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Engaging Leadership and Governance in Quality and Patient Safety Initiatives April 15, 2015 1:00 – 2:00 p.m. CT Kimberly McNally, MN, RN, BCC Trustee, University of Washington Medicine Kenneth P. Anderson, DO, MS, CPE COO, Health Research & Educational Trust
Engaging Leadership and Governance in Quality and Patient Safety Initiatives HPOE Live ! 2015 Webinar Series Kenneth P. Anderson, DO, MS, CPE 2014 Silver Award Recipient
Business Case for Improving Care • Describe the “Reasons to Participate” – Payer rewards tie to explicit quality measures – Regulators publish specifics on performance (using the Web as an “ external driver”) – Patients are demanding greater transparency – Defining and deploying “best practice” will define our future 2014 Silver Award Recipient
The Impact of NOT Focusing • When Quality and Patient Safety systems fail: – Patients lose trust – Reputational impact: patients tell friends and neighbors – Patients “vote with their feet” – growth impact – Risk management impact: it’s costly – Most important: patients may be hurt! 2014 Silver Award Recipient
Themes for Quality Efforts • Consistency – Commit to a culture of excellence for every encounter (“Flawless Execution”) • Standardization – Automate whenever and wherever reasonable – Link operations (work flows) and physician preferences for care (best practice use) • Teamwork – Interdisciplinary teams (including IT) promote greater efficiency and effectiveness 2014 Silver Award Recipient
Questions: Roles and Responsibilities • Who is responsible for quality and patient safety in our health care environment? • How do we promote the critical thinking needed to improve? • How does your personal mission align with the privilege of “caring” for our community? 2014 Silver Award Recipient
Roles of Leadership • Empower front ‐ line staff • Provide resources • Clearly state the vision • Stimulate and guide • Model behaviors • Reward and recognize 2014 Silver Award Recipient
Setting a Culture of Quality • Effective Systems Are: • Systems Based Approach – Transparent – Team ‐ based Solutions – Intentionally – Data driven designed – Measure ‐ rich – Continuously – “Systematized” improving – Well ‐ communicated – Participant ‐ based – Holistic 2014 Silver Award Recipient
Start With Key Quality Principles • High Value Care Principles (IOM): – Safe – Timely – Effective – Efficient – Equitable – Patient Centered 2014 Silver Award Recipient
Structure: Four Corners of Quality • Quality Control – Accreditation, compliance, safety, risk • Performance Excellence (Process) – Operations ‐ focused, standardization of care • Quality Development (People) – Tools acquisition and leadership training • Quality Innovation (Technology) – Delicate interface with technology as an enabler 2014 Silver Award Recipient
Quality Control – The Regulatory Base • Accredited by the Joint Commission (TJC) • Licensed by the State (Dept. of Health) • Certified for payment by the Feds (CMS) • Regulated by numerous State and Federal agencies 2014 Silver Award Recipient
Performance Excellence – Better Each Day • Role of incremental improvement: P ‐ D ‐ C ‐ A cycles of improvement engine • Advanced project planning using D ‐ M ‐ A ‐ I ‐ C • Process ‐ focused with impact on outcomes (Economic, Clinical, and Humanistic Outcomes) • CORE measures as the initial point of entry (measures tied to payment updates) • Show progress visually and simply 2014 Silver Award Recipient
Outpatient Cardiac Care Plans MI & CAD (Antiplatelet/Beta Blocker) Composite Scores Score Goal 100% 93.5% 93.3% 93.1% 95% 92.1% 90% 90.9% 88.8% 85% 88.0% 86.2% 85.8% 85.1% 84.6% 82.8% 80% 81.3% 81.2% 75% 70% 65% 60% 55% 50% Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 2014 Silver Award Recipient
Quality Through People Development • Train leaders and the Board – give them the “Keys to the Car” • Train and equip Medical Staff leaders, provide a sustaining framework • Focus on future leaders ‐ residency quality programs for young physicians; develop nursing quality leaders • Use reinforcing resources such as IHI Open School Chapter establishment 2014 Silver Award Recipient
Quality Innovation and Redesign • Answers simple question: “What works?” • Hardwire effective care patterns into daily work • Mine the EMR to create “Wisdom” • Put the tools of change in the hands of the end users, and make tools easy to use • Engage “Activated Patients” to create patient ‐ centered value 2014 Silver Award Recipient
ILI percentage by week 12 2007/8 % ILI 2008/9 % ILI 2009/10 %ILI 10 ILI % of outpatient visits 8 6 4 2 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 First week in September February 2014 Silver Award Recipient
Outpatient Influenza Like Illness 600 50 45 500 40 35 # of Cases (specific ZIPs) 400 # of Cases (all ZIPs) 30 Seasonal Flu 300 25 20 200 15 All ZIPs 60626 ‐ Rogers Park 10 100 60061 ‐ Vernon Hills 5 60091 ‐ Wilmette 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Week Jan 8 June 3 2014 Silver Award Recipient
Scorecards and Dashboards • “Measuring” is the start of “Managing” • Cascading dashboards allow direct “line of sight” communication and alignment • “A picture is worth a thousand words” – promote effective and efficient communication • Consider “whole system measures” to demonstrate broad themes of improvement 2014 Silver Award Recipient
At A Glance Project Reporting 20 2014 Silver Award Recipient
21 2014 Silver Award Recipient
Cutting Harm Across the Board in Half Total Harm per 1,000 Discharges 35.0 Yuma, Arizona Increased Reduction of Transparency of 30.0 EED’s starts Patient Harm Data EMR Go Live 25.0 Total Harm/1,000 Discharges 75% Patient Fall Reduction! Strike 20.0 Teams 15.0 10.0 5.0 0.0 Jan ‐ 12 Feb ‐ 12 Mar ‐ 12 Apr ‐ 12 May ‐ 12 Jun ‐ 12 Jul ‐ 12 Aug ‐ 12 Sep ‐ 12 Oct ‐ 12 Nov ‐ 12 Dec ‐ 12 Jan ‐ 13 Feb ‐ 13 Mar ‐ 13 Apr ‐ 13 May ‐ 13 Jun ‐ 13 Jul ‐ 13 Aug ‐ 13 Sep ‐ 13 Oct ‐ 13 Nov ‐ 13 Dec ‐ 13 Baseline 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 13.2 Hospital 29.4 19.3 14.4 13.8 13.6 16.7 17.2 10.9 12.5 14.7 5.3 6.8 10.1 11.4 8.9 7.3 Goal 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 22 2014 Silver Award Recipient
To Change the Practice of Medicine • Create higher “value” health care – engage ALL participants, especially physicians • Promote patient activation/engagement • Satisfy the Triple Aim: better care for individuals AND populations at lower cost • Standardize evidence ‐ based management: achieve scale, reduce cycle time, accelerate gains, deploy sustaining systems 2014 Silver Award Recipient
HPOE LIVE! WEBINAR Engaging Leadership and Governance in Quality and Patient Safety Initiatives April 15, 2015 Kimberly McNally, MN, RN, BCC Trustee, UW Medicine Board
What is board engagement? Board Board Work Work Engagement Engagement Relationships Relationships OUTCOMES
Board engagement leads to… Trusting Trusting Relevant Relevant Attention Attention Improved Improved relationships relationships work work to details to details governance governance
Indicators of an engaged board • Forward-thinking group whose work and meetings are designed around critical issues • Participate in well-designed opportunities for meaningful deliberation in an environment characterized by trust, candor and respect • Provide challenge and support to accelerate change • Trustees feel their time, talent and energies are well used; can articulate value produced
UW Medicine
Engagement Pyramid Collaborative Leadership through Partnership Physician Physician between the Board, Leadership Leadership executive & physician leaders Aligned Aligned - at entity and metrics metrics system level Board Board Executive Executive Leadership Leadership Leadership Leadership
Why is Collaborative Leadership Important? • Health care organizations are messy, complex and interdependent • Effective strategies require a systems approach and inclusion of multiple perspectives • Many sectors and constituents need to “own” parts of the goals and solutions • Leadership role is to build a community of leaders
Collaboration Collaboration needs a different kind of leadership; it needs leaders who can safeguard the process, facilitate interaction and patiently deal with high levels of frustration . Chrislip & Larson
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