north carolina hospital association getting buff spread,transparency and reliability getting buff...
Post on 25-Dec-2015
213 Views
Preview:
TRANSCRIPT
North Carolina Hospital Association
Getting BuffSpread,Transparency
and Reliability
Getting BuffSpread,Transparency
and Reliability
Kansas State Network Council MeetingJeff Spade Vice President, NCHAAugust 2007jspade@ncha.org
2North Carolina Hospital Association
Getting Buff Getting Buff
• Public Policy Imperatives• NC CAH Performance
Improvement Project• Performance Improvement
Primer• Performance Improvement
Concepts That Work
3North Carolina Hospital Association
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
4North Carolina Hospital Association
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
5North Carolina Hospital Association
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Me.
6North Carolina Hospital Association
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
7North Carolina Hospital Association
8North Carolina Hospital Association
9North Carolina Hospital Association
Public Policy ImperativesPublic Policy Imperatives
Medicare Mandates in MMA• Voluntary submission of 10
inpatient measures.• Update is 0.4% higher for those
who submit.• No payment difference based on
submitted data.
10
North Carolina Hospital Association
CMS Value-Based Purchasing PlanCMS Value-Based Purchasing Plan
• Beginning FY 2007, hospitals report 21 measures or lose 2% in Medicare PPS reimbursement.
• Value-based payments beginning FY 2009.• No payment increase allowed for patients
with hospital-acquired infections.• Two VBP listening sessions:
• January 17, 2007• April 12, 2007
11
North Carolina Hospital Association
VBP Program DetailsVBP Program Details
• Budget neutral.• In-line with IOM and MedPAC.• Build on existing CMS measures.• Three domains:
1) Clinical quality
2) Patient centered care
3) Efficiency• Performance measures and payments
for outpatient care.
12
North Carolina Hospital Association
Goals of CMS Value-Based Purchasing ProgramGoals of CMS Value-Based Purchasing Program
• Improve clinical quality. • Reduce adverse events.• Encourage patient centered care.• Avoid unnecessary costs.• Stimulate investments in improving
quality and/or efficiency.• Make performance results transparent
and comprehensible, empowering consumers.
13
North Carolina Hospital Association
CMS and Premier Quality Demonstration Project
• Performance rates of >76% may prevent: 5,700 deaths and 8,100 complications 10,000 readmissions and 750,000 hospital days
• For 59,000 pneumonia cases: Patients receiving the least number of quality
measures cost the hospital $11,107. Patients receiving the highest number of quality
measures cost the hospital $8,351 -- a savings of $2,756 per case.
14
North Carolina Hospital Association
Key Lessons for HospitalsKey Lessons for Hospitals
From a CMS exec:
“We are moving toward value-based payments to hospitals.”
“More important for hospital and system managers may be the trend toward incentives for preventing admissions.”
15
North Carolina Hospital Association
CMSwww.hospitalcompare.hhs.govCMSwww.hospitalcompare.hhs.gov
16
North Carolina Hospital Association
nchospitalquality.orgnchospitalquality.orgHospital Name
LVF Assessment
Ace Inhibitor
Discharge Instructions
Smoking Counseling
Overall HF
Score1
Overall
Denominator 2
Top 10% of NC hospitals: 98% 95% 89% 100% 92%Average for NC hospitals: 85% 80% 57% 83% 75% NorthEast Medical Center 99% 92% 96% 100% 97% 1,619Rutherford Hospital 89% 80% 53% 81% 74% 422Sampson Regional Medical Ctr 81% 82% 71% 98% 79% 583Southeastern Regional 82% 79% 42% 87% 67% 870Spruce Pine Community Hospital 85% 79% 89% 80% 86% 164Stanly Memorial Hospital 96% 93% 75% 95% 88% 487Transylvania Community Hospital 85% 75% 7% 100% 62% 47University of NC Hospital 99% 95% NA 67% 93% 607Watauga Medical Center 99% 77% 61% 93% 82% 276Wayne Memorial Hospital 89% 93% NA NA 90% 525
then the overall score is an unreliable measure of performance and is, therefore, not shown.
Hospitals highlighted in green reported all 4 heart failure measures and are in the top 10% for the overall score.NA (not applicable) indicates that no data is available from the hospital for this measure.
1. The overall score is the sum of patients across the measures that received the appropriate treatment (i.e., sum of numerators) divided by the sum of patients eligible for treatment (i.e., sum of denominators). 2. The sum of denominators across measures. This is not a count of unique heart failure patients. If the sum of the demoninators < 25,
17
North Carolina Hospital Association
18
North Carolina Hospital Association
“If you’re going to be naked, you’d better be buff!”
Don Tapscott and David TicollThe Naked Corporation
“If you’re going to be naked, you’d better be buff!”
Don Tapscott and David TicollThe Naked Corporation
Performance Reporting and Transparency
19
North Carolina Hospital Association
• Based on CMS indicators for pneumonia and heart failure.
• In partnership with NC Office of Rural Health, NCHA and CCME.
• Commitment by 26 small, rural hospitals.• Utilizes an optimal care score to measure
performance.• Workshops and collaborative learning
along with performance reporting.• Considered a national model for CAHs.
CAH & Rural Hospital Improvement ProjectCAH & Rural Hospital Improvement Project
20
North Carolina Hospital Association
Improvements Achieved ByImprovements Achieved By
• Collaborative workgroups, coaching & mentoring, sharing resources.
• Initial focus on pneumonia and heart failure & development of reliable care processes.
• Performance measurement, benchmarks and transparency are key.
• Analyses and reports feature: Summary of inclusions and exclusions. Composite or “optimal care” scores. CAH mean and hospital performance vs. NC and
national benchmarks (top 10% performance) and reliability targets (10-2 performance).
Spider graphs to share with med staff and board.
Pneumonia Composite ScoreData Reported from January, 2006 to December, 2006
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%K
ing
s M
ou
nta
in (
n=
116
)
An
son
(n
=1
55
)
Du
plin
(n
=1
31
)
Do
she
r (n
=5
5)
Ma
rtin
Ge
ne
ral (
n=
12
1)
Pe
rso
n(n
=1
27
)
Mu
rph
y (n
=1
82
)
Firs
the
alth
Mo
nt.
(n
=6
2)
Be
rtie
(n
=1
9)
Sw
ain
(n
=5
8)
Pe
nd
er
(n=
64
)
Ho
ots
(n
=1
8)
Pu
ng
o (
n=
22
)
Ch
ath
am
(n
=2
4)
Da
vie
(n
=3
6)
Wa
shin
gto
n (
n=
49
)
Bla
de
n (
n=
66
)
Hig
hla
nd
s C
ash
ier
(20
)
Sto
kes-
Re
yno
ld (
n=
31
)
Ch
ow
an
(n
=5
6)
Tra
nsy
lva
nia
(n
=6
4)
Alle
gh
an
y(n
=7
4)
Blo
win
g R
ock
(n
=1
7)
St.
Lu
kes
(n=
72
)
Ou
ter
Ba
nks
(n
=3
2)
Mean of CAH/Rural Hosptials National Benchmark Reliable Care
95% Reliability
National Top 10%
22
North Carolina Hospital Association
“All-or-None” Measurement“All-or-None” Measurement
• Also Optimal Care or “perfect care”.• A more stringent outcome measure that reflects
ability to manage care processes.• Completion of a full set or bundle of tasks.• Emphasizes patient centered care and focuses
on system-wide improvement.• Appropriateness of care measures help to focus
improvement efforts.• JCAHO and CMS are moving toward optimal
care measures.
PneumoniaApril 2004 through March 2005
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
PNE Composite (n=109)
Init Abx 4 (n=93)
Abx Selct (n=80)
Blood CX24 (n=43)
Blood CXAbx (n=84)Inpt FLU (n=49)
Inpt PPV (n=76)
Smk Cess (n=26)
Oxy Assess (n=109)
Hospital Name Benchmark for NC Hospitals Mean of NC Critical Access Hospitals
Pneumonia Spider GraphPneumonia Spider Graph
Heart FailureApril 2004 through March 2005
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
HF Composite (n=51)
Disch Inst (n=47)
LVF Assess (n=51)ACEI (n=10)
Smk Cess (n=10)
Hospital Name Benchmark for NC Hospitals Mean of NC Critical Access Hospitals
Heart Failure Spider GraphHeart Failure Spider Graph
25
North Carolina Hospital Association
For each patient:
Received care for all measures for which they qualify?Qualified for any measure (1=yes, 0=no)
For hospital rate: Sum of numerators
Sum of denominators
Composite Score Calculation
Composite Score Calculation
Pneumonia Composite ScoreData Reported from January, 2006 to December, 2006
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%K
ing
s M
ou
nta
in (
n=
116
)
An
son
(n
=1
55
)
Du
plin
(n
=1
31
)
Do
she
r (n
=5
5)
Ma
rtin
Ge
ne
ral (
n=
12
1)
Pe
rso
n(n
=1
27
)
Mu
rph
y (n
=1
82
)
Firs
the
alth
Mo
nt.
(n
=6
2)
Be
rtie
(n
=1
9)
Sw
ain
(n
=5
8)
Pe
nd
er
(n=
64
)
Ho
ots
(n
=1
8)
Pu
ng
o (
n=
22
)
Ch
ath
am
(n
=2
4)
Da
vie
(n
=3
6)
Wa
shin
gto
n (
n=
49
)
Bla
de
n (
n=
66
)
Hig
hla
nd
s C
ash
ier
(20
)
Sto
kes-
Re
yno
ld (
n=
31
)
Ch
ow
an
(n
=5
6)
Tra
nsy
lva
nia
(n
=6
4)
Alle
gh
an
y(n
=7
4)
Blo
win
g R
ock
(n
=1
7)
St.
Lu
kes
(n=
72
)
Ou
ter
Ba
nks
(n
=3
2)
Mean of CAH/Rural Hosptials National Benchmark Reliable Care
95% Reliability
National Top 10%
Pneumonia Trend Graph
26.4%29.6%
34.0%38.8%
47.10%
53.05% 52.00%50.0%
56.6%59.0%
63.9%
71.80%76.60%
79.80%
53.70%
83.70%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Q2 04 to Q105
Q3 04 to Q205
Q4 04 to Q305
Q1 05 to Q405
Q2 05 to Q106
Q3 05 to Q206
Q4 05 to Q306
Q1 06 to Q406
Mean of CAH/Rural Hospitals Benchmark for NC Hospitals
Top 10% NC Performance
103% Improvement
Heart Failure Composite ScoreData Reported from January 2006 to December 2006
0%
20%
40%
60%
80%
100%
120%K
ing
s M
ou
nta
in (
n=
87
)
An
son
(n
=1
26
)
Du
plin
(n
=9
9)
Do
she
r (n
=4
3)
Ma
rtin
Ge
ne
ral (
n=
14
8)
Pe
rso
n (
n=
59
)
Mu
rph
y (n
=7
3)
Firs
t H
ea
lth M
on
t. (
n=
37
)
Be
rtie
(n
=3
4)
Sw
ain
(n=
14
)
Pe
nd
er(
n=
37
)
Ho
ots
(n
=3
)
Pu
ng
o (
n=
34
)
Ch
ath
am
(n
=1
6)
Da
vie
(n
=2
3)
Wa
shin
gto
n (
n=
60
)
Bla
de
n (
n=
49
)
Hig
hla
nd
s C
ash
ier
(n=
10
)
Sto
kes-
Re
yno
ld (
n=
30
)
Ch
ow
an
(n
=6
9)
Tra
nsy
lva
nia
(n
=2
6)
Alle
gh
an
y (n
=4
2)
Blo
win
g R
ock
(n
=3
)
St.
Lu
kes
(n=
33
)
Ou
ter
Ba
nks
(n
=1
5)
Mean of CAH/Rural Hosptials National Benchmark Reliable Care
95% Reliability
National Top 10%
Heart Failure Trend Graph
34.8% 34.2% 36.0%38.8%
42.40%45.58% 46.40%
89.0% 89.5% 88.9% 88.7% 90.90% 91.65% 92.80%
46.90%
93.40%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Q2 04 to Q105
Q3 04 to Q205
Q4 04 to Q305
Q1 05 to Q405
Q2 05 to Q106
Q3 05 to Q206
Q4 05 to Q306
Q1 06 to Q406
Mean of CAH/Rural Hospitals Benchmark for NC Hospitals
Top 10% NC Performance
35% Improvement
CAH combined Indicator ScoresJanuary, 2006 through December, 2006
94.50%
89.70%
83.30%81.80% 81.10%
75.60%73.70%
71.10% 70.60%66.90%
55.10%53.00% 52.90%
0%
20%
40%
60%
80%
100%
BloodCXAB
Abx Selct Init AB 4 ACEI(HF)
SmkCess(PNE)
LVFAssess
BloodCX24
Inpt PPV SmkCess(HF)
Inpt FLU PNEACM
Dis Instr HF ACM
31
North Carolina Hospital Association
• Patient Centered Care• Design for Reliability (zero defect rates)• Evidence-based Practice• Clinical Process Improvement• Rapid Cycle Improvement • Collaborative Learning and Spreading
Innovations• Measurement and Segmentation (small tests
of change)• Commitment of Leadership• This is THE WORK of Healthcare
Organizations and Professionals
Performance Improvement PrimerPerformance Improvement Primer
32
North Carolina Hospital Association
The Concepts of Innovation, Diffusion and Spread
Spread is the Diffusion of Innovation
The Concepts of Innovation, Diffusion and Spread
Spread is the Diffusion of Innovation
Performance Improvement PrimerPerformance Improvement Primer
33
North Carolina Hospital Association
The Nature of People (Everett Rogers) The Nature of People (Everett Rogers)
Late Majority
35%
Early Majority
35%
Early Adopters
13%
Traditionalists
15%2%
Innovators
34
North Carolina Hospital Association
Target Early AdoptersTarget Early Adopters
Early Adopters are the key to successful spread of changes …..
• Receptive to change.• More socially integrated than innovators, often
opinion leaders.• Trusted by peers to evaluate changes.
… Remember “Hey Mikey, he’ll try it”
35
North Carolina Hospital Association
• What are we trying to accomplish?• How will we know that a change is an improvement?• What changes can we make that will result in an
improvement?
Act Plan
Study Do
Model for ImprovementModel for Improvement
36
North Carolina Hospital Association
Transparency and Reliability
Transparency and Reliability
Performance Improvement PrimerPerformance Improvement Primer
37
North Carolina Hospital Association
When hospitals’ quality data is reported publicly… Performance improves (for the measures being
reported). Market share doesn’t change appreciably. Reputation improves considerably.
Hibbard J, J Stockard, and M Tusler: Hospital performance reports: impact on quality, market share, and reputation.
Health Affairs 2005, 24, #4: 1150-116025
Transparency and ReliabilityTransparency and Reliability
38
North Carolina Hospital Association
39
North Carolina Hospital Association
40
North Carolina Hospital Association
A process achieves exactly the results it is designed to achieve.
Transparency and ReliabilityTransparency and Reliability
41
North Carolina Hospital Association
Reliability is failure free operation over time.David Garvin, Harvard
Choose the patient focus, who expects optimal care by all-or-none measures.IHI Innovation Team
Definitions of ReliabilityDefinitions of Reliability
Levels of Reliability in Health Care (Amalberti, Nolan)Levels of Reliability in Health Care (Amalberti, Nolan)
Chaos 10-1 10-2 10-3 10-5
Processes are largely custom-crafted each time
Standard process, checklists, training, trying hard
Standard process; redundancy, habits and patterns
Obsession with Failure: Prevent Mitigate
Redesign
Loss of identity
Each doctor writes individual orders, gives to RN
Standing orders, feedback on compliance
All MDs use same process, multi-disc. rounds
External approval necessary for certain orders
Equivalent
actor
Preventing, treating acute and chronic disease in US
Typical hospital working hard
Best hospitals Core Measures
ADEs per 1000 doses in best hospitals
Safety in anesthesia
Concentrate Your Work Here!Concentrate Your Work Here!
Chaos 10-1 10-2
Processes are largely custom-crafted each time
Standard process, checklists, training, trying hard
Standard process; redundancy, habits and patterns
Each doctor writes individual orders, gives to RN
Standing orders, feedback on compliance
All MDs use same process, multi-disc. rounds
Preventing, treating acute and chronic disease in US
Typical hospital working hard
Best hospitals in Core Measures
44
North Carolina Hospital Association
Starting Labels of ReliabilityStarting Labels of Reliability
• Chaotic process: Failure in greater than 20% of opportunities
• 10-1: 80 or 90 percent success. 1 or 2 failures out of 10 opportunities
• 10-2: 5 failures or less out of 100 opportunities
• These are IHI definitions and are not meant to be the true mathematical equivalent.
Pneumonia Trend Graph
26.4%29.6%
34.0%38.8%
47.10%
53.05% 52.00%50.0%
56.6%59.0%
63.9%
71.80%76.60%
79.80%
53.70%
83.70%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Q2 04 to Q105
Q3 04 to Q205
Q4 04 to Q305
Q1 05 to Q405
Q2 05 to Q106
Q3 05 to Q206
Q4 05 to Q306
Q1 06 to Q406
Mean of CAH/Rural Hospitals Benchmark for NC Hospitals
Top 10% NC Performance
103% Improvement
46
North Carolina Hospital Association
• Common equipment, standard order sheets, multiple choice protocols, procedures & policies
• Personal checklists• Feedback on compliance• Suggestions to work harder next time• Awareness and training• Intent, vigilance and hard work
Concepts for 10-1 PerformanceConcepts for 10-1 Performance
47
North Carolina Hospital Association
• Decision aids and built-in reminders.• Desired action is the default.• Redundant processes utilized.• Scheduling used in design development.• Habits and patterns known and included in design.• Standardization of processes based on clear specification and articulation of the norm.• Uses human factors and reliability science to design sophisticated failure prevention, identification and mitigation.
Concepts for 10-2 Performance Concepts for 10-2 Performance
48
North Carolina Hospital Association
1. Need an established, standardized improvement process, focused on rapid cycle improvement.
2. Use reliability concepts in process design.
3. 10-2 reliability requires outcomes of 95% or better. Set that as the target.
4. A commitment to measurement ..... 'rule of threes' as measurement guide. If you measure 30 cases and have three or more faults, then quit measuring and concentrate on redesign because the process is 10-1.
5. Use segmentation to develop and test the reliability of the design. Segmentation allows control of variables while the process is redesigned. Once the process is standardized to 10-2 reliability on the segmented group, then it can rollout to the broader population.
How To Accomplish10-2 Performance How To Accomplish10-2 Performance
49
North Carolina Hospital Association
The Pneumovax ExampleThe Pneumovax Example
• Commonly described in order sheets as “Give Pneumovax if indicated”
• Poorly defines a process.
• Default is too commonly not to give the Pneumovax
• No testing of competency or training of new employees can occur
The Three Step Design for ReliabilityThe Three Step Design for Reliability
Design Techniques Steps1-Identify the process to standardize
2-Segment the population to test the
design for anomalies
3-Use both 10-1 and 10-2 concepts
Prevent initial failure by standardizing the process to achieve 10-1 (step 1)
1-Utilize a robust 10-2 concept to make visible failures from step 1 after step 1 has achieved 10-1 reliability
2-Once the failure is identified, apply an action to mitigate the failure
Identify failures in step 1 and apply an action to achieve 10-1 for these failures (step 2)
1-Identify common failures
2-Develop a method to measure and study failures
3-Utilize knowledge of common failures to redesign either step 1 or step 2
In either step 1 and/or step 2 detect the failures, and use the knowledge from analysis of the failures to redesign (step 3)
51
North Carolina Hospital Association
Why SegmentationWhy Segmentation
• Allows for control of variables.• Defines the boundaries around which expectations
can be formed.• More likely to test the validity of the design rather
than confront barriers.• Fosters a deeper understanding of the design
complexity required.• Forces understanding of the differences between
segments as design strategies.• Permits design beyond the disease.• Allows the formation of more predictable timelines.
52
North Carolina Hospital Association
How to “Set-Up” ReliabilityHow to “Set-Up” Reliability
• Identify a process to make more reliable.• Determine a high volume segment for initial
design and testing.• Describe the current process (flow chart).• Identify where the defects occur in the
process.• Set a specific reliability goal for the
segment/process.
53
North Carolina Hospital Association
Reliability Design StrategyReliability Design Strategy
• Prevent initial failure using intent and standardization (10-1).• Identify defects, using redundancy,
then mitigate failures.• Measure, then communicate learning
from defects back into the process design.
Example of 3 Step Design in Implementing the Example of 3 Step Design in Implementing the Ventilator BundleVentilator Bundle
Integrate daily goals with MDR to identify defects as a 10-2 change concept (step 1)Education as
a 10-1 concept
Baseline
Feedback on compliance as a 10-1 concept
Redundancy in the form of a check by RT built into 1 hour scheduled vent checks as a 10-2 change concept (step 2)
55
North Carolina Hospital Association
• Level 1: Standardization, performance feedback, training, vigilance
• Level 2: Bundles, multidisciplinary rounds and other redundancy methods, scheduling discharges, habits and patterns
• Level 3: Failure mode analysis: prevent, detect, mitigate, and redesign
Hospital Leaders Must Understand Reliability Hospital Leaders Must Understand Reliability
56
North Carolina Hospital Association
What Improvement Teams Should Expect From LeadershipWhat Improvement Teams Should Expect From Leadership• Clearly describe the organizational outcome goals.• Understand the relationship between the processes
the teams are working on and the outcome goals of the organization.
• Set process expectations for the teams.• Demand data to show how reliable the process has
become.• Setting reasonable timelines. • If outcomes have not improved and process
reliability is high, provide resources to determine the “correctness of performance” of the processes.
57
North Carolina Hospital Association
What Leaders Should Expect of TeamsWhat Leaders Should Expect of Teams
• Expect the initial focus of work to be “getting the process right” with a known connection to an outcome.
• Expect the team to take a set of processes to an agreed upon level of reliability within a specified timeline.
• Expect the teams to use good design principles not just hard work and vigilance.
• Expect teams to develop good designs by using rapid cycle tests of change.
• Expect adequate process structure to sustain the work.
58
North Carolina Hospital Association
Key LessonKey Lesson
A single standardized process within the acceptable science is superior to allowing multiple processes while deciding which is the best because it allows testing for competency and training new employees.
59
North Carolina Hospital Association
Observation re: ReliabilityObservation re: Reliability
The reliability of known or required processes in healthcare commonly is 10-1
(80%) or worse (for non-catastrophic processes).
Given all the resources and talent that we have in healthcare, why does this happen?
The reliability of known or required processes in healthcare commonly is 10-1
(80%) or worse (for non-catastrophic processes).
Given all the resources and talent that we have in healthcare, why does this happen?
Pneumonia Composite ScoreData Reported from January, 2006 to December, 2006
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%K
ing
s M
ou
nta
in (
n=
116
)
An
son
(n
=1
55
)
Du
plin
(n
=1
31
)
Do
she
r (n
=5
5)
Ma
rtin
Ge
ne
ral (
n=
12
1)
Pe
rso
n(n
=1
27
)
Mu
rph
y (n
=1
82
)
Firs
the
alth
Mo
nt.
(n
=6
2)
Be
rtie
(n
=1
9)
Sw
ain
(n
=5
8)
Pe
nd
er
(n=
64
)
Ho
ots
(n
=1
8)
Pu
ng
o (
n=
22
)
Ch
ath
am
(n
=2
4)
Da
vie
(n
=3
6)
Wa
shin
gto
n (
n=
49
)
Bla
de
n (
n=
66
)
Hig
hla
nd
s C
ash
ier
(20
)
Sto
kes-
Re
yno
ld (
n=
31
)
Ch
ow
an
(n
=5
6)
Tra
nsy
lva
nia
(n
=6
4)
Alle
gh
an
y(n
=7
4)
Blo
win
g R
ock
(n
=1
7)
St.
Lu
kes
(n=
72
)
Ou
ter
Ba
nks
(n
=3
2)
Mean of CAH/Rural Hosptials National Benchmark Reliable Care
95% Reliability
National Top 10%
Pneumonia Trend Graph
26.4%29.6%
34.0%38.8%
47.10%
53.05% 52.00%50.0%
56.6%59.0%
63.9%
71.80%76.60%
79.80%
53.70%
83.70%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Q2 04 to Q105
Q3 04 to Q205
Q4 04 to Q305
Q1 05 to Q405
Q2 05 to Q106
Q3 05 to Q206
Q4 05 to Q306
Q1 06 to Q406
Mean of CAH/Rural Hospitals Benchmark for NC Hospitals
Top 10% NC Performance
103% Improvement
62
North Carolina Hospital Association
Reasons Why?Reasons Why?
• Current improvement methods in healthcare are highly dependent on vigilance and hard work.
• There is an inordinate focus on outcomes rather than process.
• Failure to design standard work which can be used in testing and training.
• Poor understanding of how to design reliable processes.
63
North Carolina Hospital Association
Key Learning PointsKey Learning Points
• Hard work and vigilance are not good design principles.
• 10-2 change concepts should comprise at least 25% of the improvement effort for a given project.
• If you accept benchmark level performance in your organization you often compare yourself against mediocrity and foster 10-1 performance.
• Benchmark outcomes against the industry best. • Measure processes against a specific reliability
goal (10-2).
64
North Carolina Hospital Association
CMS/Premier Demonstration, 260 hospitals nationallyCMS/Premier Demonstration, 260 hospitals nationally
Financial incentives did focus hospital executive attention on measuring and improving quality.
Hospitals’ performance has improved continuously over time.
Financial Incentives and transparency improve hospital quality performance
Findings
Hypothesis
Norling, NCHA Winter Meeting, 2007
65
North Carolina Hospital Association
Potential National ImpactPotential National Impact
“MEDIUM” 50% - 99%
“HIGH” 100%
“LOW” 0% - 49%
71%
PPM*M7M6M5M4M3M2M1
100%
PPM*M7M6M5M4M3M2M1
43%
PPM*M7M6M5M4M3M2M1
M
H
L
Care Measures
Care Measures
Care Measures
* Patient Process Measure
66
North Carolina Hospital Association
Finding 1: Hospital CostsFinding 1: Hospital Costs
67
North Carolina Hospital Association
Finding 2: MortalityFinding 2: Mortality
68
North Carolina Hospital Association
Finding 3: ComplicationsFinding 3: Complications
69
North Carolina Hospital Association
Finding 4: ReadmissionsFinding 4: Readmissions
70
North Carolina Hospital Association
Finding 5: Length of StayFinding 5: Length of Stay
71
North Carolina Hospital Association
High Reliability PerformanceHigh Reliability Performance
For Pneumonia, Heart Bypass Surgery, Hip and Knee Surgery, and AMI
PatientsAnnual Potential
$1.4 Billion in Costs6,000 Avoidable Deaths
6,000 Complications10,000 Readmissions800,000 Hospital Days
72
North Carolina Hospital Association
Campaign ObjectivesCampaign Objectives
• Original 100K Campaign interventions• Prevent Methicillin-Resistant
Staphylococcus Aureus (MRSA)• Reduce harm from high-alert medications• Reduce surgical complications• Prevent pressure ulcers• Deliver reliable, evidence-based care for
congestive heart failure• Get Boards on Board
73
North Carolina Hospital Association
Take Home PointsTake Home Points
• Collaborative learning is paramount.• Move toward optimal care or ‘all-or-none’
care process measures.• Target reliability as THE Benchmark for
performance.• Performance measurement and
transparency are essential to improvement.
• CMS measures and the 5 Million Lives Campaign are great places to start.
North Carolina Hospital Association
Getting BuffSpread,Transparency
and Reliability
Getting BuffSpread,Transparency
and Reliability
Kansas State Network Council MeetingJeff Spade Vice President, NCHAAugust 2007jspade@ncha.org
top related