Ingraining Quality in the Minds of Healthcare Institutions - How to "Do" Quality effectively
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Transcript of Ingraining Quality in the Minds of Healthcare Institutions - How to "Do" Quality effectively
Ingraining Quality in the Minds of Healthcare Institutions – How to “Do” Quality Effectively
BOARD, MEDICAL STAFF, SENIOR LEADERSHIP ENGAGEMENT
Quality as a strategic objectiveMeasurable and actionable milestonesDefined targets against benchmarkAttention getters:
Publicly reported data Pay for performance
Key External Drivers:
Quality Drivers:Centers for Medicare & Medicaid Services (CMS)
Measures
Compliance with Conditions of Participation
CORE Measures• Heart Failure• Pneumonia• Heart Attack• Surgical Care Improvement – Infection Prevention• Stroke (2010)
• Mortality Rates• Readmission Rates
Department of Health & Hospitals
The Joint Commission (TJC)
Compliance with Conditions of Participation
TJC Standards
ORYX Measures• Heart Failure• Pneumonia• Heart Attack• Surgical Care Improvement – Infection Prevention• Stroke (2010)
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Key External Drivers:
Quality Drivers:Patients or Consumers
Physicians
Payers
Consumer Advocacy GroupsAgency for Healthcare Research & QualityInstitute for Healthcare ImprovementHealthGradesLeapfrog GroupNational Database of Nursing Quality
Indicators
Measures
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) – Consumer perception of care
Physician Satisfaction and Engagement
Patient Referral Patterns
Pay for Performance – incentives placed on “appropriate” care.
Payment Penalties – reductions in payment for healthcare associated conditions.
Elimination of “Fee for Service” in all venues –
Patient Safety Indicators, mortality and complication rates, falls, decubitus ulcers, Central Line Infections, Urinary Catheter Infections, etc.
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Key External DriversCore Measure Composite Scores
“www.why not the best.org”
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Overall Quality - All Topics (Composite Score) 94% 94% 93% 97% 93% 95% 96% 96% 98% 90% 91% 98%
STPHNSMCLVRLouisianaNat AvgTop 10%
Source: whynottebest.orgPeriod: January 2009 to December 2009
Overall Quality - All Topics (Composite Score)
84%
86%
88%
90%
92%
94%
96%
98%
100%
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LouisianaNat AvgTop 10%
Key External DriversPatient Satisfaction
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How do patients rate the hospital overall? 64% 69% 60% 64% 65% 68% 75% 63% 65% 72% 66% 78%
STPHNSMCLVRLouisianaNat AvgTop 10%
Source: whynottebest.orgPeriod: January 2009 to December 2009
Patients Rate Hospital 9 or 10
0%
10%
20%
30%
40%
50%
60%
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80%
90%
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EJGH and QUEST Top Performing Hospitals Quarter 1 2010- Core Measures
QTP= QUEST Top Performers
Percentile Ranking Under 25th Top 25th Top 50th Top 75th Top 90th Top 95th
87% 93% 96% 98% 100%
Pneumonia 90%EJGH
QTP
94% 98% 100% 100% 100%
AMI 85%EJGHQTP
Heart Failure 82%EJGH
QTP 86% 93% 97% 100% 100%
SCIP 88%EJGH
QTP 89% 92% 95% 97% 99%
Overall 86%EJGH
QTP 89% 92% 95% 97% 99%
All CORE MeasuresAll or None Appropriate Care Score
89% 93% 95% 97% 98%
86%
QUEST Top Performers
Overall 86%EJGH
QTP 89% 93% 95% 97% 98%
EJGH and QUEST Top Performing Hospitals Quarter 1 2010- Core Measures
EJGH and QUEST Top Performing HospitalsMortality – Observed versus Expected Jan 2010 to July 2010
QTP= QUEST Top Performers
Percentile Ranking Top 50th Top 75th Top 90th
Mortality 0.96 0.71 0.64
0.82EJGHQTP
Patient Satisfaction EJGH Comparisons
73%
EJGH Patient Satisfaction Scores Q3 2010
Jan – Dec 2009
66% 72% 78%
Louisiana National Top 10% Nation Average
Quality EJGH Comparisons
Patient Satisfaction Scores
EJGH – Q3 2010
66% 72% 82%
Louisiana National Top 10% Nation Average
73%
Mortality
EJGH – Jan-July 2010
Top 75th Top 90th
0.80
0.71 0.64
CORE MeasuresOverall
EJGH – Q1 2010 86%
89% 93% 95% 97% 98%Under 25th Top 25th Top 50th Top 75th Top 90th Top 95th
What will it take to become a “destination health system”?
Key Drivers - Internal
EJGH Mission
Cost
Market Share Expansion
Empowered WorkforceQu
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Key Internal Drivers
Average Length of StayAverage Length of StayOct 08 – Oct 10Oct 08 – Oct 10
Average Length of StayAverage Length of StayOct 08 – Oct 10Oct 08 – Oct 10
Oct
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Nov
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Dec
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Jan
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Feb
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Mar
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Apr
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May
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Jun
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Jul-0
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Aug
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Sep
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Oct
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Nov
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9
Jan
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Feb
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Mar
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Apr
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May
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Jun-
10
Jul-1
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Aug
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Sep
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Oct
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All Payer 5.3 5.2 5.0 5.2 5.1 5.3 5.5 4.8 4.4 4.4 4.5 4.7 4.7 4.6 4.9 4.9 5.3 4.7 4.6 4.2 4.5 4.5 4.5 4.4 4.4CMI 1.49 1.54 1.43 1.54 1.45 1.45 1.50 1.52 1.48 1.45 1.43 1.47 1.59 1.48 1.47 1.49 1.51 1.53 1.50 1.44 1.47 1.47 1.45 1.48 1.52
MC ALOS 6.0 6.0 5.7 5.9 5.8 5.8 5.9 4.9 4.9 4.7 5.1 5.3 5.1 5.2 5.4 5.4 5.8 5.0 5.2 4.5 4.8 5.0 5.0 4.9 5.0MC CMI 1.63 1.70 1.55 1.69 1.58 1.50 1.64 1.60 1.62 1.55 1.59 1.56 1.65 1.62 1.61 1.61 1.58 1.62 1.63 1.58 1.57 1.59 1.57 1.60 1.66
Acute Care Admissions Excluded: SNF, PSY, GBH, RHB and Newborns
Key success factors:
Accessibility to timely quality data for all stakeholders Identified MD champion for each project Broadest possible MD engagement Support of CNS or equivalent for each project Order sets covering the continuum of care Order sets initiated by the Medical Staff leadership
Support prioritization and use Board mandate for order set use once developed and tested Overcome the “coldness” of technology
PRIORITIZATION – ORGANIZATIONAL CAPACITY
Performance improvement activities flow from the strategic plan
Organizational capacity is understood in such a way that projects cycle in and out based on resources available to support them
Process for revision of priorities essential
Quality control – metrics, monitoring, analysis, distribution Sentinel events, SEA’s Publicly reported data set improvement
TJC, DHH Mature process requiring monitoring Evidence based practice Constituent education and development Skills development to support organizational systems improvement & business development
Run (Routine Business Responsibilities)
Budget Lean
IHI Improvement Map Patient Sat, Magnet
Emerging quality priorities Innovation CI, Co-Management
Strategic
Building culture of skill set for improvement Department PI, Organizational PI
New & evolving processes requiring improvement Streamline, remove waste, improve bottom line
Improve
Staff and medical staff satisfaction, LIP Credentialing Budget HR management & development Safe environment
Administrative
STRUCTUREProcess flow map for performance
improvement systemSenior leader and physician champion for
each chartered teamCFO EngagementPatient/Caregiver InputDefinition of PI approaches and necessary
skill set for deployment
REWARDS, RECOGNITION, CELEBRATION