Albert W. Wu, MD, MPH Johns Hopkins Bloomberg School of Public Health

Leuven, 17 January 2017

Impact of Human Resource Management on

Patient Safety: Lessons from Johns Hopkins

The Big

Picture

Overview

• Managing for Safety and Quality

• Quality Indicators

• Clinical Communities

• Investigating Incidents

• Safety Rounds

• Patient Safety Research

Quality &

Safety at

Johns

Hopkins

Armstrong Institute Mission

Purpose Driven:

We partner with patients, their loved ones and all

interested parties:

• To end preventable harm,

• To continuously improve patient outcomes and

experience: and

• To eliminate waste in health care delivery

Principles Led:

• I am humble and curious

• I respect, appreciate and help others

• I am accountable for continuously improving

myself, my organization, my community

5

How We Realize Our Goals

• Advance science of patient safety and quality

• Build organizational capacity for improvement through training and supportive infrastructure

• Design, implement and evaluate interventions

• Inform policy

• Listen, learn and share

6

Quality & Safety

RESEARCH

Quality & Safety

OPERATIONS

JHM Organizational Chart

7

Schools

Hosp

itals

Affiliates

Quality & Safety at JHM

JHM Quality and Safety

Governance Structure

JHM AI Patient Safety and

Quality Board Committee

Armstrong Institute

Inpatient Hospital

PediatricsPopulation

HealthHome Care

Johns Hopkins

International

Ambulatory Practices

Ambulatory Procedures

JHM PerformanceSubcommittee

JHM Quality, Safety & Service

Executive Council Goal:

• To develop system-wide infrastructure to align existing processes and initiatives to achieve consistency, continuity, and coordination across affiliate organizations and evaluate and improve quality of patient care and outcomes

Objectives:

• Use metrics to track performance & improve outcomes

• Data collection and review ~ every 6 months

• Share best practices and lessons

• Identify policies and process improvement initiatives

• Review and approve the resources needed

• Facilitate timely communication

• Demonstrate effective implementation

Framework for Improvement

Pronovost in press

AI Business Process Review

Committee

13

LEAN

Analytics

Marketing and

Communications

Learning and

Development

PATIENTSAFETY

EXTERNAL REPORTING

PATIENT EXPERIENCE VALUE

Strategic Partnerships

Research

HEALTHCARE EQUITY

Infection Prevention

MEASURESRisky providers, units & systems

WORKCUSP

Mindful organizing

Culture measurement improvement

Event reporting

Safety case

MEASURESSurvivalPSI/HACHAIRankings

WORKPMO

Work teams

Robust Process Improvement

A3 Project management

MEASURESCAHPSNarrativesGrievances

WORKCommon language

PFACs

Include patients

Patient and families education

Care coordination

Family involved in decision-making

MEASURES stratified byRaceEthnicityPrimary language

WORKMeasure development

Indicators

Johns Hopkins Health System

Accountability Model

15

Performance below target for 1 month or 1 performance period (ex: 1 quarter)

• Local champions to form performance improvement team• Review data and investigate defects• Identify barriers and implement targeted interventions

Performance below target for 2 months or 2 performance periods

Performance below target for 3 months• Department Director / MD champion present to local Hospital Quality and

Safety Board (Trustee chair and President sign QI plan)• President presents to JHM Quality Safety Board Committee

• PI Team presents to local hospital quality council and President/ CEO• President meets with appropriate clinical director and PI team • President presents plan with timelines to JHM QSS Executive Committee

Nine

Core

Measures

Clinical Communities

Clinical Communities?

• Clinical communities are self-governing networks with broad entity representation who come together to identify and achieve goals related to quality in healthcare

• Patient-centered Strategic Objectives:• Eliminate preventable harms• Continuously improve patient outcomes and experience• Reduce waste in healthcare delivery• Standardize care through best practices/pathways

18

Clinical Communities

Framework

• Led by local physicians (1 academic lead, 1 community lead) with interdisciplinary membership that includes patients and families

• Set and communicate clear goals and measures

• Create infrastructure (PMO) – provide vertical support for project management, peer learning, analytics, and robust process improvement

• Work collaboratively on quality improvement projects, empowered to make changes

19

Clinical Communities

Framework

• Work towards standardizing evidence based practice through protocols to reduce variation in care

• Partner with value analysis and finance teams to reduce over-utilization in supplies, imaging, medications and laboratory costs, and pursue opportunities to negotiate reduced prices in these areas

• Share results frequently for data transparency

• Implement accountability / sustainability model

20

Clinical Communities

21

Hospital

Directors

Quality & Safety

Board

ICU Clinical

Community

Hospitalist

Community

Medication

Safety

Community

Post

Anesthesia

Community

Hospital A

Clinical Communities Support

• Lean• Informatics• Measure development• Financial analysis• Human factors• Teamwork• Safety culture• Implementation• Ethnography• Protocol development• Supply chain

Clinical Communities

23

▪ Joint Replacement

▪ Blood Management

▪ Spine

▪ Surgery

▪ Cardiac Surgery

▪ ICUs

▪ Congestive Heart Failure

▪ Diabetes

▪ Palliative Care

▪ Cardiac Rhythm Management

▪ Hospitalists (EQUIP)

▪ Stroke

▪ Craniotomy

▪ Psychiatry and Behavioral Sciences

▪ Patient and Family Centered Care

▪ Patient Centered Care/Maternal

Health

▪ Cleaning, Disinfection, Sterilization

▪ Medication Safety

Clinical Community Savings

• Ishi et al. 2015

The Comprehensive Unit-based

Safety Program (CUSP)

Changing the Culture, One Unit

at a Time

26

CUSP Growth

27

0

50

100

150

Total CUSP Teams at JHM

Training to Building

Capacity and Capability

Armstrong Institute

Learning Model

29

JHM/AI develops integrated safety and quality development programs for organizations worldwide

Available Trainings

30

RCA(s) at Johns Hopkins

• Sentinel Event RCA

• Mini-RCA, Concise Incident Analysis

• CUSP (Comprehensive Unit Based Safety Program) defect investigations

Sentinel Event Action Items

Progress Report• Sentinel Events with all action items completed since last

meeting

• - #, topic, date of event, champion

• Sentinel Events with Open Action Items

• Incomplete RCAs

• Completed Root Cause Analysis Reports

Mini RCA and Event Analysis

• Concise Incident Analysis (CIA)

• Purpose: to facilitate a more streamlined process for analyzing no or low-harm incidents that occur in healthcare, including the development of effective actions for improvement

When is CIA Appropriate?

• Incidents that resulted in no or low harm to the patient

• Incidents primarily limited to one work area, division, or department

• New incidents for which a comprehensive analysis was recently completed

• Initial review to determine whether or not a comprehensive incident analysis is warranted.

Safety Rounds

75% wanted prompt debriefing for individual or group/team)

R.I.S.E.

Resilience In

Stressful Events

Pager: 410-283-3953

“Provide timely support to employees who encounter

stressful, patient-related events”

Summary

• Operating Management System for Safety

and Quality

• Quality Dashboard

• Clinical Communities

• RCA + Concise RCA

• Learning at Multiple Levels

• Safety Rounds

• Staff Support

• Patient Safety Research

awu@jhu.edu @withyouDrWu