UW Medicine Case Study

Transcription

1 Learn Serve Lead April 2013 Association of American Medical Colleges

2 ABOUT THE BEST PRACTICES FOR BETTER CARE CASE STUDY SERIES Better performers from the Best Practices for Better Care initiative, identified through baseline clinical outcomes, staff survey data, and engagement in the initiative, were interviewed in winter to communicate strategies and factors for success from these organizations in the areas of quality and patient safety. A series of case studies will be developed and available online to share the success stories from these participating sites. CONTRIBUTORS TO THIS CASE STUDY UW Medicine Kimberly Burton, Ph.D. BPBC Coordinator UW Medicine Lawrence Robinson, M.D. Vice Dean of Clinical Affairs and Graduate Medical Education UW Medicine AAMC/UHC Best Practices for Better Care Project Team Alicia Blakey, M.S. Project Specialist, AAMC Susan Hossli, M.S.N., R.N. Project Manager, UHC Meaghan Quinn, MHSA Senior Program Specialist, AAMC 1

3 BEST PRACTICES FOR BETTER CARE INITIATIVE The Best Practices for Better Care initiative, started in 2011 by the AAMC (Association of American Medical Colleges) and the UHC, was launched to improve the health of the communities we serve by harnessing the unique missions of academic medicine medical education, patient care, and research and applying them to the challenge of improving health care. Medical schools, teaching hospitals, and health systems participating in this unique effort have committed to: Teach quality and patient safety to the next generation of doctors Ensure safer surgery through use of surgical checklists Reduce infections from central lines using proven protocols Reduce hospital readmissions for high-risk patients Research, evaluate, and share new and improved practices. Through data sharing, tracking, and reporting, participants are evaluating clinical practice improvement efforts and identifying educational needs. Through research and evaluation, participants are continuing to refine and discover best practices, and share knowledge with others to improve the overall health of the communities they serve. A number of resources are available to participants including quarterly reports to track performance over time, online access to benchmarking and performance improvement toolkits, educational programs and Web conferences, and performance improvement collaboratives. For more information and a list of participating institutions, visit: To access project resources, visit: 2

4 ABOUT UW Medicine includes four hospitals (University of Washington Medical Center, Harborview Medical Center, Valley Medical Center and Northwest Hospital & Medical Center), the University of Washington School of Medicine, a large physician practice plan (UW Physicians), a network of ambulatory clinics (UW Neighborhood Clinics) and a critical care air transport service (Airlift Northwest). UW Medicine also shares in the ownership of the Seattle Cancer Care Alliance and Children s University Medical Group. The University of Washington School of Medicine serves as the public medical school for Washington, Wyoming, Alaska, Montana and Idaho (WWAMI Program). UW Medicine has approximately 22,000 employees and 4,500 students and trainees. LEADERSHIP & COLLABORATION UW Medicine is led by one individual who is appointed chief executive officer (CEO) of UW Medicine, executive vice president for medical affairs, and dean of the School of Medicine, University of Washington. UW Medicine has three university-level vice presidents who report to the CEO and serve in UW Medicine administrative roles as chief health system officer, chief business officer and chief financial officer. UW Medicine has a single mission---to improve the health of the public. The leadership structure is designed to support integration and alignment of teaching, research and healthcare activities across all UW Medicine owned or managed entities. The leadership of UW Medicine have established system-level quality and patient safety goals and targets. Quality is one of the four pillars of UW Medicine s strategic priorities, and a robust infrastructure is in place to ensure the coordination and communication of these goals across all hospitals and ambulatory clinics. There is one oversight committee for quality and patient safety, the UW Medicine Quality and Patient Safety Executive Committee, which includes representation from the major practice sites. The committee meets monthly to discuss, establish, and track patient safety and quality improvement priorities. The committee then coordinates with the associate medical directors at each site to ensure that goals and targets are communicated system-wide, and that learning needs are identified and addressed across the enterprise. INFRASTRUCTURE A focus on data transparency across UW Medicine has given medical directors access to real-time, online clinical data. The data are regularly used at department meetings and other leadership team meetings to drive improvements in care delivery. 3

5 One of the advantages of the rollout of this system-wide clinical data tool was the engagement of the department chairs early on in the design and implementation of the project. Input from the clinical department chairs was critical to moving this initiative forward. PATIENT SAFETY INNOVATIONS PROGRAM The Patient Safety Innovations Program was established to encourage participation and innovation at the frontline level. Funding for the program is from the organization s self-insurance risk pool and supports the testing and development of new programs to improve patient safety. The program receives applications and awards six to eight grants each cycle. The program has supported such programs as TeamSTEPPS training and coordinating use of data for morbidity and mortality conferences to create educational modules. Leadership found that the program fosters discussion and awareness about quality and patient safety issues across the organization. Several proposals from the program have been adopted as institutional programs or priorities. EDUCATION & TRAINING The WWAMI regional medical education network is a unique academic partnership that meets the educational and workforce development needs of the five-state region. Through its undergraduate medical education (UME) and graduate medical education (GME) programs, UW Medicine provides training and programs to foster understanding of quality improvement and patient safety (QI/PS) in the next generation of health professionals. In 2007, UW Medicine developed and implemented a series of e-learning modules to educate residents broadly about QI/PS. This portfolio of online courses is available to all incoming house staff and covers topics such as central line placement, infection control, and disclosure of adverse events. In 2011, UW Medicine established a House Staff Quality and Safety Council with the goal of integrating and aligning residents training and activities in quality improvement (QI) with the organization s overall quality and safety priority areas. There are currently residents participating on the council, representing various departments from the hospitals and clinics. The co-chairs hold monthly educational sessions to discuss issues that they are facing and identify resident-led QI initiatives. The council is supported by the administration with staff and faculty support from senior leaders in the organization. Faculty advisors to the House Staff Quality and Safety Council also sit on the UW Medicine Quality and Patient Safety Executive Committee, which ensures that the residents concerns are addressed by the senior executive team and that their proposed QI initiatives are aligned with the overall health system QI/PS goals. 4

6 FOCUS ON CENTRAL LINE INFECTIONS Through Best Practices for Better Care, UW Medicine has implemented a comprehensive program for reducing central line complications and infection rates. This program was initiated several years ago by bringing together an interdisciplinary team comprising representatives from the UME and GME programs, two representatives from the UW Medicine Quality and Patient Safety Executive Committee, nurses in clinical leadership positions, staff from infection control, representatives from the practice plan, and a research expert in QI/PS. The team works together regularly to review their institution-specific data and identify interventional and educational strategies. Although the organization has had a central line checklist protocol in place for several years, results from their first Best Practices for Better Care Frontline Check-in Staff Survey showed that over 25 percent of the respondents did not know about the checklist, or reported that the organization did not use a central line checklist (see Figure 1). Based on these results, a major effort to raise awareness about central line checklist usage was started organization-wide. The team has shared these data with department chairs and program directors, and is working with anesthesia residents and the House Staff Quality and Safety Council on how to better disseminate knowledge about the central line checklist to residents. This initiative has also provided an opportunity for faculty and staff to improve education programs for medical students about central line placements and care, and to better delineate the role of students in central line maintenance. Figure 1: Results from the Frontline Check-In Survey Does your organization use a central line checklist? Percent of Respondents Yes No Don t Know Jan-12 Oct-12 5

7 In addition to the engagement of the interdisciplinary teams, this effort has improved alignment of medical and nursing staff around the goal of reducing central line infection rates. The nursing staff are engaged with the project team, and also work with the House Staff Quality and Safety Council to improve engagement of residents in improving care processes and reducing infection rates. As a result of the team s efforts, UW Medicine has achieved a marked decrease in central line bloodstream infections in the last two years. Figure 2: PSI 07: Central Venous Catheter-related (CVC) Bloodstream Infections PSI 07: CVC Bloodstream Infections Rate per UWMC BPBC KEY FACTORS FOR SUCCESS There are several key factors that have contributed to the success of UW Medicine s QI/PS efforts across the entire organization: organizational structure that supports coordinated planning, implementation, and communication about QI/PS goals; commitment from leadership and dedication of resources to QI/PS efforts across the clinical, education, and research activities; incorporation of QI/PS into the UME and GME curricula and training programs, and meaningful engagement of residents into the organizational QI/PS agenda through the House Staff Quality and Safety Council; and engagement of interdisciplinary teams that include clinical, education, and research personnel to drive clinical quality improvement in a coordinated, data-driven approach. 6

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