A little bit about the journey … Our mission is to provide good, safe patient care. Medicine is not an exact science, and the people treating you are human. Greatly increased focus on quality and patient safety, and it is paying off. But it’s a journey.

We need your help Patients, family members and the community have a vital role to play in their care. We invite you to join us on this journey to better health, and we’ll give you some tools to do this. During this presentation, I’ll share some of our challenges, our progress, as well as the things you can do.

Why is this work so critical?

Today’s hospital patient is really sick … With the expansion of outpatient and less invasive procedures, hospital lengths of stay have decreased, but the patients are sicker. Nearly half of Medicare patients have an average of three or more chronic conditions. The current 65-and-older population is expected to double by 2050.

Hospital care is not cheap Skilled staff available 24/7, millions of dollars in equipment Overhead for surgical suites, patient rooms, etc.

Cost of hospital care decreasing … Hospital care as a percent of total spending has actually declined from 43 percent in 1980 to 33 percent in Alabama’s hospitals are extremely efficient when compared to other states.  16 th lowest cost per discharge in the country  9 th lowest net patient revenue per discharge

The cost to you, the consumer Per capita health spending (all services) for 2009 was $8086 Average annual premium for employer-sponsored coverage - $15,745 in Key drivers of increased cost:  Increase in technology and new medications  Rise in chronic disease – 75 percent of increase  Administrative costs – average about 7 percent for government and private insurance plans

The hospital journey to improve care and reduce costs … Began coordinated statewide effort to improve care:  Monthly meetings of Quality Task Force  Twice-a-year forums for networking/education Formed valuable partnerships:  Work with Alabama’s Quality Improvement Organization  Reinforce focus on key quality initiatives  Huge participation in automated infection surveillance system

More on partnerships Worked with deans of nursing schools to help integrate latest science of patient safety into curriculums Joined with key state organizations to form a clearinghouse for information from IHI, a national quality improvement organization Alabama hospitals benefitted from a grant to help reduce specific infections.

More on partnerships Many Alabama hospitals have joined a national effort to reduce readmissions by 20 percent and hospital acquired conditions by 40 percent by the end of  Examples of the 10 focus areas include: the prevention of infections, falls, pressure ulcers and adverse drug events  Work includes regional workshops, best-practice sharing, data collection and use of evidence-based initiatives to improve care

Efforts paying off … reducing infections Alabama’s hospitals helped pilot automated surveillance system and are leading the country in our progress Alabama had the 2 nd highest rate of participation in a national project focused on prevention of blood stream infections. Decreased infections by 53% in two years!

Reducing infections … Of the hospitals participating, 40 percent went without a single blood stream infection for two years! Another project prevents catheter-associated urinary tract infections Alabama’s hospitals worked with Public Health to create a statewide system for reporting infections. The public can view hospital-specific infection information online.

Efforts are paying off … literally CMS, the agency that pays hospitals for caring for Medicare patients, has begun pay for performance. One percent of all hospital reimbursement withheld and used to reward hospitals on their performance. Alabama hospitals ranked number one in quality performance and quality improvement. As a result, Alabama’s hospitals will receive the second largest bonus payment of any state.

Efforts paying off … for patients! Not every quality improvement project is easy to quantify, but … Estimates are that through the two-year program targeted at reducing blood stream infections:  11 lives were saved  $4.8 million was saved by reducing infections and shortening days in the hospital

The journey never ends Research on techniques, medications, etc., continues to provide evidence of ways to improve care. Quality and patient safety are being built into the culture of hospitals, but it takes reinforcement Being in the 95 th percentile for infection reduction is fine until it’s your mother who gets an infection … striving for 100 percent!

We need you to join us on the journey Through next spring all hospitals will be working with patients and families to improve care. Information about how you can help is available at

Your role in the journey … be informed Ask questions when you go to the doctor or the hospital Many tools available including these websites:  Hospital Compare  Blue Cross Blue Shield  Alabama Department of Public Health Listen carefully to instructions, particularly when leaving the hospital

Your role in the journey … fight infection While in the hospital, wash your hands frequently Don’t touch surfaces that need to be germ-free Ask visitors to stay home if they are sick Cover your hands and mouth when coughing Ask your caregivers if they’ve washed their hands

Your role in the journey … more info. On the new quality website, you’ll find:  Lists of suggested questions to ask your doctor/hospital  Links to the quality reporting websites mentioned  Information on advance directives  A list of medical terminology  A resource list for businesses to use with employees

So, join us on the journey It’s a never-ending road, but one that’s well worth traveling!