Georgia Hospital Engagement Network Patient and Family-Centered Safe Care: Our Top Priority

Transcription

1 Georgia Hospital Engagement Network Patient and Family-Centered Safe Care: Our Top Priority Overview The Georgia Hospital Engagement Network (GA HEN) serves 112 Georgia hospitals located across the state. Of the 137 acute care hospitals in Georgia, only one is not a member of any HEN. Three acute long-term care facilities, 12 teaching hospitals, 74 urban/suburban hospitals and 55 rural hospitals are also voluntarily engaged to meet the 40/20 bold aims. The GA HEN hospitals zealously share their successes with other hospitals and HENs, often serving as speakers at training events. Excitement grows during in-person events as participants network and ask one another for contact information. Copies of resources such as policies and checklists that support their successes are freely shared. They have become a strong and committed network of individuals and hospitals, partnering to assure that patient and family-centered safe care is provided to all patients in Georgia. Georgia has served as lead for various affinity groups: rural, maternity, patient and family engagement and CAUTI. Partnerships and Networking There is no doubt the Partnership for Patients Hospital Engagement Network Program has promoted true partnerships and alignment needed to make rapid changes. The national attention regarding the Partnership for Patients has generated excitement and enthusiasm for meeting the aims of the Partnership, and has led to reinforcement of existing and stimulated the development of new collaborative projects among external partners. We would not be where we are without HEN resources and support! We have learned successful strategies from other participants related to discharge and reducing readmissions. We are including patients in our work. They have been helpful in modifying our discharge process. HEN has been a catalyst to get us more on track and getting executive buy-in. We have been prompted to be creative in engaging staff through HEN Parties. We have been able to share our own successes with others too! The HEN Partners Steering Committee includes members from Georgia Public Health, Quality Improvement Organization (QIO) - Alliant Georgia Medical Care Foundation (Alliant GMCF), Southeastern Kidney Council, ESRD Network, Medical Association of Georgia (MAG), Georgia Health Care Association(SNF), Georgia Association for Home Health Agencies, State Office of Rural Health, Medicaid, representatives from the state level primary care, home health care, and nursing home associations, and other HENs. Potential projects are brought to Selina Baskins, RN Northridge Medical Center this group. The partners respect each other s strengths and capacities. We emphasize coordination of activities to avoid duplication. Together, we present a united front with the 1

2 The Georgia Hospital Association's all-out embrace of patient and family-centered care serves as a definitive model for others. I am proud of their no holds barred commitment to the patients they serve. Victoria Nahum Executive Director Safe Care Campaign same message regarding the aims and judiciously and strategically use partner-specific resources that will enhance and hasten results. Hospitals participating in our Patient and Family Engagement (PFE) pilot program with the National Partnership for Women and Families have been able to provide leadership in showing others the value of PFE. It is heartening to read in many training event evaluations that PFE is a major thrust for them now. Many hospitals indicate they are using both intentional rounding and communication white boards to actively partner with patients and their designated family member(s) or care giver(s) in their health care. Education regarding their condition is continuous. Patient and family knowledge regarding medications and follow up care is leading to smooth and safe transitions of care avoiding unnecessary readmissions. Working with the March of Dimes, Georgia Public Health and other professional groups such as the Georgia Society for Obstetrics and Gynecology, we were able to reduce Early Elective Deliveries (EEDs) in just 9 months by 45%, with a current rate of 3.6% as of September Maintenance of these gains has been reinforced by working with the Department of Community Health and Medicaid to include aligned measures related to their new payment policy related to EEDs. These relationships have led to additional work we have just begun with Public Health related to reducing maternal hemorrhage. Working with the QIO (Alliant GMCF) and the Community Care Transitions Program (CCTP), we have spread successful strategies for reaching out to the community to non-cctp areas. Hearing the value of the strategies used by CCTP, individual hospitals are initiating many of the best practices such as linking with their Area Agency on Aging to provide services like care coaching and promoting self-management through the chronic disease self-management program within their communities. Alliant GMCF has provided experienced trainers to educate hospitals on communication, teamwork and mutual support strategies using TeamSTEPPS and medication reconciliation using the MATCH Tool Kit. Working with Georgia Public Health, Georgia HAI Coordinator, Georgia HAI Advisory Committee, Georgia Infection Prevention Network, Atlanta APIC and Alliant GMCF, we are embarking on a joint project on antibiotic stewardship by engaging pharmacists and physicians. In concert with these activities, we have provided education on reduction of Clostridium difficile and other MDROs. The Public Health HAI Coordinator, QIO HAI Specialist, and Georgia HEN IP meet regularly to coordinate education and other work for the state including NHSN support. 2

3 The patient and family- centered approach plays a major role in meeting our goals beyond the doors of our organizations. As advocates for quality patient care, it is crucial to ensure our patients and their families are empowered to partner with all healthcare providers to meet our goals in achieving quality outcomes for all Georgians. Jacqueline Herd, MSN, BS, RN Chief Nursing Officer, Atlanta Medical Center Georgia HEN staff has benefited from other HENs success by participating in national pacing events and affinity group calls. Serving as Affinity Group Leads or Co-Leads for various Affinity Groups (Rural, Hospital Acquired Infection, Maternal, Patient and Family Engagement) has provided staff the opportunity to help plan and lead events. These events assist Georgia hospitals in achieving PfP aims by hearing successes from their peers. Through the HEN Leaders conference calls, we have shared and obtained resources helping Georgia hospitals to rapidly spread what others have learned to eliminate harm and reduce preventable readmissions. For example resources developed by Georgia hospitals using their successes such as the Georgia HEN Enlightened Leadership Guide, Getting to Zero: Executive and Organizational Behaviors were shared. On the other hand, Georgia benefitted from the Patient and Family Engagement Master Classes, Minnesota Safe Skin and Safe from Falls Roadmaps, and several Joint Commission resources. Highlights/Accomplishments The PfP Hospital Engagement Network is the first true example of all patient safety stakeholders and organizations working together for patient- and family-centered care to improve quality and eliminate preventable harm. This strengthened partnership with patient safety stakeholders ensures a unified voice regarding patient safety along with comprehensive non-duplicative technical assistance to all hospitals to improve patient safety. There is a renewed emphasis on patient and family-centered care. Hospitals are exploring and using new methods to actively engage patients and their families in health care decisions. In addition, our focus on leadership engagement has led to improvement in support of our aims throughout the hospitals. The GHA Board recently unanimously adopted 2014 goals including reductions in catheter-associated urinary tract infections, readmissions, and patient and family-centered care, which addresses disparities and truly engages them in healthcare decisions. The public-private partnership between the Georgia Hospital Association and the Georgia Department of Public Health is a shining example of how real cooperation is changing the healthcare landscape in Georgia. GHA's support of DPH has strengthened the department's reach through essential programs promoting 'Safe Sleep' for babies, the importance of breastfeeding, and reducing the pre-term birth rate, among others. We are truly grateful. Dr. Brenda Fitzgerald Commissioner GA Department of Public Health 3

4 Results Coming together with our partners, we have averted more than 2,260 adverse events and 3,182 readmissions, avoiding related costs in excess of $56 million. More than 5,300 early elective deliveries were prevented, allowing for full gestation, better outcomes and head starts in school. Baseline 2010 (except ADE-Q1-2013) 5,307 Early Elective Deliveries (EED) 3,182 Readmissions $28.0M-30.5M 921 Adverse Drug Events (ADE) $1.8 M 321 Central Line Associated Blood Stream Infection (CLABSI) $ M 286 OB Other $900 K Deep Vein Thrombosis /Pulmonary Embolism DVT/PE $119K - $770K 70 Falls $787K-2.1M 52 Catheter Associated Urinary Tract Infection (CAUTI) $39K - $308K 2 Surgical Site Infection CABG (SSI) $117K Note: Incidences of Harm reduced from CY2010 baseline to CY7/12 6/13. Readmission Reductions are from CY2010 to CY 4/12-3/13. Data Sources: Readmissions Data-Hospital Wide Readmissions calculated from Georgia Discharge Database (GDDS); EED Data- Self Reported by hospitals; HAC/HAI Data- are calculated using CMS/AHRQ specifications from GDDS. $21.8 M-41.8M 4

5 The results can be attributed to sharing of lessons learned among HEN hospitals. We currently have more than 80% of Georgia HEN hospitals using national best practice strategies to assure patients receive the care they deserve and eliminate harm and avoid preventable readmissions, and that number grows daily! In just 18 months, significant gains have been made. Lessons Learned Certain Leadership and Organizational behaviors have made Getting to Zero possible. The model displayed on the following page includes the general behaviors and actions that Georgia hospitals have found to be successful in moving their organizations to a no harm environment. Hospital evaluations have aided in our identification of needed topics, and we have been able to see a gradual Employees focus on what their leadership tells them is important and model the behaviors and actions that the leader wants the staff to emulate. Sheila Bennett, RN, BSN, MHA, SPHR Vice President/CNO, Floyd Medical Center 5

6 CEO huddles help to bring attention to safety and give visibility to the importance of quality. It becomes clear that quality is no longer just my job. Mary Pizzino Effingham Hospital change from initially feeling overwhelmed to a new sense of excitement regarding their accomplishments. Leadership commitment which also assures active physician and hospital Board engagement is a must. Leaders need to visibly include the voice of the patient, spread the vision that quality and safety is everyone s responsibility, hold all accountable and celebrate successes. These Leadership behaviors promote the organizational behaviors needed to get to zero: standardized and reliable processes that lead to patient and family-centered care for every patient every time for which all hold each other accountable; institutionalization of the concepts of all teach, all learn and the answer is in the room which will lead rapid change to eliminate harm; and engagement and motivation through keeping the drum beat going through recognition and celebrations. GETTING TO ZERO Leadership Commitment Behaviors Expect care that is what you want your mother to receive Define quality with voice of customer Gain board and physician active engagement in improving quality and safety Close the gap between leadership and front line staff sense of urgency Communicate strong visibility/transparency related to quality/safety campaign Narrow knowledge and execution gap Spread vision that quality is everyone s responsibility and what s best for patient; not just external requirement Systems and processes to support patient and family-centered care Standardized reliable process for every patient every time Demand accountability and consistency from each other Align quality, service and safety Engage and motivate through continuously Beating the Drum Institutionalize concepts of all teach, all learn and the answer is in the room to spread rapid cycle change Culture of Safety Organizational Behavior 6

7 As of December 1, 2013, the GA HEN has provided 131 educational activities for 9,726 participants totaling hours of training with an average evaluation summary of 4.55 on a scale of 1-5, with 5 being excellent. Through these programs, many hospitals that would never have been able to attend without HEN resources, have learned from national experts and taken this knowledge back to others in their hospital. A recurring statement on training event reports relates to the value participants attribute to hearing from their peers what worked for them. Forward Look Culture change to address all harm across the board is often the most difficult to attain, but we are beginning to see the shift occurring in our hospitals. We will continue to provide hospitals with tools and resources to accomplish this. We have found that positive recognition creates a friendly competition and motivates increased attention to improvement efforts. Additional tasks will continue to be used and built into the Safety Leaders Circle criteria such as participation in three Adverse Drug Events to broaden the reduction of harm related to medications. Many report that the use of bundles, nurse driven protocols, and front line engagement contributes to their success. They are also finding that the use of intentional rounding is supportive of patient and family-centered care. Going forward, we will continue to advance these techniques in the context of our model shown below. 7

8 If we don t do quality care, we cannot keep the doors open it is plain and simple, and the right thing to do. As CEO, it is my responsibility to get everyone on board. We have a culture of accountability for evidence-based practices. Norma Morgan, CEO Effingham Hospital Staff will continue to coach hospitals regarding adaptive and technical solutions including: Culture of Safety for all staff and patient and familycentered care, evidence-based leadership, reliable systems process design, front line defects analysis, CUSP, Lean Six Sigma and TeamSTEPPS. Hospital visits to an assigned cohort will continue with a focus on making Harm Across the Board the new normal. The results of a proposed practical model for Patient and Family Engagement will be provided to the GHA Board for their endorsement and promotion through the 2014 strategic plan. In 2014, we will utilize Victoria Nahum to provide on-site coaching to hospitals interested in doing more to engage families and patients. Three learning labs will also be conducted by Georgia Regents University, where teams from hospitals are able to see patient and family engagement in action, and have candid conversations with staff that practice patient and family-centered care. Our third year commitment form includes a pledge by CEOs to focus on implementing specific strategies related to patient and family engagement. The HEN Partners group will be informed of new HEN directions and they will be engaged in assuring coordination of similar efforts to assure unity of approach and avoiding duplicative services and requirements. The agenda will continue to include time to review each stakeholder s projects and outline how to complement efforts for the greatest results statewide. The signature style developed for the National Content Developers events includes various strategies that engender positive movement. These components, already incorporated into many of our meetings, will be used more extensively in all HEN events. We will frame events and pose questions to run on as well as include active engagement exercises so participants can process and harvest what they have learned. In all our HEN conversations, we will be promoting the answer is in the room, encouraging all teach, all learn, and keeping the drum beat going, using yes and, and effective questions; flipping; making assertions and declarations; and acknowledging and recognizing achievements especially publicly. The PfP HEN program has clearly demonstrated value in promoting patient and family-centered safe care. The HENs have long-standing strong relationships that they can call on to encourage hospitals across the country to make significant and rapid changes to eliminate harm and reduce unnecessary readmissions. Future contracts to achieve continuing all harm efforts might benefit from up front direct involvement of HENs, QIOs and other safety stakeholders to provide input into specific scopes of work for the various quality and safety CMS contracts. These discussions would aid in assuring no duplication, but rather the supportive synergy of all working together on similar results-oriented projects simultaneously to achieve current and future bold aims. 8

9 GA HEN Partners External Partners Addie Sims (Consumer Representative) AHA HRET Alliant/Georgia Medical Care Foundation (QIO) American Heart Association/American Stroke Association Amerigroup /Georgia Medicaid Care Management Organizations Area Agency on Aging Atlanta APIC Atlanta Regional Commission Ethica Evercare Georgia Association of Healthcare Quality Georgia Association of Home Health Agencies Georgia Cancer for Oncology Research and Education (CORE) Georgia Chapter of Certified Nurse Midwives Georgia Department of Community Health, Medicaid Department Georgia Department of Human Services Georgia Department of Public Health Georgia Department of Public Health, Healthcare- Associated Infections Program Georgia OB/GYN Society Georgia Health Care Association Georgia Hospice and Palliative Care Association Georgia Infection Prevention Network (GIPN) Georgia Medical Care Foundation (QIO) Georgia Nurses Association Georgia Nursing Leadership Coalition Georgia Organization of Nurse Leaders Georgia Society for Clinical and Resource Management Georgia State Office of Rural Health Georgia State University Institute of Industrial Engineers IPRO March of Dimes Medical Association of Georgia National Partnership for Women and Families National Transitions of Care Coalition Pharmaco-Therapeutics Committee Premier Georgia Roger Resar, MD Safe Care Campaign Southeast Kidney Council The Studer Group United Healthcare VHA Georgia Georgia HEN Hospitals Appling Healthcare System/Appling Hosp. Atlanta Medical Center Bacon County Hospital and Health System Barrow Regional Medical Center Bleckley Memorial Hospital Burke Medical Center Candler County Hospital Cartersville Medical Center Chatuge Regional Hospital, Inc. Chestatee Regional Hospital Clearview Regional Medical Center Clinch Memorial Hospital Coffee Regional Medical Center, Inc. Coliseum Medical Centers Coliseum Northside Hospital Colquitt Regional Medical Center Cook Medical Center Crisp Regional Hospital, Inc. DeKalb Medical At Hillandale DeKalb Medical At North Decatur Doctors Hospital of Augusta Doctors Specialty Hospital Dodge County Hospital Donalsonville Hospital, Inc. East Georgia Regional Medical Center Eastside Medical Center Effingham Health System Elbert Memorial Hospital Emanuel Medical Center Emory Johns Creek Hospital 9

10 Emory University Hospital Emory University Hospital Midtown Erlanger at Hutcheson Evans Memorial Hospital, Inc. Fairview Park Hospital Fannin Regional Hospital Flint River Hospital Floyd Medical Center Georgia Regents Medical Center Good Samaritan Hospital Grady Health System/Grady Memorial Hospital Gwinnett Medical Center System Habersham Medical Center Hamilton Medical Center Higgins General Hospital Houston Medical Center Irwin County Hospital Jasper Memorial Hospital Jeff Davis Hospital Jefferson Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital Lower Oconee Community Hospital Meadows Regional Medical Center Medical Center of Central Georgia Medical Center of Peach County Memorial Hospital and Manor Midtown Medical Center Miller County Hospital Monroe County Hospital Morgan Memorial Hospital Mountain Lakes Medical Center Murray Medical Center, Inc. Newton Medical Center North Fulton Hospital North Georgia Medical Center Northridge Medical Center Northside Medical Center Oconee Regional Medical Center, Inc. Optim Medical Center - Jenkins Optim Medical Center - Screven Optim Medical Center - Tattnall Perry Hospital Phoebe Dorminy Medical Center Phoebe Putney Memorial Hospital Phoebe Sumter Medical Center Phoebe Worth Medical Center Piedmont Fayette Hospital Inc. Piedmont Henry Hospital Piedmont Hospital, Inc. Piedmont Mountainside Hospital, Inc. Piedmont Newnan Hospital, Inc. Pioneer Community Hospital of Early Polk Medical Center Putnam General Hospital Redmond Regional Medical Center Saint Joseph s Hospital of Atlanta Smith Northview A Campus of South GA Medical Center South Georgia Medical Center South GA Medical Center Berrien Campus SE Georgia Health System, Brunswick SE Georgia Health System, Camden Southern Regional Medical Center Southwest GA Regional Medical Center Spalding Regional Medical Center St. Francis Hospital, Inc. St. Mary's Health Care System, Inc. Stephens County Hospital Sylvan Grove Hospital Tanner Medical Center/Carrollton Tanner Medical Center/Villa Rica Taylor Regional Hospital Tift Regional Medical Center Ty Cobb Regional Medical Center Union General Hospital, Inc. University Hospital University Hospital McDuffie Upson Regional Medical Center Warm Springs Medical Center Washington County Regional Medical Center Wayne Memorial Hospital Wills Memorial Hospital 15

11 Other HEN Hospitals Athens Regional Medical Center, Inc. (VHA, Inc.) Brooks County Hospital (VHA, Inc.) Cander Hospital Svannah (Premier, Inc.) Children s Healthcare of Atlanta at Egleston (Ohio Children s Hospital Solutions for Patient Safety) Children s Healthcare of Atlanta at Scottish Rite(Ohio Children s Hospital Solutions for Patient Safety) Emory Adventist (Premier, Inc.) Gordon Hospital (Premier, Inc.) Grady General Hospital (VHA, Inc.) John D. Archbold Memorial Hospital (VHA, Inc.) Mayo Clinic Health Systems in Waycross (VHA, Inc.) Memorial Health University Medical Center (Premier, Inc.) Mitchell County Hospital (VHA, Inc.) Northeast Georgia Medical Center (VHA, Inc.) Northside Hospital (VHA, Inc.) Northside Hospital Cherokee (VHA, Inc.) Northside Hospital Forsyth (VHA, Inc.) Rockdale Medical Center (Lifepoint, Inc.) St. Joseph's Hospital Savannah (Premier, Inc.) WellStar Cobb (Premier, Inc.) WellStar Douglas (Premier, Inc.) WellStar Kennestone (Premier, Inc.) WellStar Paulding (Premier, Inc.) WellStar Windy Hill (Premier, Inc.) West Georgia Health System (Premier, Inc.) Non-HEN Hospitals Trinity Hospital of Augusta Hospital Name Changes Berrien County Hospital South GA Medical Center Berrien Campus Doctors Hospital Doctors Specialty Hospital Gwinnett Medical Center Duluth part of Gwinnett Medical Center System Hughston Hospital Northside Medical Center The Medical Center Midtown Medical Center Memorial Hospital of Adel Cook Medical Center A Campus of Tift Regional Medical Center Peach Regional Medical Center Medical Center of Peach County Smith Northview Hospital Smith Northview A Campus of South GA Medical Center Walton County Hospital Clearview Regional Medical Center 16