Strategic Planning for Stroke Center Accreditation/Certification. Suzanne Borgos, MBA/MHA VP, Planning

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1 Strategic Planning for Stroke Center Accreditation/Certification Suzanne Borgos, MBA/MHA VP, Planning

2 Disclosures I have no pertinent relationships to disclose. 2

3 Stroke Care at Capital Health Regional Medical Center Campus -Joint Commission Primary Stroke: Disease-Specific Certification: 2008, 2010, NJ Department of Health Primary Stroke Center Designated: NJ Department of Health Comprehensive Stroke Center Designated: Joint Commission Comprehensive Stroke Center Designated: 2013 Hopewell Campus NJ Department of Health Primary Stroke Center Designated: 2007 Joint Commission Primary Stroke: Disease- Specific Certification: 2008, 2010, 2012, 2014 Capital Health Regional Medical Center is the Nation s ONLY Hospital Named Both 2012 Top Performer in Stroke and Comprehensive Stroke Center by Joint Commission 4

4 The Strategic Approach to Program Create a shared vision Development Evaluate your current and future competitive position related to neurovascular services in your region Develop a business plan and strategies to achieve your vision that addresses capital needs, physician needs, operational performance, and quality Constantly monitor your progress and competitive environment and amend your plan accordingly 5

5 Why Do We Need Stroke and Cerebrovascular Centers? Approximately three to six million people in the United States have unruptured brain aneurysms Stroke is the third leading cause of death in the United States and is the leading cause of disability Time to treatment, experienced providers, and the proper infrastructure can lead to improved outcomes It is estimated that about 300,000 people in the United States have arteriovenous malformations Certified Stroke and Cerebrovascular Centers The estimated direct and indirect cost of stroke in the United States for 2010 is $73.7 billion According to the 2005 Behavioral Risk Factor Surveillance System (BRFSS), 2.1% (146,000) New Jersey residents age 18 or older had a history of stroke Sources: American Stroke Association; National Institute of Neurological Disorders and Stroke, State of New Jersey, Department of Health and Senior Services, and Office of Health Care Quality Assessment, 6

6 Marketing Associations Quality assurance Outcome metrics Foundation Stroke/Cerebrovascular Cognitive & behavioral disorders Movement disorders Epilepsy Headache center Neuromuscular disorders Trauma/brain Neuro-ophthalmologic disease Neuro-oncology Pain Seizure disorders Spine/back Sleep Comprehensive Neuroscience Program Components Adult Pediatric General neurosurgery techniques Minimally invasive surgical techniques Stereotactic neurosurgery Stereotactic radiosurgery Functional neurosurgery Certified nursing Nutrition Pharmacy Psychology Pain management Social services Post-acute rehabilitation Outreach Inpatient Care Disease Specific Programs Program Infrastructure Neurodiagnostics Neuroradiology Neurosurgery Research and Education Other Program Elements Stroke/neuro unit Intensive care Acute rehab unit Epilepsy monitoring unit EEG Wada testing EMG Intracranial electrode monitoring Evoke potentials Transcranial doppler Sleep lab CT Functional MRI Nuclear medicine PET SPECT Bi-plane angiography MRA CT Angiogram Conventional angiography Interventional (angio, stent) Non-invasive screening Education Research Clinical research trials Source: Health Strategies & Solutions, Inc. Neuroscience and stroke programs offer varying degrees of clinical services. Your institution must decide what services it would like to provide locally. 7 7

7 A Vision for Creating a Statewide Neuroscience Continuum of Care for Stroke Patients Cerebrovascular services must be enhanced at both the community and tertiary level in order to provide a comprehensive continuum of care. The example below illustrates how the cerebrovascular continuum of care will many times begin and end at community facilities and emphasizes that facilities can work together to provide comprehensive services. A patient presents at a community hospital ER with a Sub-arachnoid Hemorrhage. 1 2 The patient receives a diagnostic imaging scan and a discussion takes place between the neurologist and a neurosurgeon about the course of treatment. The patient is discharged to their primary physician and continues rehabilitation on an outpatient basis as necessary. 7 3 If deemed necessary, the patient is transferred to a tertiary facility. If not, the patient remains at the community hospital for their course of treatment. 6 The patient is transferred to a community site for rehabilitation services as necessary. 5 The patient is transported to the neurointensive care unit staffed by a neurointensivist. 4 The transferred patient is determined to be a candidate for neurointerventional repair of the aneurysm and a neurosurgeon performs a coil embolization. 8

8 The Strategic Approach to Program Create a shared vision Development Evaluate your current and future competitive position related to neurovascular services in your region Develop a business plan and strategies to achieve your vision that addresses capital needs, physician needs, operational performance, and quality Constantly monitor your progress and competitive environment and amend your plan accordingly 9

9 Competitive Position Analysis Criteria Criteria Total demand for stroke care in your market Outmigration of stroke cases outside of your service area or outside of the state Competitor analysis Current stroke clinical resources/ programs in the market Internal assessment of current stroke program Strengths Clinical gaps Clinical pathway of stroke patients in the market Data Sources NJ state data or other state data if you are located close to a state border NJ state data or other state data if you are located close to a state border Publically available information as well as interviews with your medical staff and EMS providers Interviews with key physicians, nurses, and senior leaders Before deciding to pursue stroke certification, a hospital or health system must evaluate its demand for stroke services, the current clinical pathway of stroke patients in the area and the strengths of its competitors. In many cases, a clinical partnership with a stroke leader in the area may be the best option for further developing current service offerings and achieving stroke certification. 10

10 The Strategic Approach to Program Create a shared vision Development Evaluate your current and future competitive position related to neurovascular services in your region Develop a business plan and strategies to achieve your vision that addresses capital needs, physician needs, operational performance, and quality Constantly monitor your progress and competitive environment and amend your plan accordingly 12

11 Key Business Plan Elements Business plan element Identified Resources Needed Estimated Cost Organizational structure/ leadership team Major facility and equipment needs Physician and other staff recruitment needs Recommended marketing approach Volume targets All of these elements need to be quantified whenever possible so that a financial impact can be estimated and senior leadership is fully aware of the commitments that need to be made to ensure success. 13

12 Sample Key Strategic Initiatives Related to Comprehensive Stroke Center Development Operational Performance Provide a seamless and one-call transfer process Enhance neuro infrastructure at multiple sites Improve ED neuro services Obtain TJC stroke designation Establish best practices for the referral of neuro patients to rehabilitation Quality Establish service line quality committee Physician partnerships Education Recruit top-notch physicians Strengthen physician relationships Educate the community Educate the physicians Educate EMS Marketing Create a brand identity Develop materials tailored to both physicians and the community at large Strategies need to be developed in each of these areas regardless of the level of stroke certification you are seeking 14

13 The Strategic Approach to Program Create a shared vision Development Evaluate your current and future competitive position related to neurovascular services in your region Develop a business plan and strategies to achieve your vision that addresses capital needs, physician needs, operational performance, and quality Constantly monitor your progress and competitive environment and amend your plan accordingly 15

14 A Program Evaluation Tool will Assist With You Achieving and Maintaining Accreditation COE Competency Current State Desired State Leading diagnostic and treatment technology Clinical excellence and innovation Full range of diagnostic, treatment, and support services Coordinated, cost competitive, efficient services that provide the best value in the region Strong patient service orientation Physician engagement Clinical trials/research Outreach and referral network development Multidisciplinary integration and coordination Dedicated administrative and physician infrastructure Clarity of program vision and strategic direction Demonstrated superior quality Focused marketing/distinctive brand identity Before and after accreditation, a stroke center should routinely review its performance as it relates to all of TJC quality metrics and program requirements. This tool provides you with an additional mechanism to help senior leadership evaluate additional program characteristics and establish annual priorities

15 Key Takeaways 17

16 Critical Success Factors Develop a joint vision with your physician leaders and clearly communicate it throughout the organization Determine if there is sufficient volume or high outmigration in your market/region for complex, neurovascular services or more of a need for basic neurovascular services Evaluate potential partners that will help to enhance your stroke services and assist with the certification process Recruit exemplary clinical talent at all levels of the service line Be committed to the capital investment that developing a stroke program will take Develop mutually beneficial relationships with network or transferring hospitals Ensure that patients are treated for their acute episode and then sent back to their community for follow-up and ongoing care If you properly evaluate your market and gain organizational buy-in related to the resources and time required to deliver high quality stroke care, you will be well positioned for achieving and maintaining stroke center certification 18

17 QUESTIONS AND DISCUSSIONS 19