Ingraining Quality in the Minds of Healthcare Institutions – How to “Do” Quality Effectively

BOARD, MEDICAL STAFF, SENIOR LEADERSHIP ENGAGEMENT

Quality as a strategic objectiveMeasurable and actionable milestonesDefined targets against benchmarkAttention getters:

Publicly reported data Pay for performance

Key External Drivers:

Quality Drivers:Centers for Medicare & Medicaid Services (CMS)

Measures

Compliance with Conditions of Participation

CORE Measures• Heart Failure• Pneumonia• Heart Attack• Surgical Care Improvement – Infection Prevention• Stroke (2010)

• Mortality Rates• Readmission Rates

Department of Health & Hospitals

The Joint Commission (TJC)

Compliance with Conditions of Participation

TJC Standards

ORYX Measures• Heart Failure• Pneumonia• Heart Attack• Surgical Care Improvement – Infection Prevention• Stroke (2010)

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Key External Drivers:

Quality Drivers:Patients or Consumers

Physicians

Payers

Consumer Advocacy GroupsAgency for Healthcare Research & QualityInstitute for Healthcare ImprovementHealthGradesLeapfrog GroupNational Database of Nursing Quality

Indicators

Measures

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) – Consumer perception of care

Physician Satisfaction and Engagement

Patient Referral Patterns

Pay for Performance – incentives placed on “appropriate” care.

Payment Penalties – reductions in payment for healthcare associated conditions.

Elimination of “Fee for Service” in all venues –

Patient Safety Indicators, mortality and complication rates, falls, decubitus ulcers, Central Line Infections, Urinary Catheter Infections, etc.

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Key External DriversCore Measure Composite Scores

“www.why not the best.org”

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Overall Quality - All Topics (Composite Score) 94% 94% 93% 97% 93% 95% 96% 96% 98% 90% 91% 98%

STPHNSMCLVRLouisianaNat AvgTop 10%

Source: whynottebest.orgPeriod: January 2009 to December 2009

Overall Quality - All Topics (Composite Score)

84%

86%

88%

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92%

94%

96%

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100%

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Key External DriversPatient Satisfaction

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How do patients rate the hospital overall? 64% 69% 60% 64% 65% 68% 75% 63% 65% 72% 66% 78%

STPHNSMCLVRLouisianaNat AvgTop 10%

Source: whynottebest.orgPeriod: January 2009 to December 2009

Patients Rate Hospital 9 or 10

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EJGH and QUEST Top Performing Hospitals Quarter 1 2010- Core Measures

QTP= QUEST Top Performers

Percentile Ranking Under 25th Top 25th Top 50th Top 75th Top 90th Top 95th

87% 93% 96% 98% 100%

Pneumonia 90%EJGH

QTP

94% 98% 100% 100% 100%

AMI 85%EJGHQTP

Heart Failure 82%EJGH

QTP 86% 93% 97% 100% 100%

SCIP 88%EJGH

QTP 89% 92% 95% 97% 99%

Overall 86%EJGH

QTP 89% 92% 95% 97% 99%

All CORE MeasuresAll or None Appropriate Care Score

89% 93% 95% 97% 98%

86%

QUEST Top Performers

Overall 86%EJGH

QTP 89% 93% 95% 97% 98%

EJGH and QUEST Top Performing Hospitals Quarter 1 2010- Core Measures

EJGH and QUEST Top Performing HospitalsMortality – Observed versus Expected Jan 2010 to July 2010

QTP= QUEST Top Performers

Percentile Ranking Top 50th Top 75th Top 90th

Mortality 0.96 0.71 0.64

0.82EJGHQTP

Patient Satisfaction EJGH Comparisons

73%

EJGH Patient Satisfaction Scores Q3 2010

Jan – Dec 2009

66% 72% 78%

Louisiana National Top 10% Nation Average

Quality EJGH Comparisons

Patient Satisfaction Scores

EJGH – Q3 2010

66% 72% 82%

Louisiana National Top 10% Nation Average

73%

Mortality

EJGH – Jan-July 2010

Top 75th Top 90th

0.80

0.71 0.64

CORE MeasuresOverall

EJGH – Q1 2010 86%

89% 93% 95% 97% 98%Under 25th Top 25th Top 50th Top 75th Top 90th Top 95th

What will it take to become a “destination health system”?

Key Drivers - Internal

EJGH Mission

Cost

Market Share Expansion

Empowered WorkforceQu

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Key Internal Drivers

Average Length of StayAverage Length of StayOct 08 – Oct 10Oct 08 – Oct 10

Average Length of StayAverage Length of StayOct 08 – Oct 10Oct 08 – Oct 10

Oct

-08

Nov

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Dec

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Feb

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May

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Jul-0

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Sep

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Oct

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9

Jan

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Feb

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Mar

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Apr

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May

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Sep

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All Payer 5.3 5.2 5.0 5.2 5.1 5.3 5.5 4.8 4.4 4.4 4.5 4.7 4.7 4.6 4.9 4.9 5.3 4.7 4.6 4.2 4.5 4.5 4.5 4.4 4.4CMI 1.49 1.54 1.43 1.54 1.45 1.45 1.50 1.52 1.48 1.45 1.43 1.47 1.59 1.48 1.47 1.49 1.51 1.53 1.50 1.44 1.47 1.47 1.45 1.48 1.52

MC ALOS 6.0 6.0 5.7 5.9 5.8 5.8 5.9 4.9 4.9 4.7 5.1 5.3 5.1 5.2 5.4 5.4 5.8 5.0 5.2 4.5 4.8 5.0 5.0 4.9 5.0MC CMI 1.63 1.70 1.55 1.69 1.58 1.50 1.64 1.60 1.62 1.55 1.59 1.56 1.65 1.62 1.61 1.61 1.58 1.62 1.63 1.58 1.57 1.59 1.57 1.60 1.66

Acute Care Admissions Excluded: SNF, PSY, GBH, RHB and Newborns

Key success factors:

Accessibility to timely quality data for all stakeholders Identified MD champion for each project Broadest possible MD engagement Support of CNS or equivalent for each project Order sets covering the continuum of care Order sets initiated by the Medical Staff leadership

Support prioritization and use Board mandate for order set use once developed and tested Overcome the “coldness” of technology

PRIORITIZATION – ORGANIZATIONAL CAPACITY

Performance improvement activities flow from the strategic plan

Organizational capacity is understood in such a way that projects cycle in and out based on resources available to support them

Process for revision of priorities essential

Quality control – metrics, monitoring, analysis, distribution Sentinel events, SEA’s Publicly reported data set improvement

TJC, DHH Mature process requiring monitoring Evidence based practice Constituent education and development Skills development to support organizational systems improvement & business development

Run (Routine Business Responsibilities)

Budget Lean

IHI Improvement Map Patient Sat, Magnet

Emerging quality priorities Innovation CI, Co-Management

Strategic

Building culture of skill set for improvement Department PI, Organizational PI

New & evolving processes requiring improvement Streamline, remove waste, improve bottom line

Improve

Staff and medical staff satisfaction, LIP Credentialing Budget HR management & development Safe environment

Administrative

STRUCTUREProcess flow map for performance

improvement systemSenior leader and physician champion for

each chartered teamCFO EngagementPatient/Caregiver InputDefinition of PI approaches and necessary

skill set for deployment

REWARDS, RECOGNITION, CELEBRATION