Quality Leadership: From Bedside to the Board

Transcription

1 Quality Leadership: From Bedside to the Board Susan Moffatt-Bruce, MD, PhD, FACS Chief Quality and Patient Safety Officer Associate Dean of Clinical Affairs, Quality and Patient Safety Associate Professor of Surgery Associate Professor Biomedical Informatics 1

2 Value = Q U A L I T Y C O S T Mortality Patient Safety Indicators Hospital Acquired Infections Hospital Acquired Conditions Patient Satisfaction Readmissions Length of Stay Cost per procedure Cost per patient Cost per encounter Cost per admission Cost of readmissions Cost of length of stay Cost of unneeded tests Cost of consultations Cost of drugs 2

3 CMS Quality Measures 160 Inpatient Measures Outpatient Measures VBP Cancer Psych Rehab Tax Relief and Health Care Act of 2006 Deficit Reduction Medicare Act of 2005 Prescription Drug, Improvement, and Modernization Act of The American Recovery and Reinvestment Act of Affordable Care Act Pay-For-Reporting 0.4% point reduction in the annual market basket update for not reporting Pay-For-Reporting 2.0% point reduction in the annual market basket update for not reporting Value Based Purchasing 1% payment reduction incentive in % payment reduction incentive by 2017

4 CMS Quality-Based Payment Initiatives THE HOSPITAL INPATIENT & OUPATIENT QUALITY REPORTING PROGRAM PSYCHIATRIC / REHABILIATION / CANCER VALUE BASED PURCHASING 1.0% 1.25% 1.5% 1.75% 2.0% READMISSION REDUCTION PROGRAM 1% 2% 3% 3% 3% HOSPITAL-ACQUIRED CONDITIONS 1% 1% 1% MEANINGFUL USE* 1% 2% 3%

5 5 The Reality of Healthcare Transformation

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7 7 12 surgeons had a high risk-adjusted rate of complications.

8 Surgical Quality Officer Quality Medical Director Quality and Safety Advisor What s in a name? That which we call a rose By any other name would smell as sweet. Medical Director for Quality Patient Safety Officer Chief Surgical Quality Officer 8

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10 Lead Reorganization Support and lead Change Management Make long-term investments in technology to support high-value, patient-centric care Commit to comprehensive measurement and reporting of outcomes as a Strategy Make organizational commitments to full health system integration 10

11 Surgical Quality Officer: Why is the SQO necessary? Provide well-defined leadership in quality and safety Establish a governance structure for leading surgical quality and safety efforts Establish mechanisms to improve surgical quality and safety Work with other institutional leaders Seek out best practice models and quality improvement techniques Demonstrates to internal and external stakeholdersthat the institution is committed to quality and safety 11

12 Hospital Culture & Strategy for Improvement Department Culture & Strategy for Improvement Personal belief & behavior

13 Causes of Resistance to Change Organizational Causes Group Causes Individual Causes Inertia Group norms Fear of the unknown Culture Group cohesion Fear of failure Structure Leadership Job security Lack of rewards Poor timing Individual characteristics Previous experiences 13

14 The hospital s rate of colon surgical site infections (SSI) in increasing. There are distinct surgical divisions that perform colon surgery and each have their own SSI rates measured. The surgical quality medical director is very concerned and implements a best-practice bundle. She commits to measure and sharing all surgeon-specific rates on a monthly basis. A 25% reduction is established; the division that reaches their goal the fastest will not only be celebrated, but they will also receive more block time. This is an example of which conflict-handling strategy? a. Avoidance b. Accommodation c. Compromise d. Competition 14

15 Progress is impossible without change, and those who cannot change their minds cannot change anything. George Bernard Shaw

16 Key Characteristics of an effective SQO Proven leadership qualities, including: A compelling vision A sense of accountability Effective communication skills Excellent problem-solving abilities The capacity to think strategically and analytically Strong change management skills Relationship and consensus-building talents Mentorship capabilities An understanding of organizational behavior and culture 16

17 Leadership Theory Charismatic Leadership Transformational Leadership Controlling or Power Leadership Authentic Leadership Know who they are and what they believe in and value Act on values openly and candidly Followers consider them ethical people People come to have faith in them 17

18 The new surgical quality officer is holding a retreat. Amongst the many things he discusses, are the goals to eliminate never events in the operating room. The following week, after a long and difficult care, the radiologist calls him to alert him to a retained sponge. The division director immediately shares the event with the faculty and openly discussed why he thinks it happened and commits to engaging in the root cause analysis to improve the system. This is an example of: a. Transformational leadership b. Authentic leadership c. Charismatic leadership d. Power leadership 18

19 Managers Focus on the present Maintain status quo and stability Leaders Focus on the future Create change Implement policies and procedures Initiate goals and stragies Remain aloof to maintain objectivity Create a culture based on shared values Maintain existing structure Establish an emotional link with followers Use position power Use personal power 19 Art and Science of Leadership, Nahavandi

20 White coat leadership All knowing In charge Autocratic Inpatient Blames others Improvement leadership Humility Exhibits curiosity Facilitates improvement Learns from others Communicates effectively 20

21 Intentional On-purpose Skillful Above the Line Below the Line Impulsive On-autopilot Resistant Tim Kite, 5D 2015

22 Training and Qualifications of a SQO Leadership status and past experience in administrative senior positions; membership on a national surgical association Familiarity with data analytics and large clinical databases Knowledge of accepted approaches to change management: Lean, Six Sigma Ability to build effective teams; understand emotional Intelligence and management training 22

23 How to build an effective training environment Assessment and feedback Opportunity to implement change Effective Training and Development Support from the Chair Individual awareness and motivation Presence of role models and mentors 23

24 Event + Response = Outcome E + R = O Tim Kite, 5D 2015 The single biggest problem in communication is the illusion that it has taken place. George Bernard Shaw

25 Specific Responsibilities of the SQO Oversee the departmental quality and safety programs Organize data analytics; data collection and reporting Foster surgical education and training in QI Plan and initiate QI efforts and serve as the surgical champion Serve as the quality liaison with the hospital and executive teams 25

26 Key Resources for the SQO -Surgical Quality Safety Committee (SQSC) -Multidisciplinary Peer Review Committee (MPRC) -Institutional support -Data and analytic support 26

27 Quality and Safety Scorecard Type of Event Retained Foreign Bodies Wrong procedure/site/person events Medication Events with Harm (Severity E-I) Severe Injury Falls (Resulting in Change in Patient Outcome) Hospital Acquired Decubitus Ulcer Central Line Blood Stream Infections Ventilator Associated Pneumonia Hospital Acquired Surgical Site Infections Hospital Acquired Clostridium Difficile Infection Total Potentially Avoidable Events

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29 Observed vs Expected Mortality 3.00% 2.85% 2.50% 2.58% 2.22% 2.00% 1.91% 1.50% 1.78% 1.80% 1.78% 1.88% 1.00% 2012 (Partial) (Partial) Mortality Rate (Obs) Mortality Rate (Exp) 6/30/ /31/ /31/2010-6/30/2011 6/30/ /31/ /31/2011-6/30/2012 6/30/ /31/ /31/2012-6/30/2013 6/30/ /31/ /31/2013-6/30/2014 6/30/ /31/ /31/2014-6/30/2015 Mortality Rate 29 90% 85% 80% 75% 70% HCAHPS Doctor Communication Real-Time Risk and Shrinkage-Adjusted Projected Odds Ratio Report Data Snapshot Timestamp: 06/21/ :30 PM COLORECT SSI 07/01/ /30/2015 (Semiannual)

30 Scorecard-Academic Peers and Surgeon Specific LOS Index Direct Cost Index 7 Day Readmit 14 Day Readmit 30 Day Readmit Mortality Index PSI 09 PSI 10 PSI 11 PSI 12 PSI 13 A B C D CCF Stanford

31 Volume-driven to Value-driven Clinical Care Cost Volumedriven Healthcare Value-driven Healthcare Quality 31

32 Change is the law of life. And those who look only to the past or present are certain to miss the future. John F. Kennedy A good leader takes a little more than his share of the blame, a little less than his share of the credit. Arnold H. Glasow To be trusted is a greater compliment than being loved. George MacDonald