Thomas Kelley, MD Chief 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 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% Surgical Complications 14.5% Blood Stream Infections 41% Urinary Tract Infections 37% 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. 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 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 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 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 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 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

Florida’s Quality Journey Phase 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 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 23 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 Refine data measurements Expand number of hospitals participating Sustain improvement

Contact Information and Resources FHA Five Years of Quality Report: Thomas Kelley, MD Chief Quality and Transformation Officer, Orlando Health Florida Hospital Association 306 East College Avenue Tallahassee, Florida Phone: (850) Fax: (850)