MHA: Strategic Quality What’s Up Wednesday | Lunch and Learn Your clinical quality, process improvement resource

Jessica Rowden, RN, BSN, MHA

Clinical Quality Improvement Manager

Housekeeping

Please ask questions

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Give feedback

Offer suggestions of what would be beneficial to your organization

Be a featured hospital speaker!

April Lunch Menu Hors d’oeuvres

Refresher: Data/Website/Reports

Main Course Leading change and avoiding drift with PDSA

Hospital spotlight – St. Louis University Hospital

Transparency Update

HEN 2.0 Update

Dessert Upcoming Events

Refresher

HIDI: www.hidianalyticadvantage.com

– MOHEN – if you have not uploaded your data, touchbase with me

– HIDI is able to upload data from other HEN cohorts into Quality Collections for continuation of tracking; touchbase with me

– Analytic Advantage Reports available under the Quality Tab/SQI; touchbase with me if you have questions

SQI Website: http://web.mhanet.com/strategic-quality/

Leading Change and Avoiding Drift Focus on PDSA/PDCA

Making Change Happen

Critical thinking about the current system – flow chart the current system

Benchmarking – reach out to higher performers

Take the patient’s perspective – shed a different light on things that need to change

Using technology – bar code medications or hard stops in EHR

Creative thinking – think outside the box

Using change concepts (listed on the next slide)

Category Change Concept Questions to Ask

1) Eliminate Waste Eliminate things that are not used

Can you think of an activity or resource that doesn’t add value?

2) Improve Work Flow Find and remove bottlenecks

Is there some aspect of your processes where the work doesn’t happen as smoothly as it should?

3) Optimize Inventory Match inventory to predicted demand

Do you have too much or too little of the items you use or provide? Is your work held up because items are poorly organized or not available?

4) Change the Work Take care of basics Changing the work environment itself can make all other process changes more effective. Does the culture resist or embrace new ideas?

5) Producer/Customer Interface

Focus on the outcome What are the needs of the people you serve? Do they understand the value of your services? Do they have ideas for ways you can improve?

6) Manage Time Do tasks in parallel Can you cut down on the time it takes to do anything in the organization – whether it’s waiting times or the time to develop a new idea or project?

7) Focus on Variation Standardization (create a formal process)

What aspects of your systems vary and make your outcomes unpredictable?

8) Focus on Error Proofing Use reminders Can you make it harder for people in your system to make mistakes? For instance, can you make the information necessary to perform a task available in, say, a checklist – rather than in one’s memory?

9) Focus on the Product or Service

Listen to customers Is the service or product you provide a good one? Can it be better?

Observe the cycle in the OHNO CIRCLE

Drift Correction for Design Issues: Management by Improving Process

Pick your organization’s Top 3 Focus Areas

Compare baseline rates to current rates

Flowchart process as designed vs. reality

Go to the GEMBA

Spend some time in the OHNO circle

Model for Improvement & PDSA

“To help people”

Provide health with care

Safe

Effective

Patient-centered

Timely

Efficient

Equitable

Pre-PDSA First Step - AIM

IDENTIFY:

What are we trying to accomplish?

What do we need/want to improve, and why?

Numbers increasing/decreasing

Survey focus

New quality measure

What to measure?

Relevant—really relates to the process

Meaningful—measure whole or part, timing

Available—use information that you can access with reasonable ease

Pre-PDSA Second Step – Measuring and Data

Identify if change in an improvement will maintain the efficient use of resources

Do you have favorable results without using more resources than necessary?

Is use of the resource helping?

Ensure that patients get evidence-based care

Work toward an HRO structure

Reduce variations in treatment

Understand the relationship between interventions and outcomes

Additional Benefits of Measurement

Measuring abstracts concepts such as “good” care

Communicate leadership goals to staff in clear terms that promote improved accountability from staff

Identify problems/evaluate solutions

Establish objective guidelines for delivery of care

Improve ability to comply with quality measures for value-based reimbursement

Pre-PDSA: Third Step – Making a Change

Now What?

What to do with what you measure

What do your initial numbers tell you?

How can you change practice to move the numbers?

How will you know what made the numbers change?

You know your baseline and have a theory….

HERE

THERE

Achieving sustainability requires planning on the front end

Make your process standard work

PDSA

Step 1: Plan Plan the test or observation, including a plan for collecting

data. State the objective of the test.

State the questions you want to answer and make predictions about what will happen and why.

Develop a plan to test the change. (Who? What? When? Where?)

What data will need to be collected?

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PDSA

Step 2: Do Try out the test on a small scale.

Carry out the test.

Document problems and unexpected observations.

Begin analysis of the data.

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19

Problem Solving

Display Clear

Acknowledge

PDSA

Step 3: Study Set aside time to analyze the data and study the results.

Complete the analysis of the data.

Compare the data to your predictions.

Summarize and reflect on what was learned.

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PDSA

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Step 4: Act Refine the change, based on what was learned from the test.

Determine what modifications should be made.

Prepare a plan for the next PDSA.

PDSA is an acknowledgment of failure,

but a victory in learning

Tips for testing changes

Have a C-Suite Champion

Stay a cycle ahead

Scale down the scope of tests

Pick willing volunteers

Avoid the need for consensus, buy-in, or political solutions

Don’t reinvent the wheel

Pick easy changes to try

Debrief on the results of every change

Drift

What is drift and why does it happen?

How do you know when you’re drifting?

Situational Awareness

DRIFT

Safety Across the Board

Design Levels for Reliability

Level One Intent, vigilance and hard work

• Common equipment (and other structural standardization)

• Standard orders sheets

• Personal check lists

• Feedback of information on compliance

• Awareness and training

Level Two Design informed by reliability science and research in human factors

• Design Concepts

• Standardization of processes

• Building decision aids and reminders into the system

• Taking advantage of existing habits and patterns

• Making the desired action the default (based on evidence)

• Creating redundancy

• Scheduling using proper operations theory

Level Three Design of integrated systems and high reliability organizations

• Sophisticated design of human interactions and working relationships

• Weick’s Attributes

• Preoccupation with failure (Prevent)

• Sensitivity to operations (Prevent)

• Reluctance to simplify interpretations (Identify)

• Deference to expertise (Identify/Mitigate)

• Commitment to resilience (Mitigate)

People Support Systems

Engage staff at all levels

Leadership support is crucial

Middle management support is the most crucial

Map out how the process improves efficiency, safety, benefits to patients and/or staff

Self Reinforcing

Publicize successes to promote pride in accomplishment

Spend purposeful time with staff – leaders at every level

Recognize early adopters at both the individual and team level. Promote the spread of adoption by sharing stories of success

Wall of fame

Award ceremonies

Learn from successes and failures. Don’t be afraid to be wrong

Once standard work has been established create and communicate ground rules to speak up when challenges are encountered

Assign high value to those who report errors/near misses

Hospital Spotlight St. Louis University Hospital

Reduction of Central Line

Infections

St. Louis University Hospital

• 72% decrease in central line infections from 2013 to 2014

• 69% decrease in central line infections from 2013 to 2014

CVC Review Process

• Daily review of all lines

• CVC Insertion Checklist

• Nurse managers complete a defect tool for all CVC infections

Other Tools and Resources

• CHG Bath Documentation

• CHG Bedrail Wipe down

• Identification of patients who tamper with lines

• CUSP Teams

• Increased use of mid line catheters

Physician/Resident Interventions

• CVC Physician Advisory Group

• Physician “Best Practice Alert (BPA)”

• Physician/Resident Certification • Blue Certification

• Gold Certification

Transparency Initiative Update

Transparency Launch

On Tuesday, February 17th MHA launched phase one of the price and quality transparency initiative

Objective

To support Missouri’s hospitals in continuing to provide safe, timely, effective, efficient and patient-centered care by sharing best practices

Where is the Data Stored?

The state aggregate price and quality data will be posted on MHA’s website, Focus on Hospitals.

2015 Missouri Quality Outcome Measures

Which Measures Are Included?

Twenty-one claims-based measures have been selected to highlight Missouri’s health care quality strategy

New measures with data uploads coming soon:

◊ SSI – Colon ◊ SSI – Abd Hyster ◊ Post Op Sepsis Rate ◊ C Diff

◊ MRSA ◊ Readmissions – COPD ◊ Readmissions –

Hip/Knee Replacement

How Can I Validate?

Concurrent to the release of state-aggregate data, hospitals will be able to access their hospital-specific quality data via HIDI Analytic Advantage® for internal review

Resources

MHA has developed a tutorial to assist quality staff with accessing and understanding their quality data

Transparency Timeline

Summer 2015- Data Use Agreements with non-marketing clause dissemination

January 2016- Hospital-Specific Dashboard release (for hospitals who sign DUA)

Upcoming Education

Missouri Quality Transparency Update

Tuesday, April 7. Noon-1 p.m.

Register here

Missouri Quality Measure Coding

Tuesday, April 21. 10-11 a.m.

Register here

Questions?

Dana Downing

Vice President of Quality Program Development

573\893-3700, ext. 1314

ddowning@mhanet.com

HEN 2.0 Update

HEN 2.0 Overview

We are adding a HEN 2.0 tab to our website:

http://web.mhanet.com/strategic-quality/

We will keep an weekly updated document of HEN happenings

For formal announcements, we will send an email to those organizations in our network as well as update our HEN 2.0 tab

Optional/additional topics

Severe Sepsis and Septic Shock

Hospital Culture of Safety that fully integrates patient safety with worker safety

Iatrogenic Delirium

C. diff including antibiotic stewardship

Undue Exposure to Radiation

Airway Safety

Failure to Rescue

HEN 2.0 Overview

10 core topics (all applicable topics are required)

Adverse Drug Events

CAUTI

CLABSI

Injuries from falls and immobility

OB adverse events

Pressure Ulcers

SSI

VTE

VAE

Readmissions

HEN 2.0 Hospital Expectations to Ensure Success

Once the project is awarded and begins, have your CEO sign a commitment that they will work on the aims of the PfP, especially CAUTI and readmissions

Have your QI HEN lead co-sign the commitment

Ensure your success in HEN 2.0

Participate in webinars and in-person meetings and utilize the tools and resources available to them to drive improvement in all target areas

Form a HEN team

HEN 2.0 Timeline

March 23

• MO submit final preliminary budget to HRET

March 28

• HRET submit RFP to CMS

Summer 2015

• CMS to award grant

• Formal letters of commitment will be sent to MO hospital CEOs

August 1

• Projected start date of HEN 2.0

Questions? Press *1 or type them in the question box

PDSA?

Drift?

St. Louis University Hospital CLABSI success story?

Transparency?

HEN 2.0?

7 Things to Start Next Week: Action Items

Sign up for the regional meeting in your area and for the Q101

Open invite to all applicable positions in your organization

Spend some time in the OHNO circle

Start the PDCA cycle on a change project

Make sure you are working on important issues – what matters to patients and families

Make staff leaders of system design and process improvement

Assess your organization, are you ready to become a HRO?

Review your organization’s transparency data

Discuss your organization’s HEN commitment with your CEO and leadership team

Join LinkedIn

Network with me, Jessica Rowden (and follow me on twitter @Jessica_Rowden)

We are building a MHA SQI group as another networking platform!

Upcoming Events, April & May

MHA Spring Regional Quality Workshop – Readmissions and Care Coordination: Aim Towards Outcomes

April 14 - Marriott West, 660 Maryville Centre Dr, St. Louis (Register)

April 15 - Drury Lodge, 104 Vantage Dr, Cape Girardeau (Register)

April 17 - Comfort Inn, 1821 N. Missouri, Macon (Register)

April 22 - Hilton Garden Inn, 19677 East Jackson Dr, Independence (Register)

April 24 - Hilton Garden Inn, 4155 South Nature Center Way, Springfield (Register)

May 20, 21 – Quality 101 Conference, Hilton Garden Inn, Columbia (Register)

Visit our website for additional events and links

OB Harm Regional Meetings, May & June

May 4 – SSM St. Clare, 1015 Bowles Avenue, Fenton, MO (Register)

May 6 – Southeast Hospital, 1701 Lacey Street, Cape Girardeau, MO (Register)

May 7 – CoxHealth 3801 S National, Springfield, MO (Register)

May 27 – Women’s and Children’s Hospitals, 404 Keene Street, Columbia, MO (Register)

June 2 – Saint Luke’s Hospitals of Kansas City, 4401 Wornall Road, Kansas City, MO (Register)

All meetings held from 10:00 a.m. to 3:00 p.m.

Visit our website for additional events and links

MHA:SQI - http://web.mhanet.com/strategic-quality/

Leslie Porth, PhD-C, MPH, R.N.

Division Vice President for Strategic Quality Improvement

Triple Aim

Population Health

Oversight of division (Quality Improvement, Quality Works,

Emergency Preparedness)

MONL

Alison Williams, R.N., BSN, MBA-HCM

Vice President of Clinical Quality Improvement

Dana Downing, B.S., MBA-H, CPHQ

Director of Quality Program Development

Patient and family engagement

National quality measures

Quality outcome transparency

Electronic clinical quality measures

MBQIP grant lead

MOAHQ

Jessica Rowden, R.N., BSN, MHA

Clinical Quality Improvement Manager

Clinical quality SME

Data management and analytics

HEN/AHRQ grant projects

TeamSTEPPS

Host of WUW|LNL

MOAHQ

MONL

Cheryl Eads

Executive Assistant of Quality Improvement

Provides support to the SQI team

Coordinates webinars, conference calls and meetings

Distributes correspondence and communication

Assists in maintaining reports

Lporth@mhanet.com 573/893-3700x1305

Awilliams@mhanet.com 573/893-3700x1326

Ddowning@mhanet.com 573/893-3700x1314

Jrowden@mhanet.com 573/893-3700x1391

Ceads@mhanet.com 573/893-3700x1382

Clinical quality SME

Oversight of Quality Improvement

Grant management

Collaboratives management

MONL

MOAHQ

Thank you for joining us

Please fill out the evaluation

Give feedback

Debrief: tell us what went well and what didn’t

Offer suggestions to help us improve

What topics would be beneficial to your organization

Be a featured hospital speaker!

See you next month, May 6 @ noon

On the menu: HRO principles and hear from a hospital’s journey to create a goal of zero harm for their organization

Resources are tight…what can we do

Visit Missouri Health Matters

Take action and be heard

Support Medicaid expansion