Thomas Kelley, MD Chief of Quality and Transformation Orlando Health
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Transcript of Thomas Kelley, MD Chief of Quality and Transformation Orlando Health
Thomas Kelley, MDChief of Quality and Transformation
Orlando Health
Leading the Way to Better Care: Florida’s Quality Journey
Session Overview
• Describe how Florida’s hospitals worked together to significantly improve care while reducing costs across the state.
• Identify the key lessons learned over the five years Florida’s hospitals worked together to reduce readmissions, complications, and infections.
• Develop actionable steps for collaboration around quality improvement in their own state.
A Look Back: Florida Healthcare Quality Five Years Ago
Florida hospitals were the target of criticism for poor health outcomes and high costs compared to hospitals in other states.
A Look Back: Florida Healthcare Quality Five Years Ago
Performance based on:
• CMS Core Measures• Infection Rates• Mortality Rates• Patient Experience• Management of
Chronic Conditions
Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports
Goal: Improve Care Together
• Reduce patient harm• Tackle high-impact areas• Build a better reputation nationally and
improve our results• Reduce costs• Save lives, prevent complications, and help
patients return home sooner and stay home
Collaborating to Improve Quality
• Under the leadership of the 239 member association, hospitals made a commitment to improve care, save lives and lower costs through:– shared successes and failures– the knowledge of experts– the latest evidence-based best practices– a community of trust, communication and
collaboration
Collaborating to Improve Quality
• Why did hospitals choose to work through the Florida Hospital Association?– Provided opportunities for hospitals to work
together verses independently– Dedicated staff; provided structure– Resources to effect improvement
Readmissions
15%
SurgicalComplications
14.5%
Blood StreamInfections
41%
Urinary TractInfections
37%$15.9 MILLIONCOST SAVINGS
$6.67 MILLIONCOST SAVINGS
$25 MILLIONCOST SAVINGS
Florida’s Results: Making a Difference Statewide
The Power of Collaboration:Reduce Readmissions
Florida was first state to use published “potentially preventable” readmission rates for all hospitals. For the first time, hospitals had
meaningful data readily available. The Process
• Identified critical information needed to transition a patient to different levels of care.
• Worked with state agencies to modify existing patient hand offs to ensure smoother transitions.
• Explored standardized discharge orders and patient education.
FHA collaborated with: •Agency for Health Care Administration •Florida Association of Directors of
Nursing•Florida Department of Elder Affairs •Florida Medical Directors Association•Florida Orthopedic Society
The Power of Collaboration:Reduce Readmissions
FHA also worked with the state’s largest health plans to:• understand plan services to
help keep people out of the hospital
• establish standard methodology for measuring readmissions
• explore principles for payment alignment
What We Learned
• Data were critical to understanding the problem and identifying barriers
• Multi-faceted issue that requires sustained coordination and partnership among hospitals, health plans and other caregivers
Collaborative on Readmissions
What Florida Did to Reduce Readmissions• Improved discharge instruction• Improved handoff communication• Scheduled follow-up visits• Evaluated end-of-life care
THE FACTS• 107 participants statewide• First to publicly report readmissions rates by hospital• First statewide readmissions program
Orlando Health: Readmissions Results
Improving Surgical Care: Florida Surgical Care Initiative
Largest statewide surgical collaborative in the nation• 67 hospitals statewide• Piloted in partnership with
Florida Hospital Association, American College of Surgeons with support from Florida Blue
• Focus on high-impact areas, including surgical outcomes for elderly patients and surgical site infections
The Process
• Hospitals collected information on patient’s condition prior to operation
• Qualified surgical reviewers tracked outcomes 30 days after procedure
• Hospital staff called patients as a follow-up
Improving Surgical Care: Florida Surgical Care Initiative
Preventing Patient Harm• Pilot extended with additional data collection
options• Monthly educational meetings focus on topics
such as surgical site infections• Continuous shared learning opportunities
THE FACTS• 67 hospitals statewide• Piloted in partnership with Florida Hospital Association,
American College of Surgeons with support from Florida Blue
Reduce Bloodstream and Urinary Tract Infections & Improve Hospital Culture
• Focused on building culture of quality, improving best practices and appropriate use of catheters
On the CUSP: Stop BSIs and Stop CAUTI
THE FACTS• The On the CUSP initiative launched in 2009• Engaged 69 units in 35 hospitals in the CLABSI program• Engaged 21 units in 10 hospitals in the CAUTI program• 16 NICUs participated in the Perinatal Quality Collaborative• Florida was one of initial states to participate• Partnership with HRET
Orlando Health: CAUTI Results
The Tools: CLABSI Top Ten Checklist
Orlando Health: CLABSI Results
16
12
8
4
0
Month
Numb
er CL
ABSI
s
2011 2012 2013 2014CLABSI by FY
Mean=7.6 Mean=7.1Mean=4.4
Mean=6.7
Florida’s Quality JourneyPhase II
Eliminating Harm
• Florida hospitals are actively working on improvement initiatives in ten focus areas through this collaborative.
• Goal is to reduce patient harm by 40% and readmissions by 20%.
HRET-FHA Hospital Engagement Network
THE FACTS• 77 hospitals collaborating, sharing resources and best practices
Extensive education and training programs• Strong leadership engagement and support• Topic specific listservs• One-on-one coaching and support• Tracking monthly progress
Harm Prevention
1,135 Cases of Harm Prevented
Orlando Health: HEN Results
Ensure a Safe Reporting Environment & Foster Sharing
• PSOFlorida provides an environment where hospitals and physicians may submit data on medical errors and mistakes, learn evidence-based best practices drawn from state and national patient safety data and share insights with peers
• Learning and discussion is facilitated through webinars, protected websites, newsletters and research.
Five Years Later: We’ve Moved the Needle
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Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports
2011
Lessons Learned• It is possible to achieve statewide improvement, in a state as
diverse as Florida• Focusing on improving quality in specific areas of care can lead to
meaningful progress• Quality care can cost less• Collaboration among hospitals is the additive that accelerates
quality gains• Culture is integral to improving quality• Data are critical to understanding the problem, tracking progress• Partnerships extend quality efforts and increase learning• Greater opportunity ahead by expanding collaboratives to include
pre- and post-acute networks
Quality Remains the Top Priority
• Sustained Board of Trustee Engagement• Focused on statewide data to understand how
Florida compares to other states• Identified champions to provide leadership• Refined “advocacy” role to emphasize quality and
patient safety • Established a Quality Committee dedicated to
promoting improvement in clinical outcome strategies
Partners
What’s Ahead
Florida Surgical Care Initiative (FSCI)• Expansion of FSCI• Expanded data collection options
Healthier Hospitals Initiative• New program with goal to embed
sustainability into culture and operations for improved health of patients, staff and the community
Partnership for Patients• 77 hospitals statewide• Focused on 10 key areas• Expanded to address patient and family
engagement and leadership development
• Refine data measurements
• Expand number of hospitals participating
• Sustain improvement
Contact Information and Resources
FHA Five Years of Quality Report: www.fha.org/quality
Thomas Kelley, MDChief Quality and
Transformation Officer, Orlando Health
Florida Hospital Association306 East College Avenue
Tallahassee, Florida Phone: (850) 222-9800
Fax: (850) 561-6230 www.fha.org