1. Hospital Performance Stories: Reducing Harm Across the Board (HAB)
April 11, 2013
1pm – 2:30pm ET

2. What You will Hear Today
“Charge” to be in action on HAB with your hospital C-Suite to adopt a culture of safety
Two powerful hospital leadership stories on HAB
Guidance on how to use the HAB template
How to get support to develop your hospital’s leadership story

3. Welcome! Dennis Wagner, Partnership for Patients
Jack Jordan , Partnership for Patients
Maulik Joshi, AHA/HRET
Debbie Reed-Gillette , Partnership for Patients

4. Harm Across the Board Hospital Leadership Stories
Susan Bowen
Shepherd Center, Georgia HEN
Tammy Dye
Schneck Medical Center, Indiana Hosp. Assoc., AHA/HRET HEN

5. Promoting Safety and Injury Prevention
Improving Harm Across the Board Shepherd Center Atlanta, GA Susan M. Bowen, RN, CPHQ, CLNC, CSHA
Promoting Safety and Injury Prevention

6. Data reflects ALL Inpatient Units, including ICU.
Breakthrough in “All Harm” Reduction: From Average of 109 To 66 Harms/1,000 Discharges
Harms / 1,000 discharges shown a reduction from ~109 / quarter in 2010 to 66 / quarter in 2011
Decreased rate of about 40 harms / 1,000 discharges is from improvement in ADE, Falls, and VTE
Ongoing 0 VAP rate
Data reflects ALL Inpatient Units, including ICU.
VTE Data includes all patients (Medical AND Surgical) with VTE defined codes that were not coded as present on admission.
CY 2010 / CY 2011 VTE data is forecasted due to data artifacts in the data set.

7. Data reflects ALL Inpatient Units, including ICU.
Reduce Number of Patient All Harm “Across the Board”: From Average of 25 to 15 Total Harms Per Quarter
Data reflects ALL Inpatient Units, including ICU.
VTE Data includes all patients (Medical AND Surgical) with VTE defined codes that were not coded as present on admission.
CY 2010 / CY 2011 VTE data is forecasted due to data artifacts in the data set.

8. Source: Shepherd Internal Discharge Phone Calls
Breakthrough in Readmission: From Average of 2.4% to 1.9% of Discharges
(3 / 231) (5 / 252) (6 / 258) (9 / 226) (7 / 230) (1 / 222) (5 / 231) (4 / 232)
Source: Shepherd Internal Discharge Phone Calls

9. Pearls Culture of Safety promoted from the top
Board conducts Patient Safety Rounds monthly
Senior Leaders / Staff receive financial reward for decreasing Harm
Ownership at point of care - “Workgroup” design and strategy
11 WG’s align regulatory / evidence based safe practice
Surveillance and real-time coaching; at point of care delivery
A Quality Department that employs the “Right” resources
Trained Internal Improvement Advisors
Clinical specialist and Industrial Health System Engineers
Promoting “Mindful Behavior” vs. Mandates without rationale
Mindful Practice Information Tools define expectations of : Consumer, Clinician,
and our organization
Be Alert / Be There - what you do or what you fail to do  outcome
Continually challenging “status quo”
Unacceptable to rest on our own laurels
Mentality that even one is not acceptable
Celebrate innovative care

10. Defining Moments In Our Journey
Realizing that we were DRIP’s…
Redesigned our Structure
Defined data that drove “safety” and what mattered most
Communication of data had to go from bottom up/back
Facing we were guilty of “Word Abuse”…
Misuse of “empowerment” and “transparency”
Began to Walk the talk

11. Strategies that Drive Results
Challenge of Pre-Existing Beliefs
“Medical stuff is not a problem for us; we don’t have to worry since it’s not required”
Rehab not Acute
Strategies to Overcome
Trend data to understand medical complexity
Ahead of the Curve mentality
Hardwire “Process Thinking”
Internal Advertisement: Safe Performance Outcomes
Mindful Practice Culture: E. Scott Geller

12. Our Risk Profile: Potential for Harm by HAC
HACs
2012 Annual number of patients at risk in each area
ADE
# of inpatients that were discharged from ALL units: 915
CAUTI
# of inpatients on ALL Units with indwelling catheters: 699
CLABSI
# of inpatients on ALL Units with central lines: 470
Falls
Pr Ulcer
VAP
# of inpatients on ALL Units with a ventilator: 203
VTE
# of inpatients that were discharged from ALL units: medical/surgical: 915
TOTAL
Risk opportunities for harm across the board: 5032
Readmit
2 minutes for slides 2-4
SSI, OB AE, and EED are not applicable
All Data includes ALL Inpatient Units, including ICU

13. Our Hospital HAC Rates: Per Discharge
HACs
Baseline
CY 2010
Actual
CY 2011
Ideal
Target
Annual
10% Improvement Target
Actual CY 2012
(# Harms)
Year End
Improvement Status
ADE
ALL Inpatient Units
.0078
.0041
.0037
.0022 (2)
Exceeding Target
CAUTI
.0255
.0196
.0177
.0372 (34)
Opportunity
CLABSI
.0055
.0066 (6)
Falls (with harm)
.0011
.0021
.0019
.0011 (1)
Pr Ulcer
.0022
.0033 (3)
VAP
VTE*
Medical AND Surgical Patients
.0671
(Baseline)
.0481
.0432
.0153 (14)
Total
.1092
.0801
.0721
.0645 (60)
Readmit
ALL Inpatient Discharges -
.0238
.0214
.0186 (17)
2 minutes for slides 2-4
Note: Calculations are based on rate per discharge, NOT rate per device days as seen in NSHN
* VTE Data includes all patients with VTE defined codes that were not coded as present on admission.
CY 2010 / CY 2011 VTE data is forecasted due to data artifacts in the data set.

14. Our Hospital’s Risk Profile
Total annual risk opportunities Across the Board
5032
2012 Annual Volume of Inpatient Discharges
915
Number of Risk Opportunities per patient Discharge
5.5
Number of PfP Harm Areas Applicable (0 – 11) 8
Number of PfP Harm Areas Applicable & Adopted
Number of PfP Areas at or “Exceeding Target” status 4
Number of PfP Areas at “IDEAL” status 1
2 minutes for slides 2-4

15. Future Actions to Reduce Harm
Continuance on imbedding ABC’s of Mindful Practice:
“Treat every procedure/every task with the same level of attention to detail as the first time”
Review every piece of data for communication to ensure clarity:
“If it is unclear to the people it doesn’t matter”
Reduce confusion when transitioning from Policy to Practice
Implement Process Maps

16. Patient Safety Leaders
2 minutes

17. Panel Discussion: Focusing on “Results”
What is the most exciting message you heard?
What is the biggest insight this gave you?

18. Improving Harm Across the Board Schneck Medical Center Seymour, Indiana Tammy Dye, VP Clinical Services & CQO
To be a healthcare organization of excellence, every person, every time.

19. Hospital Trend In Reducing HARM
Harms/1,000 discharges
Readmissions

20. Hospital Trend In Reducing HARM
Total # of Harms
Readmissions 20

21. Hospital Trend In Reducing HARM21

22. Hospital Trend In Reducing HARM22

23. Pearls Leadership (It always starts here)
Leaders must create, support, and role model a culture of excellence
Just Culture
Quality is a strategic priority
Aligning Processes & People
Standing agenda item in staff meetings
Becoming process literate
Standardize processes
Cascading goals

24. Pearls Transparency Share progress / opportunities Dashboards
Unblinded Scorecards
Patient Family Advisory Council
Just Culture

25. Strategies to Drive Results
Schneck’s fosters a culture for reporting harm, good catches & hazards so that that they learn and improve patient care safety
Just Culture & Good Catch Program
On-line event reporting
Safety rounds
RCA’s
Unblinded physician scorecards
Mortality audits
Patient Family Advisory Council
Good Catch Program
Just Culture

26. Risk Profile by Areas of Risk
HACs
Estimated annual number of patients at risk in each area
ADE
4587 of inpatients:
CAUTI
1268 pts in IP units with catheter in place:
CLABSI
668 pts in IP units with central lines:
Falls
4587 of discharges:
Ob AE
747 of women with deliveries:
Pr Ulcer
SSI
5502 of applicable surgical pts:
VAP
183 of patients on a ventilator:
VTE
EED
283 of women with elective deliveries
Readmit
4587 of inpatients at risk of readmit:
TOTAL
31,586 Risk opportunities for harm across the board

27. Improving HAC Rates (per discharge)
HACs
Baseline
[time period]
Target
Current
Improvement Status (scale)
ADE
(2011)
40% ↓
0.007 (Jan-Dec 2012)
Progress
CAUTI
(2011)
40% ↓
0 (Jan-Nov 2012)
Ideal
CLABSI
0 (2011)
Sustain
0 (Jan-Dec 2012)
Falls w Injury
0 (Jan-Dec 2011)
0 (Jan-Sep 2012)
Ob AE
0.012 (Dec 2011)
40% ↓
(Jan-Sep 2012)
EED
0 (Dec 2011)
Pr Ulcer
0 (Oct-Dec 2011)
(Jan-Sep 2012)
SSI
0.003 (2011)
0.003 (Jan-Sep 2012)
VAP
0.0 (2011)
VTE
(2011)
40% ↓
Readmit
0.066 (2011)
0.068 (Jan-Sep 2012)

28. Our Hospital Risk Profile & Result
Annual Volume (Discharges)
4587
Total risk: annual harm opportunities
31,586
Risks per patients (Total Opportunities)/Discharges)
6.9
Number of PfP Harm Areas Applicable (0 – 11) 11
Number of PfP Harm Areas Applicable & Adopted
Number of PfP Areas at Improvement Target 1
Number of PfP Areas at IDEAL 10

29. 1 Hospital Acquired Conditions Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12
CAUTI 1
CLABSI
Pressure Ulcer
VAP
Standardized processes through care bundles and protocols
Assign Champions / Educate
Transparency of performance data

30. Future Actions to Reduce Harm
Creation of HAC Dashboard with Self Directed Stakeholder Teams assigned to the oversight and improvement of key metrics and outcomes.
Ongoing participation with educational opportunities and collaboratives to learn and educate on best practice.
Continuing performance and process improvement initiatives

31. Safety Committee
2 minutes

32. Panel Discussion: Focusing on “Leadership Story”
What was the most exciting message you heard? What is the biggest insight this gave you?

33. Review of HAB Template

34. Improving Harm Across the Board

35. (**Delete this slide when content of presentation is complete)
TEMPLATE GUIDE
Treat harms as events that can be summed
Focus on harms (outcomes) rather then preventive measures (process)
Special conditions can be considered a harm (e.g., EED, Readmits, …)
Produce an overall harm trend for the hospital
(**Delete this slide when content of presentation is complete)

36. 2012 Breakthrough in Reducing HARM: 250 to 50 harms/1,000 discharges

37. Cut “harm across the board” in half: 60 patients per quarter to under 30

38. 2012 Breakthrough in Readmission: From 20% of discharges to 10% of discharges

39. 2012 Breakthrough in Reducing Readmissions: From 20 per quarter to 10 per quarter

40. Pearls Please list the drivers of safety that produced these results.
Include one about patient and family engagement, if relevant

41. Defining Moment(s) In Our Journey
Name and date one or two defining moments.
Moments that caused the organization to commit to extraordinary safety.
Moments that resulted in a big breakthrough in the organization’s ability to deliver safety.

42. Strategies to Drive Results
What challenges did you encounter that you were able to overcome to achieve the results you are presenting here?
What were the strategies you used to overcome them?

43. Risk Profile by Areas of Risk
HACs
Estimated annual number of patients at risk in each area
Number
ADE
# of inpatients:
CAUTI
# pts in IP units with catheter in place:
CLABSI
# pts in IP units with central lines:
Falls
# of discharges:
Ob AE
# of women with deliveries:
Pr Ulcer
SSI
# of applicable surgical pts:
VAP
# of patients on a ventilator:
VTE
EED
# of women with elective deliveries
TOTAL
Risk opportunities for harm across the board
Readmit
# of inpatients at risk of readmit:
2 minutes for slides 2-4

44. (**Delete this slide when content of presentation is complete)
Improving Harms by HAC
Scale: number of hospital-acquired conditions (HACs) at each level
IDEAL: level represents what we see as best possible
At Target: level represents meeting improvement target
Progress: level not yet at target
Opportunity: level represents an improvement opportunity
(**Delete this slide when content of presentation is complete)
2 minutes for slides 2-4

45. Improving HAC Rates (per discharge)
HACs
Baseline
[time period]
Target
Current
Improvement Status (scale)
ADE
CAUTI
CLABSI
Falls
Ob AE
Pr Ulcer
SSI
VAP
VTE
EED
Total
Readmit
2 minutes for slides 2-4

46. Improving HAC Rates (per discharge)
HACs
Baseline
[CY 2011]
Target
Current
[CY 2012]
Improvement Status (scale)
ADE
0.008
CAUTI
0.0008
CLABSI
Falls w Injury
Ob AE
0.012
EED
Pr Ulcer
SSI
0.003
VAP
0.0
VTE
0.0002
TOTAL
0.024
Readmit
0.066

47. Improving HAC Rates (per discharge)
HACs
Baseline
[CY 2011]
Target
Current
[CY 2012]
Improvement Status (scale)
ADE
0.008
40% ↓
CAUTI
0.0008
40% ↓
CLABSI
Sustain
Falls w Injury
Ob AE
0.012
40% ↓
EED
Pr Ulcer
SSI
0.003
VAP
0.0
VTE
0.0002
40% ↓
TOTAL
0.024
40% 
Readmit
0.066

48. Improving HAC Rates (per discharge)
HACs
Baseline
[CY 2011]
Target
Current
[CY 2012]
Improvement Status (scale)
ADE
0.008
40% ↓
0.007
CAUTI
0.0008
40% ↓
CLABSI
Sustain
Falls w Injury
Ob AE
0.012
40% ↓
0.0011
EED
Pr Ulcer
0.0002
SSI
0.003
VAP
0.0
VTE
40% ↓
TOTAL
0.024
40% 
0.0113
Readmit
0.066
0.068

49. Improving HAC Rates (per discharge)
HACs
Baseline
[CY 2011]
Target
Current
[CY 2012]
Improvement Status (scale)
ADE
0.008
40% ↓
0.007
Progress
CAUTI
0.0008
40% ↓
Ideal
CLABSI
Sustain
Falls w Injury
Ob AE
0.012
40% ↓
0.0011
EED
Pr Ulcer
0.0002
SSI
0.003
VAP
0.0
VTE
40% ↓
TOTAL
0.024
40% 
0.0113
Readmit
0.066
0.068

50. Our Hospital Risk Profile & Result
Annual Volume (Discharges)
Total risk: annual harm opportunities
Risks per patients (Total Opportunities)/Discharges)
Number of PfP Harm Areas Applicable (0 – 11)
Number of PfP Harm Areas Applicable & Adopted
Number of PfP Areas at Improvement Target
Number of PfP Areas at IDEAL
2 minutes for slides 2-4

51. Future Actions to Reduce Harm
What other actions will you take to reduce harm in the future?

52. Photo of Hospital CEO & Safety Team
2 minutes

53. Patient Voice: A Call to Action
Bob and Barb Malizzo

54. CMS & AHA/HRET: Call to Action
Dennis Wagner
Jack Jordan
Charisse Coulombe
Debbie Reed-Gillette