race for results: accelerating knowledge adoption to improve quality

Child Health Corporation of America, All Right Reserved, 2007

RACE for Results: Accelerating Knowledge Adoptionto Improve Quality

Lessons Learned from a Children’s Hospital Alliance

Donna Payne, Sr. Vice President, CHCA

Janet Guptill, President, KM At Work, Inc.

ACHE 2007 Congress on Healthcare Leadership

March 21, 2007, New Orleans

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Improving the Performance of Children’s Hospitals

Knowledge Transfer Improves Hospital PerformanceKnowledge Transfer Improves Hospital Performance

Strategy Drives Approach Informal peer networking builds a culture of sharing and collaboration Formal collaboratives are needed to create immediate results Systematic rewards and support are needed to spread initial results

Knowledge Transfer involves Technology, People/Process, and Strategy

Technology enables information sharing and people directories People processes ensure productive interaction and knowledge exchange Strategy determines impact measures and ensures organizational momentum

CHCA Case Study Results: 42 children’s hospitals participate in 30 peer networking forums, regularly sharing improvement

tools and resources, exchanging best practices and learning from industry experts 18 children’s hospitals averted 13,478 adverse drug events (ADEs), representing $2.7 million in

net savings, and reduced PICU blood stream infections (BSIs) by 57% More than 60 intensive care units are working to sustain and spread improvements in ADEs and

BSIs based on the initial collaboratives’ work

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Knowledge Transfer Building Blocks at CHCAKnowledge Transfer Building Blocks at CHCA

Peer Networking Performance Improvement

Spread

TECHNOLOGY Online communitiesPeer group meetings

CollaborativesC, C, c

RACE for ResultsJuried annual award

PEOPLE & PROCESS

TeleconferencesList servesForum directorsSpecial reportsBenchmarking

PDSA approachResults reported to peers and executivesDedicated PI staff

Awards process with external judgesPeer reviewed publicationAmbassador programExternal published resultsReal time tools and resources

STRATEGIC IMPACT

Individual employee improvement in productivitySatisfaction + individual hospital improvement in results

Organization-wide improvement, e.g., cost reduction, error reduction, safety improvementAccelerate improvementSafe, efficient and effective

Focus on spreadKnowledge available when you need itBest practicesPeer assistance

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Knowledge Transfer to Improve Performance: A Case StudyKnowledge Transfer to Improve Performance: A Case Study

42 non-competing hospitals US, Canada $14 billion combined revenue (1) Average per member revenue of $330 million If Fortune 500 would be ranked 142 IDN influence:

– 500,000 inpatients; 10 million outpatients (2)– 102,000 employees (2)– >20,000 pediatric physicians (5,162 medical specialists;1,985 surgical specialists(2))

Top 5 among U.S. health systems/IDNs

Sources: (1) Estimated from Goldman Sachs report to CHCA, July 2004; (2) Estimated from personnel report in AHA Guide 2003/ 2004


RACE for Results: Accelerating Knowledge Adoptionto Improve Quality

Peer Networking

Performance Improvement

Spread


Peer Networking:Creating a Connected Culture

How CHCA Forums Accelerate Knowledge Exchange and Build Connections

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Peer Networking Builds LoyaltyPeer Networking Builds Loyalty

The Opportunity: The combined knowledge and expertise of all the member hospitals is tapped when

a new manager comes on board Centralized knowledge space limits brain drain due to turnover and retirements

– CEO turnover is 30% annually industry wide; higher among departmental managers– Average hospital staff age is 50; getting new employees trained quickly is critical

Online communities among peers limits “re-inventing the wheel” each time an issue is faced

The Relevance: Employee satisfaction drives customer satisfaction and market share Employee productivity drives operating cost and margin

Results: 42 children’s hospitals participate in 30 forums representing over 2600

executives/managers.

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Peer Networking Forums are Highly ActivePeer Networking Forums are Highly Active

Ambulatory 22 Materials Management 33

Cardiac 28 OR Directors 31

CFO 40 PACT 34

CHAPs 17 Patient Financial Services 21

CIO 36 Payor Contracting 33

CNO 40 Pediatric Practice Exec. 22

COO 40 Pharmacy Buyers 40

Corporate Compliance 28 Pharmacy Directors 39

Customer Service 20 PHIS 37

Dietary 33 Physician Relations 22

Executive Dialogue 40 Quality and Safety Leaders

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Facilities Management 33 Radiology Directors 33

Health Information Mgmt 33 Respiratory Directors 32

Home Care 17 Risk Managers 25

Human Resources 32 SMAC 30

JCAHO 35 Social Work Community 15

Lab Directors 32 SPBD 28

Overall 2006 satisfaction:5.24 of 6.0

(87%)

2006 Hospital Participation in Forums

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Peer Networking Forums webpagePeer Networking Forums webpage

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How does it work?How does it work?

Internet site for Forum members only– Exclusivity, confidentiality, knowledge of colleagues – Dedicated staff facilitator – Supports 3-5 Forums depending on content

knowledge and required expertise– Share documents, post weblinks, initiate discussions, find resources

Technology combined with meetings keeps the group connected– Teleconferences, webcasts, bi-annual meetings – Ad hoc conversations, focused research, group problem-solving– Rapid response to posted questions– Benchmarking and identifying variation

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How can you learn from this?How can you learn from this?

Upgrade intranet to include 2-way communication capabilities– Incorporate suggestion box for online idea submissions– Utilize team e-rooms for special projects or cross-facility peer group networking– Institute employee email system and instant intranet access to facilitate

organization-wide communication Reinforce a culture of connectivity

– Post meeting materials and minutes online before and after– Incorporate online learning tools where appropriate– Exclusively utilize email and intranet site to keep employees current on

organization-wide strategies, department-specific issues, or for shift scheduling Potential reward

– Reduces error, reduces time spent searching for solutions to common issues, improves employee satisfaction, facilitates employee professional development

– Reinforces organizational strategy and performance goals


Performance Improvement:The Power of Collaboratives

How CHCA Collaboratives Accelerate Adoption

How CHCA Collaboratives Accelerate Adoption

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Collaborative Reduces Adverse Drug EventsCollaborative Reduces Adverse Drug Events

The Opportunity: ADEs occur in 6 to 10 percent of hospitalized patients Narcotics among highest risk for errors for children

– 50 percent of ADEs related to narcotics– 5.2 narcotic-related ADEs for every 100 patients

The AIM Statement: Reduce the occurrence of ADEs related to opioid and non-opioid

narcotics by 50 percent

Results: 18 children’s hospitals averted 13,478 ADEs, representing $2.7 million in

net savings (CHCA-approved methodology)

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Hospital Teams: Atlanta Birmingham Buffalo Cincinnati Columbus Corpus Christi Dayton Fort Worth Kansas City Miami Nashville New Orleans New York/Morgan-Stanley New York/Komansky Center Orange Palo Alto Pittsburgh St. Petersburg

16 teams (89%) had a reduction in ADE rate – Average among teams with a reduction: 64% reduction– Average for all teams: 49% reduction

11 teams (61%) had at least a 50% reduction in ADE rate

BE

TT

ER

Avg.

CHCA Hospitals with reduction in ADE rate

Goal

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Developed new tools and knowledge to detect adverse events3 new trigger tools have effectively prevented adverse events

– 15 pediatric triggers improved detection of ADEs by 22x– 8 triggers increased narcotic ADE detection – 16 neonatal triggers improved detection of ADEs by 12x

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Adverse Drug Event Collaborative webpageAdverse Drug Event Collaborative webpage

Add ADE Collaborative screenshot

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Collaborative Reduces Blood Stream InfectionsCollaborative Reduces Blood Stream Infections

The Opportunity: Catheter-associated blood stream infections (BSIs) are a serious threat to

patients’ safety Areas of highest risk for BSIs include PICU, NICU, CICU, and

Hematology/Oncology

The AIM Statement: Reach zero tolerance for BSIs among targeted patient populations

Results: 18 children’s hospitals reduced BSIs in the PICU by 57% Hospitals prevented 112 BSIs resulting in nearly $1 million in estimated net

cost savings Accelerating a goal: One PICU has been BSI free for 563 days as of 9/20/06

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Collaborative Reduces Blood Stream InfectionsCollaborative Reduces Blood Stream Infections

18 teams (62%) achieved a reduction in BSI rate – Average among teams with a reduction: 57% reduction– Average for all teams: 31% reduction

11 teams (38%) achieved a 50% reduction in BSI rate

Includes only hospitals with a reduction in Catheter-related BSI rate

-100

-80

-60

-40

-20

0

% c

han

ge

Bet

ter

GOAL:50% reduction

*

*

*

*Statistically significant improvement p<0.05

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Blood Stream Infection Collaborative webpageBlood Stream Infection Collaborative webpage

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Surgical Infection Prevention CollaborativeSurgical Infection Prevention Collaborative

The Opportunity: Surgical Site Infections (SSIs) are third most frequently reported

hospital acquired infection– 16 percent of all nosocomial infections – Among surgical patients, 38 percent of all infections,

77 percent of deaths for patients with SSI– SSIs increases LOS 7 to 10 days

In children:– One of the most common indications for operative intervention– 40 to 60 percent of SSIs are preventable– >200,000 surgical procedures (n=34 hospitals)– Inappropriate use of prophylactic antibiotic = 25 to 50 percent of operations

Source: CDC’s National Nosocomial Infections Surveillance (NNIS)

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The AIM Statement: Appropriate use of prophylactic antibiotics as follows:

– Selection: 95 percent of procedures will be accompanied by prophylactic antibiotics consistent with hospital guidelines

– Start time: 95 percent of procedures will have antibiotic prophylaxis initiated 30-60 minutes before the incision

– Re-dosing: 95 percent of procedures for which re-dosing is indicated will receive a 2nd dose of intraoperative antibiotics consistent with hospital guidelines

– Post-operative discontinuation: 95 percent of procedures will have prophylactic antibiotics discontinued within 24 hours after surgery

Skin preparation performed as follows:– Hair removal: 95 percent compliance with appropriate hair removal (for those patients

undergoing hair removal)– Skin antisepsis: 95 percent compliance with appropriate skin antisepsis

SIP bundle compliance: 95 percent of procedures will be accompanied by appropriate prophylactic antibiotic use ( selection, timing, intraoperative re-dosing if necessary and post-operative discontinuation) and appropriate hair removal

Reduce Surgical Site Infection (SSI) by 50 percent


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Surgical Infection Prevention Collaborative Surgical Infection Prevention Collaborative

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The Power of Collaboration: 28 Hospitals set Goal to reduce

Surgical Site Infections by 50% 11 outcome, process and

balancing measures On-line tracking and reporting

(July 2006-2007) Final Report: September 2007

Hospital Teams: Akron Atlanta Birmingham Boston Chicago Columbus Corpus Christi Dallas Detroit Fort Worth Hartford Houston Kansas City Los Angeles

Memphis- Le Bonheur Memphis - St Jude Miami Milwaukee Nashville New Orleans New York Palo Alto Philadelphia Phoenix Pittsburgh Seattle St. Petersburg Washington, DC

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Dedicated Performance Improvement staff and resources– Trained in IHI improvement methodology– Hospitals agree to share results, post data and publish results – Use industry and hospital expert panels to validate clinical direction – Combine research and rapid cycle - essential for academic engagement

Technology tools and partners integral to success– Knowledge repository available real time

• improvements, tool kits, lessons learned, comparative data, audios of webcasts and lessons learned

– Strategic partners essential to spreading results and gaining credibility • AHRQ Partnership for Quality Grant helped fund participation and training for all 42

hospitals• Data-sharing agreements developed to expand comparative data sets (Vermont

Oxford Neonatal Network and others)

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Post performance targets and results on intranet– Develop online performance reporting capabilities– Customize for different audiences: employees, physicians, consumers, board– Include resources and educational materials for ease of access

Reinforce a culture of transparency– Engage physicians in research design and collaborative process– Build in research rigor and evidence-based medicine findings– Utilize dedicated PI staff to ensure that project leadership is experienced,

professional, and credible Potential reward

– Improves patient safety, reduces operating costs, reduces patient errors– Focuses on organizational performance and peer accountability


Spread:RACE for Results Rewards Initiative

How Awards Program Achieves Spread and Sustainability

How Awards Program Achieves Spread and Sustainability

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Quality Awards Program Accelerates SpreadQuality Awards Program Accelerates Spread

The Opportunity: Provide an incentive for hospitals to document their success in improvement Create a competitive and rigorous selection process for formal recognition Recognize team efforts within organizations and accelerate knowledge adoption

RACE for Results: Recognize and Celebrate Excellence Initiated in 2004 – idea of CHCA Vice President, David Bertoch Judged by recognized national experts Awarded to hospital demonstrating sustained performance improvement Ambassador status includes obligation to teach others Relay RACE rewards adoption of others’ successes Relay Report sustains focus on spread and sustainability

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RACE for Results AwardRACE for Results Award

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RACE for Results 2006 EntriesRACE for Results 2006 Entries

“Asthma Attack” Critical Care Units Quality Improvement

Collaborative: Reducing Ventilator Associated Pneumonia Rates in Three Pediatric Care Units

Duplicate Medical Record Number Clean-Up Improvements in Beta-Agonist Therapy

Practices Improving Patient Safety by Decreasing

Mislabeled Specimens Improving Patient Safety by Standardizing the

Patient Identification Process Improving Patient Safety through Reduction of

Medication Errors Increasing ED Patient Care Revenue Measuring the Impact of a Short Stay Unit with

Bronchiolitis/ Viral Pneumonia Patients Meeting the Standard of Evidence-Based

Asthma Care Pain Control in Children with Sickle Cell Vaso-

Occlusive Crisis

Patient Safety Indicator Validations for Application to Unique Pediatric Population

Preventing Cardiopulmonary Arrest outside the ICU – Implementation of a Medical Response Team

RACE for the Gold: A Swift Reduction of Catheter-Related Blood Stream Infections in the PICU

Reducing Adverse Drug Events related to Opioid and Non-Opioid Narcotics in Children

Reducing Catheter-Related Bloodstream Infections in Children

Reducing Central Line Associated Bloodstream Infections in the NICU

Reducing TPN-Associated Medication Errors Using a Multi-Process Approach

Reduction in Manual Differential Turnaround Time for Emergency Room Patients

Stat Medication Administration: Improving Timeliness and Patient Safety

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Judged by Nationally Recognized ExpertsJudged by Nationally Recognized Experts

David Classen, M.D., M.S., Vice PresidentFirst Consulting Group

Lloyd Provost, M.S., PartnerAssociates in Process Improvement

Teri C. Simmonds, RN, PartnerSafe and Reliable Healthcare, LLP

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2006 RACE for Results Winners2006 RACE for Results Winners

The Children’s Medical Center, Dayton

winner of the RELAY Award reduced central venous catheter-associated

bloodstream infections by 100%.

Children’s Hospital of Omaha’s “Asthma Attack” led to reduced LOS and readmission rates, and improved medication management.

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RACE for Results WinnersRACE for Results Winners

2004 2005 2006 2007

Little Rock: Reducing Catheter-Related Bloodstream Infections through Repeated Rapid Cycle Improvements

Cincinnati: Reducing Cost through Improving Quality

Palo Alto: Decreasing ADEs By Implementing Safety Best Practices

Washington DC: Using PHIS to Target Reducing Infections in VP Shunt Surgeries

Omaha: "Asthma Attack“

Dayton: Reducing Catheter-Associated Bloodstream Infections in Children

11 Entries 12 Entries 17 Entries 30 Entries

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Press Releases Press Releases

FOR IMMEDIATE RELEASEThe Children’s Medical Center of Dayton Reduces Infections and Wins National Award for ExcellenceDAYTON, OH (March 30, 2006)The Children’s Medical Center of Dayton (Dayton Children’s) has received a national quality and safety award from Child Health Corporation of America (CHCA), a business alliance of 42 of North America’s leading children’s hospitals. The distinguished “RACE for Results” award recognizes and celebrates excellence in performance improvement within children’s hospitals. Dayton Children’s earned a 2006 “RACE for Results” award for its success in reducing bloodstream infections in the Pediatric Intensive Care Unit (PICU). The hospital collaborated with 28 other children’s hospitals to pursue an improved care system for children requiring treatment involving central venous catheters, a serious threat to patients’ safety. The result was a 100 percent reduction in infections; the hospital has gone a full year without a single central venous catheter-associated bloodstream infection in their PICU!“We are honored that our efforts to improve safety have been recognized by our peers, the leading children’s hospitals in North America,” said David Kinsaul, President and CEO of Dayton Children’s. “And we’re very motivated by the improved quality of care we’ve been able to offer our patients. We’ve already started spreading this improvement to other areas of our hospital.”Dayton Children’s was selected for the prestigious “RACE for Results” award by a panel of independent national quality and safety experts. Children's Hospital of Omaha was also a recipient of a 2006 CHCA “RACE for Results” award.

FOR IMMEDIATE RELEASEAsthma Best Practices Wins Children’s Hospital Omaha National Award for ExcellenceOMAHA, NE (March 29, 2006)Children’s Hospital in Omaha, announced today that it is a recipient of a national quality and safety award sponsored by Child Health Corporation of America (CHCA). The distinguished “RACE for Results” award recognizes and celebrates excellence in performance improvement within children’s hospitals.The award is given by CHCA, a business alliance of 42 of North America’s leading children’s hospitals, to children’s hospitals that demonstrate significant and sustained improvements in care through the use of CHCA data and improvement resources. Children’s Hospital earned a 2006 “RACE for Results” award for its work in improving care for children with asthma. By using national asthma and steroid data, Omaha began a series of projects to help implement new treatment guidelines and restructure their Respiratory Care Department. These projects helped to reduce unnecessary time spent in the hospital and return visits after being discharged from the hospital.“We are honored to be recognized among our peers, the leading children’s hospitals in North America, for our efforts in making asthma care more safe, effective and efficient,” said Gary Perkins, CEO of Children’s Hospital Omaha. “This particular improvement is just one in a series of improvements to change the way we care for children.”Children’s Hospital was selected for the prestigious “RACE for Results” award by a panel of independent national quality and safety experts. The Children’s Medical Center of Dayton was also a recipient of a 2006 CHCA “RACE for Results” Relay award.

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RACE Results in Performance ImprovementRACE Results in Performance Improvement

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Formal RACE for Results awards program– Formal application process with strict submission requirements– External judges panel representing industry experts in quality and patient

safety– Results announced at award ceremony during annual Quality

& Safety Meeting– Winners required to serve as Ambassadors during subsequent year to teach

techniques and encourage adoption of proven practices Formal marketing campaign to publicize event

– Emails, posters, web notices to promote the competition and publicize winners – Email-based Relay Report to report progress as proven practices are

replicated across the alliance– Resources and contacts posted on the intranet to facilitate connections and

encourage adoption– Benchmarking reports regularly published to document improvements

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Walk the Talk– If you are serious about knowledge transfer and adoption of proven practices,

develop programs and tools to facility this activity– Start with the strategy and invest in the technology – Redefine job roles and incentive structures to reward collaboration and

knowledge adoption Create a culture of connectivity

– Online spaces for collaboration and informal conversation - Get ready for the MySpace generation

– Incorporate web thinking into every communication intention– Build web-based tools into every job in the hospital, make it part of the way

work gets done Measure the results

– Tie collaboration activity to attainment of strategic goals– Publicly celebrate successes – Learn from failures – focus on continual improvement

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Knowledge Transfer Building BlocksKnowledge Transfer Building Blocks

Peer Networking Performance Improvement

Spread

TECHNOLOGY Create MySpace for your employees, physicians, and customers

Create public campaigns for targeted improvement goals

Publish results on the hospital website – customize for each audience

PEOPLE & PROCESS

Create online people directories, create peer group moderator roles, highlight personal success stories

Develop a dedicated PI staff – this may incorporate Six Sigma, IHI Collaboratives, etc – or may be internally developed

Incorporate proven practice sharing into annual awards ceremonies, dept budget reviews, employee performance reviews

STRATEGIC IMPACT

Enhanced employee satisfaction and productivity, strong customer satisfaction scores

Focused improvement in targeted areas, e.g., patient safety, financial performance, wait times, turnover, etc.

Faster decisions, quicker adoption of proven practices, rapid innovation absorption

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Questions?

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Contact us for further discussionContact us for further discussion

Donna Payne, Sr. Vice President, [email protected] 913-262-1436

Janet Guptill, President, KM At Work, [email protected] 314-963-7710

race for results: accelerating knowledge adoption to improve quality

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