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Transcript of You Can’t Fix It If You Don’t Know About It! · You Can’t Fix It If You Don’t Know About...
1
Donna Saxton, MHA, MPH, FACHE
VP Quality and Safety Ochsner Health System
Cyntrell
Janeau, RNPerformance Improvement
Coordinator Ochsner Medical Center New Orleans
You Can’t Fix It If You Don’t Know About It!
Sandy Kemmerly, MD
Donna Saxton, MHA, MPH
Ochsner Health System and General ElectricConfidential & Proprietary Information
2
Part one
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Ochsner Health System
Ochsner Health System»
Large academic, tertiary medical center ~ 70 medical specialties
»
Seven hospital locations, 1557 licensed beds»
Over $1 billion in annual revenue
»
600+ employed MDs, »
Approximately 12,000 employees
Largest multi-specialty group practice in Gulf South»
40 + neighborhood clinic sites
Member of “Six Clinics”
peer group:»
Cleveland Clinic Foundation, Mayo Clinic, Henry Ford Health System, Lahey Clinic, and Lovelace Health System
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Ochsner Health System and General ElectricConfidential & Proprietary Information
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Rwerwewrwer
DestrehanElmwood
OCHC - Slidell
Slidell
Hamm Heart-Vasc
HammondCovington
Uptown
Baptist
Lapalco
Metairie
OHC - KennerOCHC - Metairie
Ochsner Medical Center
OMC - Kenner Lake Vista
OHC - Algiers OBAlgiers
OMC - West Bank
OMC - Baton Rouge
Abita Springs
MidCity
Bluebonnet
Prairieville
Mandeville
Denham Springs
St. Anne
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Leadership
Ochsner Health System and General ElectricConfidential & Proprietary Information
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The dashboard
Category Goal Metric Period Actual Mortality NA Number of Inpatient DeathsMortality Rate <2% All Inpatient Deaths/Inpatient Discharges
Core Measures >90% Patient Appropriate Score (PACS) AMI >90% PACS
Heart Failure >90% PACS PN >90% PACS
SCIP >90% PACSOccurrence Reporting
Number of Falls Na Number of FallsFalls Rate <3 Inhospital falls: Per 1000 patient days
Discharges with Pressure Ulcers 0 Number of Patients with Pressure UlcersPressure Ulcers Rate 0% Patients with Pressure Ulcers/Discharges (%)
Medication Error (harm) Zero (0) NQF "with harm" status errors reportingInfection Control
Class 1 infections Zero (0)Post Op Surgical Site Infection - CDC definition
Class 1 infection rate Zero (0) Total Infections / Total Procedures (%)Catheter Associated UTI Zero (0) Number of Infections
Ventilator Associated Pneumonia (VAP) Zero (0) Number of InfectionsCentral Line Infections (CLI) Zero (0) Number of Infections
30 day re-admit rate <10% Acute Inpatient, All Payor 30 day re-admits
Risk Adjusted Mortality Index <.75 ***** Actual to Expected <.75 (All Payor Adult)Risk Adjusted Complication Index <.75 ***** Actual to Expected <.75 (All Payor Adult)
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Questions from Leadership
Despite standardized definitions of quality indicators….Why the lag in the data?Why is data reporting not consistent?Why do we have facilities who report zero hospital acquired pressure ulcers, falls, and medication errors with harm?
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Every now and then…
Ochsner Health System and General ElectricConfidential & Proprietary Information
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part two
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Our Communication mission
Ochsner Health System and General ElectricConfidential & Proprietary Information
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In the beginning…
System-wide teaser campaign―
Naming contest for systemAnnouncements at meetings (all levels in organization)Daily newsletters“Everyone”
emailsMail box in-servicesWebsite announcements (multiple pages)Computer learning modules –
not for training but to provide overview of systemIn-depth webinar with quality departments to introduce them to system capabilities
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Implementation –
Part 1
Began at Main Campus (largest facility)― Strict deadline due to previous contract agreements― One database for entire system
Initial "To Do”
list from vendor carried out by a representative from the PI Department and representative from the IT DepartmentSketched out phased implementation for other system hospitals
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Implementation –
Part 1
Held rapid cycle meetings with key departments to complete “pre-work”
in anticipation of customization
Designed constraints in the system to support― Definitions of occurrences― Standardized reporting
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Implementation –
Part 1
Team + Computer Screen = Event Specific Customizations― Analysts― Data entry
Focused on Dashboard Metrics― Medication/Fluid Errors― Pressure Ulcers― Falls
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Training Approach –
Part 1
Just in timeOne week prior to go liveFocused on Super Admins
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Resource Development
Ochsner Health System and General ElectricConfidential & Proprietary Information
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System Implementation (Part 2)
Rapid cycled each implementation at system facilitiesOne month cycle consisted of:―
Initial planning meeting with quality dept to establish go live date―
Facility “go live”
date determined training dates(JIT)Training schedule established and communicated to system facility“Go live”
date to coincide with search and destroy mission for paper occurrence forms
―
JIT training for quality departments one week prior to facility training―
Overlapped implementation cycles at system facilities
Ochsner Health System and General ElectricConfidential & Proprietary Information
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System Training
Tiered training (super admin, admin, general)Super Admins
attended live training
― They became the admin trainers –
team approach/divide and conquer
Feedback from attendees and observers revealed inconsistencies in training
― Standardized training agendas― Embedded standardized definitions of occurrences in
training
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Part three
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Reporting
Jan-Jun 2008 vs
Jan-Jun 2009
50% percent increase in reported occurrences across the system
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Run Chart
400500600700800900
10001100
Jan-08
Feb-0
8Mar-
08Apr-
08May-
08Jun
-08Jul
-08Aug-
08Sep-
08Oct-
08Nov-
08Dec-
08Jan
-09Fe
b-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Num
ber
of O
ccur
ence
s
Number of Occurrences Average for Time Period
Implementation Phases
Ochsner Health System and General ElectricConfidential & Proprietary Information
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SPC
0.00
200.00
400.00
600.00
800.00
1,000.00
1,200.00
1,400.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
xx-barLCLUCL
Ochsner Health System and General ElectricConfidential & Proprietary Information
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The dashboard
Category Goal Metric Period Actual Mortality NA Number of Inpatient DeathsMortality Rate <2% All Inpatient Deaths/Inpatient Discharges
Core Measures >90% Patient Appropriate Score (PACS) AMI >90% PACS
Heart Failure >90% PACS PN >90% PACS
SCIP >90% PACSOccurrence Reporting
Number of Falls Na Number of FallsFalls Rate <3 Inhospital falls: Per 1000 patient days
Discharges with Pressure Ulcers 0 Number of Patients with Pressure UlcersPressure Ulcers Rate 0% Patients with Pressure Ulcers/Discharges (%)
Medication Error (harm) Zero (0) NQF "with harm" status errors reportingInfection Control
Class 1 infections Zero (0)Post Op Surgical Site Infection - CDC definition
Class 1 infection rate Zero (0) Total Infections / Total Procedures (%)Catheter Associated UTI Zero (0) Number of Infections
Ventilator Associated Pneumonia (VAP) Zero (0) Number of InfectionsCentral Line Infections (CLI) Zero (0) Number of Infections
30 day re-admit rate <10% Acute Inpatient, All Payor 30 day re-admits
Risk Adjusted Mortality Index <.75 ***** Actual to Expected <.75 (All Payor Adult)Risk Adjusted Complication Index <.75 ***** Actual to Expected <.75 (All Payor Adult)
Ochsner Health System and General ElectricConfidential & Proprietary Information
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PACs
Percent of Discharges
Without Harm
AMI
PN
SCIP
CHF
Med Errors
Pressure Ulcers
Patient Safety
Indicators
Falls
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Dashboard Reporting
Leadership has moved past initial “data”
barriers and on to improvement―
Supports further accountability up and down leadership structure
Improvement doesn’t rest on the quality departments shoulder anymore
Data on dashboards reporting real time―
Raw data is reported as leading indicators
―
Data is now dynamicData integrity ensured―
Third party (informatics) pulls data for dashboard
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Alleviated Fears!
Severity Scoring― E vs
F
― Analysis results:No notable difference!Staff picked a higher level of incident severity
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Transparency
Quality leadership has access to all events across the system― Big Culture Change!― Reports developed to support ongoing surveillance― Events are discussed at monthly operating meetings,
focus is improvement, not blame― Organization leadership engaged in outcomes and
action plans
Ochsner Health System and General ElectricConfidential & Proprietary Information
29
Impact on Quality Departments
Organizational culture change = change in work process in the department ―
Quality departments are facilitating change and getting out of analysis paralysis!
―
Not just reporting the data and arguing validity―
Movement away from “recreational data collection”
Daily operations have shifted from extremely delayed retrospective manual chart audits real time investigations ―
Weekly Falls and Pressure Ulcer calls
Added capacity into quality departments
Ochsner Health System and General ElectricConfidential & Proprietary Information
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System Falls
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12
Week
Num
ber
of F
alls
Number of Falls Number of Falls With InjuryAve of Time Period Ave of Time PeriodLinear Trend
First month of w eekly calls
Second month of w eekly calls
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Response
Serious Event Group― Fired alerts improve notification of serious events― Ease or running surveillance reports further supports
notification and response to events― Increased awareness of reporting occurrences has led
to increased verbal reporting of occurrences
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Patient Safety Initiatives
Leadership support system wide patient culture assessment― Base line assessment― Highly utilized occurrence reporting system is
foundation for: Highly Reliable OrganizationImproved surveillance has identified underlying root causes of incidents across the system
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Success factors
Don’t get bogged down in consensus –
especially when under time constraintsCommunication between implementation team is crucialClear understanding of operational issues are necessary when customizing they systemUnderstand how your organizations learnAlways look aheadContinue to spread ongoing learningsDon’t stop promoting the system
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Lessons learned
When customizing, you aren’t always going to get it right on the first, second, third try…Flex to every situation―
Nothing is ever set in stone
―
Cannot put everything in a bucket―
Cannot please everyone!
You will always overlook something, that’s ok! Just don’t stop improving!Learn something from every implementation
Ochsner Health System and General ElectricConfidential & Proprietary Information
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Next Steps
Communication –
8 times 8 ways!Continuous renewal of the message!― Relentless pursuit of problem identification is the key
to faster improvement
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Questions?