22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org

Partnerships Work!

Healthcare Partners Collaborate for Better Outcomes

Teri Aldini, RN, BSN, MSA, Project ManagerSusan Burns, BA, Director of Marketing

Alina Pabin-Prusak, BSW, MUP, Long-Term Care Outreach Manager

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Define Collaboration

To work together, in a joint intellectual effort

♣

“Power in organizations is the capacity generated by relationships.” - Margaret Wheatly

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Why Bother?

• Collaboration “Knows no Bounds”

• It can cross the entire healthcare continuum

• Partners have different needs that can be met by others

• The benefits are bigger than the effort

• If you have a vision and a willingness, the dream can become a reality

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Benefits of Successful Collaboration

• Shared workload■ Reduces the burden on resources (financial, staff)

• Opportunity for building new relationships

• Increases visibility of all organizations

• Maximizes talent

• Improves outcomes

• Shared ownership

• True community involvement

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Where do We Start?• Establish a vision

■ Identify something that needs improvement in your community

• Assess what is currently happening around the issue• Identify your potential partners

■ Who can help your vision become reality?■ Who can benefit from this as well?

• Start communicating your vision to them■ How will you reach them?

• Get them all in the same sandbox

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Getting Everyone in the Sandbox

• Gain commitment

• Identify shared goals■ Remind each other of them

• Establish communications strategy■ Use it wisely

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Playing in the Sandbox

• Create ground rules and enforce them■ Play nice!■ Handle conflicts in a constructive

way■ Disagree and still work together

• Define roles in advance

• Insist on the support of leadership

• Practice joint decision-making

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Building a Sandcastle

• Together■ Brainstorm activities and

strategies► Creative ideas

■ Develop an action plan► Who, when, where, how

■ Develop an evaluation strategy► We’ve succeeded when…► What do I want to know?► What do I want others to know?

• Go out and build the castle

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Keep the Sand and the Builders

• Maintain flexibility ■ Different styles and different ways to meet goals

• Allow change■ Leaders and feedback

• Check progress

• Reinforce your shared vision and common goals

• Celebrate success

• Use humor

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Admire Your Castle

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Concrete Examples

• Flu Immunization Awareness Campaign■ “Strike Out the Flu”

• Michigan Heart Failure Discharge Documentation Collaborative

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Strike Out the Flu

• Public Awareness Campaign

• Vision: If You Build It …They Will Come■ MPRO and Visiting Nurse Association of Southeast

Michigan ■ Summer 2004 ■ Raise community awareness on need for flu

immunizations■ Comerica Park (home of the Detroit Tigers) is the

“perfect venue”■ This has never been done in Detroit

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Play Ball!

• September 30, 2004 - Tigers lose 4 to 6 in the second game of a double header to the Tampa Bay Devil Rays. MPRO alerted by Tigers that we can have the ball park the following Friday for our requested press event – plenty of time…or so we thought

• Event Day is set for October 8, 2005…but wait…the unthinkable happens

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Even the Best Laid Plans Can Go Awry, and They Did!

“Flu shot shortage looms Chiron, vaccine maker that was to provide half of U.S. supply, forced to shut down British plant.” -

October 6, 2004: 6:41 p.m. EDT

• Days before the “big-event” national flu vaccine shortage announced

• MPRO re-crafts message and gets the commitment of partners to participate in revamped press conference

• 48 hours to put it all together

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Meet the “Dream Team”

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The “Strike Out the Flu” Team

• American Cancer Society

• American Diabetes Association

• American Heart Association

• American Lung Association

• Cystic Fibrosis Foundation

• City of Detroit Health Department and Senior Citizens Department

• MPRO

• National Kidney Foundation

• Visiting Nurse Association of Southeast Michigan

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Common Goals

• Unified awareness campaign created to inform the public on how to protect themselves from the flu

• Focus experts on giving simple prevention tips, i.e. hand washing, anti-viral medications, and plenty of rest

• Experts are gathered to provide reassurance and advice to their constituencies

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Visuals are in Place

• Slogan is picked

• Message is targeted

• Uniforms picked out

• Scoreboard is lit

• Team baseball hats created

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Game Day Arrives and it’s a Home Run!

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Michigan Heart Failure Discharge Documentation Collaborative

• Collaborative for clinical improvement

• 39 Michigan hospitals

• Partners■ Blue Cross Blue Shield of Michigan■ American College of Cardiology – MI Chapter■ Hospitals■ MPRO

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Why Did we Come Together?

• Heart failure was top diagnosis

• Opportunity for improvement

• Quality of Care Measure tracked by Medicare and the Joint Commission (JCAHO)

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Goals

• To improve adherence to evidence-based heart failure care standards, improve patient outcomes, and decrease readmission rates

• Assure that a fully executed discharge document that includes all six Medicare/JCAHO elements is embedded into the care of the heart failure patient

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Opinion leaders Data

Roles in the Partnership

HospitalsHospitals

MPRO BCBSM QI Expertise Measurement

MI-ACC

Physician Champions Project Leaders Multidisciplinary teams

Physician leadership Physician Network QI Expertise

GFHC Funding

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What are the Elements?

• Heart Failure-1 Discharge Instructions■ Activity level■ Diet■ Discharge medications■ Follow-up appointment■ Weight monitoring■ What to do if symptoms worsen

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Our Model for Improvement

• Institute for Healthcare Improvement (IHI)Collaborative Model

• Designed to help close the gap by creating a structure in which organizations can easily learn from each other and recognized experts

• Short-term (6-15 months)• Seek improvement in a focused topic area

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Our Model for Improvement (cont.)• Organizational commitment

• Learning sessions■ Organizations come together to learn about the

chosen topic■ Barriers and strategies■ Storyboarding as a technique

• Plan changes

• Action periods ■ Team test changes in the clinical setting

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HF - 1: Discharge Instructions(CMS Surveillance Data)

0.11 0.13 0.150.19 0.21

0.11

0.30 0.28

0.36

0.28

0.0

0.2

0.4

0.6

0.8

2003Q4 Baseline 2004Q2 2004Q4Remeasurement

Av

era

ge

Ra

te

Nation Michigan

Outcomes

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Hospital Generated DataDocumentation of all Six HF Core Measures

0.48 0.460.53 0.53 0.55

0.500.54

0.590.64

0.68

0.0

0.2

0.4

0.6

0.8

1.0

2003Q4 Baseline 2004Q1 2004Q2 2004Q3 2004Q4Remeasurement

Av

era

ge

Ra

te w

/ Sta

nd

ard

E

rro

r

Non-HFDDI Hospitals w/data in QNet ExchangeHFDDI Hospitals w/data in QNet Exchange

Outcomes (cont.)

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Comparison Between Participating and Non-participating Hospitals

Hospital Generated DataHF-1 Discharge Instruction

50% 54%59%

64% 68%

94%

48% 46%53% 53% 55%

40%

50%

60%

70%

80%

90%

100%

2003Q

4

2004Q

1

2004Q

2

2004Q

3

2004Q

4

National

Benchm

ark

2004 Q

3

Avera

ge R

ate

Participating Hospitals Non-participating Hospitals

76.0p

01.0p

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Did the Collaborative Work?

• The data has spoken!

• National recognition■ National American College of Cardiology

presentation■ American Heart Association abstracts

• Partnership and collaboration continues■ 38 more hospitals■ Cardiovascular focus

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Project Motto

Go over, go under, go around, or go through, but never give up!

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Lessons We’ve Learned

• Partnering works! ■ Organizations may not always know the specifics,

but patience and perseverance will reap rewards

• Events open the door for further collaborations

• Be adaptable and prepare for the unexpected

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Now You Try It

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Contact Information:

Teri Aldini, RN, MSA, Project Manager, (248) 465-7340, or taldini@mpro.org

Susan Burns, BA, Marking and Public Relations Director, (248) 465-7375, or sburns@mpro.org

Alina Pabin-Prusak, BSW, MUP, Manager, Long-Term Care Outreach, (248) 465-7371, or apabin@mpro.org

This material was prepared by MPRO, the Medicare Quality Improvement Organization for Michigan, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services.