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

Partners

What’s 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

Contact Information and Resources

FHA Five Years of Quality Report: www.fha.org/quality

Thomas Kelley, MDChief Quality and

Transformation Officer, Orlando Health

Thomas.Kelley@orlandohealth.com

Florida Hospital Association306 East College Avenue

Tallahassee, Florida Phone: (850) 222-9800

Fax: (850) 561-6230 www.fha.org