4/23/2012
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Category 6Operations Focus
April 16, 2012
William Conway, MDSr. Vice-President & Chief Quality Officer, HFHS
& CMO, Henry Ford Hospital
Panelists
William Conway, MD Sr. VP and CQO, HFHS & CMO, HFH [email protected]
Linda Bargamian Project Manager, Management [email protected]
Sharon Harpootlian
Bruce Muma, MD
Director, Medical [email protected]
CMO, HF West Bloomfield [email protected]
Lucy Young Director, System Quality Initiatives andHFH Performance [email protected]
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Integration Across 9 Business Units
4 acute care hospitals – Henry Ford Hospital staffed by Henry Ford Medical Group– 3 Community hospitals supported by both employed and
private practitioners
Henry Ford Medical Group Henry Ford Physician Network Community Care Services Behavioral Health Services Health Alliance Plan
“The Henry Ford Experience” 7 Pillars of Performance
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Operations Focus
How do you design your work systems?
How do you design, manage, and improve your key organizational work processes?
What are your health care and process effectiveness results?
Work Systems & Key ProcessesWork System & Key Process – Focus on “Each Patient First”
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How do we design & Improve?HFHS Model for Improvement (MFI)
Model for ImprovementUsed broadly in our leadership system . . . .
From designing new worksystems HF West Bloomfield Hospital Patient-Centered Medical Home
To kaizen events . . . To front-line daily improvement
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Model For ImprovementTraining
MFI (PDCA & Change Management)– New Leader Academy– Leader Academy– Advanced Leader Academy– Physician Leader Academy
Lean Training– Henry Ford Production System
(2-day class)– Lean Boot Camp (1-day class)
Change Management– Influencer Model
“Just-in-time” Training for Teams
Designing a New Work SystemPatient-Centered Medical Home
Henry Ford Health SystemPatient-Centered Team CareSM
Advanced Access
Same Day Appointments
Self-CareKiosk / Web
AccessHealth Assessments
Preventive Care Scheduling
E-VisitsRN Visits
Population Management
Preventive Care RemindersCPG Reminders
Shared Medical Appointments
Clinical Practice Guidelines (CPG)
Chronic Disease Management
Protocol Management
Routine Common Illness
Mid-level Provider Visits
Stable Disease Follow-upMinor Urgent CarePreventive Care
Planned VisitsScheduled Physicals
Tests completed prior to appt.
RN Case ManagementComplex Chronic Disease Care
“Ambulatory Intensivist”Poly-pharmacy Management
Palliative CareHome Care for Frail Elderly
Care CoordinationSpecialty Care
1ST Floor
2nd Floor
3rd Floor
4th Floor
Am
bu
lato
ry
Inte
ns
ive
Car
e In
terv
en
tio
ns
Clin
ica
l Pra
ctic
e R
ed
esi
gn
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Pilot Locations
Depression Management
OPD Discharge
Using Multiple PDCA Cycles to Redesign a Work System
Standardize all operations
Chronic Disease Mgt (Autos, HAP, UAW)
Patient Focus Groups
PGIP(BCBSM)
MiPCT(CMS State)
Care InnovationSteering Committee
e-Visits
Designing a New Work SystemPatient-Center Medical Home
Patient-Centered Medical Home Process Change Workplan
Inventing - R&D Piloting Spreading Fully Deployed
Depression – Impact Model in PCTC
PCTC RN Care Management
Gestational Diabetes Diabetes Self Management Educ.
Childhood Obesity PCTC Tel-Assurance Pediatric MH Special Needs Patients
Smoking Intervention Program
Back Pain for BCBSM Diabetes Support Group Facilitation
Depression In Primary Care
Anti-coagulation clinics
Panel Managers Health Engagement Visits
E-Visits Weight Management
OPD Discharge Process DocSite to OptimEyes E-Messaging Wound Care
DocSite Performance Reports
HAP/HEDIS P4P bonus for staff
DocSite use during visit Cardiac Rehab
Quality Bonus Lipid Clinic E-Prescribing
Clinical Program Culture Change Process Redesign
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No Harm
System Priority
StrategicRetreat
6 Aims CMS & IHIInitiatives
Key Work Process: Care DeliveryNo Harm Campaign
Design,Manage, Improve
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Infection
EmployeeOther
Medication Harm
Procedural
Care Delivery
C-Diff
Coded
Complications
Falls
Pressure Ulcers
Back Injury
Sharps
Assaults
Renal Failure
Blue Alert
OB Harm
Hypoglycemia
Sources of
Harm
Harm is unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalization, or that
results in death whether or not considered preventable.
Anticoagulation
Narcotics
Other
NSQIP
Pneumothorax
BSIs
VAPs
UTIs
Surgical Site Infections
Antibiotic Stewardship
Sepsis
Deep venous thrombosis
Leveraging our Core Competencies“Put Everyone to Work”
Efficient Use of Resources
Public Relations, Human Resources, Quality and Safety, Performance Improvement partnership
Safety Champion network
Delegate accountability and build on existing operational systems
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Infrastructure to Share Learnings & Deploy Improvement
System Quality Forum
Care InnovationTeam
Other QualityInitiatives
No Harm Steering
Committee
Medication(Pharmacy Council)
Falls & Pressure Ulcers(CNO Council)
Culture Change(Quality Forum)
OB Harm (OB Collaborative)
Procedural Harm (NSQIP SystemCollaborative)
Glucose(CMO Council)
BSI, VAP, SSI,C-Diff, UTI
(Infection ControlCouncil)
SharePoint Site
Sharing metrics;Building accountability
Design, Manage,Improve
It’s About Process
AND
Culture Change
(Change Management)
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Change Management: Creating a Culture of Safety
Leadership– Safety rounds
Training & Awareness– Human Factors– Conflict Management
Simulations
Communications– Departmental Safety
Champions (450+)– Weekly Safety Huddles– Daily event debriefs
Collaboratives– ICU, ER, OR, OB
Huddles
Engage . . .Innovate . . .Reduce Harm
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Engage . . .Innovate . . .Reduce Harm
Culture of Safety Results
76 77
74
6259
34
81 82
7468
65
53
8083
79
7370
58
0
10
20
30
40
50
60
70
80
90
100
Mgt actions show safety is
a priority
We are encouraged to
speak up
I would feel safe as a
patient here
Lots of nurse doctor
teamwork
Clinical disagreements resolved well
Communication breakdown
leading to care delays rare
%
Culture of Safety Question
2006 - 2010 Comparison of Percent Favorable: (4 - Agree and 5 - Strongly Agree)
2006 2008 2010 AHRQ 75th Percentile 2010 AHRQ 90th Percentile 2010
N=15,767 N=15,683 N=16,566 N=10,407 N=10,994 N=10,994
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HFHS Overall No Harm Results
HFHS Combined Harm RateCombined Harm Rate HFHS Hospitals by Hospital
20
30
40
50
60
70
80
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep
-08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep
-09
Nov
-09
Jan-
10
Mar
-10
May
-10
Jul-1
0
Sep
-10
Nov
-10
Jan-
11
Mar
-11
May
-11
Jul-1
1
Sep
-11
Nov
-11
Rat
e p
er 1
000
Day
s
HFH Clint on Twshp Warren West Bloomf ield Wyandot t e All All w M/ C and t rauma
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Harm Reduction Segmented by TypeInfection Related Harm Rate HFHS Hospitals
2
3
4
5
6
7
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep
-08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep
-09
Nov
-09
Jan-
10
Mar
-10
May
-10
Jul-1
0
Sep
-10
Nov
-10
Jan-
11
Mar
-11
May
-11
Jul-1
1
Sep
-11
Nov
-11
Rat
e p
er 1
000
Day
s
Includes BSI, SSI, VAP, c-diff, UTI(599.0, 996.64)
ALL HFHS HospitalsProcedure Related Harm Rate
5
6
7
8
9
10
11
12
Mar
-08
May
-08
Jul-0
8S
ep-0
8N
ov-0
8Ja
n-09
Mar
-09
May
-09
Jul-0
9S
ep-0
9N
ov-0
9Ja
n-10
Mar
-10
May
-10
Jul-1
0S
ep-1
0N
ov-1
0Ja
n-11
Mar
-11
May
-11
Jul-1
1S
ep-1
1N
ov-1
1
Rat
e p
er 1
000
Day
s
Other Harm Rate HFHS Hospitals
10
12
14
16
18
20
22
24
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep
-08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep
-09
Nov
-09
Jan-
10
Mar
-10
May
-10
Jul-1
0
Sep
-10
Nov
-10
Jan-
11
Mar
-11
May
-11
Jul-1
1
Sep
-11
Nov
-11
Rat
e per
100
0 D
ays
Includes Renal Failure, DVT, Blue Alert and Misc codes
Medication Harm Rate HFHS Hospitals
10
15
20
25
30
Feb
-09
Apr
-09
Jun-
09
Aug
-09
Oct
-09
Dec
-09
Feb
-10
Apr
-10
Jun-
10
Aug
-10
Oct
-10
Dec
-10
Feb
-11
Apr
-11
Jun-
11
Aug
-11
Oct
-11
Dec
-11
Rat
e p
er 1
000
Day
s
Obstetrical Harm OB Bundle (In process) OB Result (outcome)
0%
20%
40%
60%
80%
100%
10Q1 10Q2 10Q3 10Q4 11Q1 11Q2 11Q3 11Q4
Compliance w all expected aspects of care during labor Induction
HFH HFWH HFMHHFWBH Total
0%
20%
40%
60%
80%
100%
10Q1 10Q2 10Q3 10Q4 11Q1 11Q2 11Q3 11Q4
Compliance w all expected aspects of care during labor Augmentation
HFH HFWH HFMH
HFWBH Total
0
0.5
1
1.5
2
2.5
3
3.5
Q1
2009
Q2
2009
Q3
2009
Q4
2009
Q1
2010
Q2
2010
Q3
2010
Q4
2010
Q1
2011
Q2
2011
Q3
2011
Q4
2011
HFHS System OB Birth Trauma
AHRQ Est. 90%ile
HFHS
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Quality Pays
Harm reduction produced a $10 million variable cost reduction over 4 years
Over 10 years, malpractice expense was cut by 60%, saving more than $26 million per year
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Looking Forward Continue to identify key processes, owners and related
performance measures at all Business Units and in all work systems
Develop additional everyday in-process measures and drive accountability at every level
Continue to drive standard work – in clinical, administrative, and management processes
- Better deploy identified best practices across all Business Units and Work Systems
- Leverage our new EMR (EPIC) to drive standard practice
Leverage our annual Quality Expo to identify and spread best practices
- Update and share our annual No Harm Report
http://www.henryford.com/noharm
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Panel Discussion
William Conway, MD Sr. VP and CQO, HFHS & CMO, HFH [email protected]
Linda Bargamian Project Manager, Management [email protected]
Sharon Harpootlian
Bruce Muma, MD
Director, Medical [email protected]
CMO, HF West Bloomfield [email protected]
Lucy Young Director, System Quality Initiatives andHFH Performance [email protected]
A History of Quality Improvement Q101 (first use of industrial improvement tools) 1989
Pursuing Perfection (IHI/RWJ) - Eliminating Suicide Project 2002
CMS demonstration on surgical site infections; tight Glucose Control Project
2003
MHA Keystone ICU Projects 2004
Chronic Care Initiative with HAP and Autos 2004
100K Lives Campaign – Mentor Hospital 2005
E-Prescribe 2006
Sepsis Management 2006
Care Redesign Centers (B6, F4, Medical Home) 2007
5M Lives Campaign – Mentor 2007
No Harm Campaign 2008+
Lean Lab Process Management 2009
Depression Management in Chronic Disease 2010
Patient Guided Care Redesign 2011
Care Coordination (leveraging Readmissions work) 2012
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National Best Practice Safety Innovations
HFHS Process HFHS Outcome Validation
Perfect Depression Care Model Up to 180 lives saved from 2002 to 2011
Codman Award (TJC) 2006 Nat’l Suicide Action Alliance (HHS) 2011
Sepsis Bundle and Deployment In the last 12 months 211 deaths prevented
New England Journal of Med., Kaiser, HCA, others
No Harm Campaign 16,360 fewer harm events over the past three years
AHA Quest for Quality Award 2010 VHA Patient Safety Leadership Award 2009
John M. Eisenberg Patient Safety and Quality Award 2011 (NQF and TJC)
Dialysis Catheter Antibiotic Lock Prevent 80 catheter infections annually Nat’l Kidney Foundation of MI Innovations Award 2011
NSQIP Execution and Deployment
1,000 fewer procedural harm events annually
American College of Surgeons National Initiative Consultants 2009-2011
Pharmacist Directed Anticoagulation Service
Out of Range Test ResultsDecreased by 80%
CMS Partnership for Patients Best Practice2009 ASHP Safety Award
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