1. Jonathan Merrell R.N. Acting Deputy Director for Quality Health Care
Indian Health Service
Jonathan Merrell R.N.
Acting Deputy Director for Quality Health Care

2. Welcome New Acting Director: RADM Michael D. Weahkee
HHS Secretary’s Priorities
Patients
People
Partnerships

3. IHS Priorities People Partnerships Quality Resources People Quality

4. People
Recruitment and Retention
Global recruitment
Commissioned Corps

5. Partnerships Tribal Partners Boys and Girls Club
MD Anderson Cancer Center
OEHE Drought Response

6. RPMS Seeking input on modernization and improvement
Two listening sessions held
Written comments due 8/25
More info at

7. Quality TeleED services beginning
Deputy Director for Quality Health Care
IHS Quality Consortium
Quality Framework
Portland Area Quality Program
California YRTC

8. Quality Framework
Goals
Improve Health Outcomes for Patients Receiving Care
Provide a Care Delivery Service All Patients Trust
Priorities
Strengthen Organizational Capacity to Improve Quality of Care & Systems
Meet & Maintain Accreditation for IHS Direct Service Facilities
Align Service Delivery Processes to Improve Patient Experience
Ensure Patient Safety
Improve Transparency and Communication among IHS Stakeholders
Regarding Patient Safety and Quality

9. Quality Framework Steering Committee
Formed at IHS Headquarters to oversee implementation of the Quality Framework
Significant change in composition – January 2017
Diverse expertise from IHS and HHS
Meet Bi-weekly to monitor progress of implementation
Advises on implementation priorities
Stand and be recognized

10. Quality Framework Steering Committee - membership
Jonathan Merrell, RN,BSN, MBA, Dep. Director Quality (A), IHS HQ – Chair
CAPT Michael Toedt, MD, CMO, IHS HQ
RADM Kevin Meeks, Dep Director of Field Operations (A), Area Director, Oklahoma
CAPT Celissa Stephens, RN, BSN, MSN, Chief Nurse, IHS HQ
RADM Ty Reidhead, MD, Area Director, Phoenix
Miles Rudd, MD, FAAFP, CMO, Portland
RADM Sarah Linde, MD, Director OCPS (A), IHS HQ
Laura Herbison, RN, BSN, CEO, Western Oregon, NCCEO Chair
Ira Salom, MD, NNMC, NCCD Chair
Susy Postal, DNP, Chief Health Informatics Officer, IHS HQ
CAPT Jeff Salvon-Harman MD, QFSC (detailed), IHS HQ
Kathleen Kimmel, RN, MHA, QFSC (detailed), IHS HQ
Darlene Fleischmann, JD, QFSC (detailed), IHS HQ

11. Implementation - Priority 1: Strengthen Organizational Capacity to Improve Quality of Care & Systems
Proposed Office of Quality to HHS, Congress January 2017
Governance policy updated:
Convene at least 2x per year
Quality and Safety on every agenda
Minimum staffing of GB defined
Human Resources – expanded Title 38 pay for ED providers/Directors and CRNAs

12. Implementation - Priority 1: Strengthen Organizational Capacity to Improve Quality of Care & Systems
Accountability Dashboard
Responding to requests for:
measuring to standards
reporting results to oversight agencies
supporting internal quality enhancements
Accountability Dashboard Working Group
Identified candidate accountability measures,
Developed measurement definition documents
Established methods and frequency of data collection
DRAFT

13. Accountability Dashboard Workgroup Members
RADM Ty Reidhead, MD, Area Director, Phoenix – Chair
Kathleen Kimmel, RN, MHA, QFSC, IHS HQ – Co-Chair
Bruce Finke, MD, CMO, Nashville
Joe Bryant, Pharm D., Oklahoma
Vanessa Weaver, OIT, IHS HQ
Anne Fugatt, Phoenix
Travis Watts, Pharm D., Oklahoma
RADM Michael Weahkee, MBA, MHSA, PIMC
CAPT Michael Toedt, MD, CMO, IHS HQ
Susy Postal, DNP, Chief Health Informatics Officer, IHS HQ
RADM Kevin Meeks, Dep Director of Field Operations, Area Director, Oklahoma
RADM Sarah Linde, MD, Director OCPS, IHS HQ
CAPT Jeff Salvon-Harman MD, QFSC, IHS HQ
Darlene Fleischmann, JD, QFSC, IHS HQ
Jonathan Merrell, BSN, MHA, Dep. Director Quality, IHS HQ

14. Implementation - Priority 1: Strengthen Organizational Capacity to Improve Quality of Care & Systems
Credentialing Software Acquisition

15. Implementation - Priority 1: Strengthen Organizational Capacity to Improve Quality of Care & Systems
Credentialing policy update in clearance
Credentialing software acquired (MD-Staff)
Pilot implementation in 4 Areas
Kick-off meeting and demonstration meeting completed for pilot Areas
Testing implementation across the spectrum of prior processes (paper, electronic spread sheet, electronic credentialing software)
Pilot implementation at all 4 Areas by 31 July 2017
Intent: standardize credentialing processes (supported by software), improve Med Staff application/credentialing/privileging processes, support Ongoing/Focused Professional Performance Evaluation, create portability of credentials within IHS for TDY/Details and contractors

16. Credentialing Workgroup – members
CAPT Jeff Salvon-Harman, MD, QFSC, IHS HQ, - Chair
David Civic, MD, MMM, FAAFP, Dir. of Quality, Phoenix
Miles Rudd, MD, FAAFP, CMO, Portland
CAPT Dione Harjo, MPH, Oklahoma
Destiney Doney, CPCS, Billings
Jeffrey Johnston, DAP, IHS HQ
Daniel Rosenstengel, DAP, IHS HQ
Darlene Fleischmann, JD, QFSC, IHS HQ
LCDR Andrea Scott, BS, MBA, Dep Director OIT, IHS HQ
CAPT Michael Toedt, MD, CMO, IHS HQ
Jonathan Merrell, RN, BSN, MBA, Dep. Director Quality, IHS HQ
CAPT Nicki Lurie, MD, Senior Advisor, IHS HQ
RADM Sarah Linde, MD, Director OCPS, IHS HQ
CAPT Mark Rives, DSc, MS, MBA, CHCIO, Dir. OIT, IHS HQ
Kathryn Lewis, OIT, IHS HQ
Ruben Duran, OIT, IHS HQ
Michelle Riedel, OIT, IHS HQ
Thomas Sullivan, OIT, IHS HQ

17. Implementation - Priority 2: Meet & Maintain Accreditation for IHS Direct Service Facilities
Draft SOW for Accreditation Master Contract reviewed by Areas, finalizing RFP
2016 Mock Surveys: completed for all hospitals not formally or mock surveyed in the prior 12 months. Findings consistent with past formal surveys: Gov. Board, Life Safety, Facilities, QAPI
Quarterly Brown Bag webinar series highlights best practices that support successful accreditation

18. Implementation - Priority 2: Meet & Maintain Accreditation for IHS Direct Service Facilities
Now focusing on continuous accreditation readiness
Example: Albuquerque Area Continuous Accreditation Readiness Program (CARP)

19. Implementation - Priority 3: Align Service Delivery Processes to Improve Patient Experience
Patient Experience of Care Survey Work Group
Standardized approach using tablet computers connected to an internet analytics application for real time access to survey results
Process improvement focus (incorporating elements from IPC and SouthCentral Foundation)
Survey administered with tablet devices, pilot testing at 4 facilities
Micmac
PIMC
Rosebud
Warm Springs

20. Patient Experience of Care Survey Pilot - current pilot members
Bruce Finke, MD, CMO Nashville – Chair
PIMC:
Kathy Dill, RN, BSN, MHSA
Peggy Morgan-Griffith
Kyle Jahn, IT
Mike Nez, IT
LT CDR, Mark Downing, IT Network Specialist
Rosebud:
Lisa Bordeaux, Hospital Liaison
Kathleen Kimmel, RN, MHA, QFSC, IHS HQ – Co-chair
Warm Springs
Carol Prevost, CEO
Michele Miller, IT
Micmac
Theresa Cochran, CEO
Perry Ciszewski, IT, Nashville AO
Katie Espling
Dawn Schillinger
Samantha Cochran

21. Patient Experience of Care Survey Pilot - current adviser members
Bruce Finke, MD, CMO Nashville – Chair
Advisors:
CAPT Laura Herbison, RN, BSN, CEO, Western Oregon
Mark Veazie, DPH, Phoenix
CAPT Jeff Salvon-Harman, MD, QFSC, IHS HQ
Julie Sadovich, PhD, Acting Director IPC, IHS HQ
Kathleen Kimmel, RN, MHA, QFSC, IHS HQ –
Co-chair
CAPT Michael Toedt, MD, CMO, IHS HQ
Jonathan Merrell, RN,BSN, MBA, Dep. Director Quality, IHS HQ
RADM Ty Reidhead, MD, Area Director, Phoenix
Darlene Fleischmann, JD, QFSC, IHS HQ
Athena Elliot, Executive Advisor, IHS HQ

22. Implementation - Priority 3: Align Service Delivery Processes to Improve Patient Experience
Patient Wait Times Working Group
Primary care, non-follow up appt scheduling
wait time
cycle time ED
door-to-door
door-to-provider
Left Without Being Seen (LWBS)
Candidate standards developed and 2 IHS Circulars in clearance.

23. Patient Wait Times Workgroup – current members
CAPT Michael Toedt, MD, CMO, IHS HQ – Chair
Jana Towne, RN, BSN, MHA, Phoenix Area Nurse Consultant
Paula Mora, MD, Navajo
Lori Christensen, MD, Clinical Director, Gallup
Sara Michaels, MD, Medical Officer, Shiprock
Pauline Stubberud, Dir. Prof. Quality Svcs, NNMC
LT Abby Bacon, RN, MSN, CIC, Fort Thompson
Ouida Vincent, MD, FACOG, NNMC
Julie Sadovich, PhD, Acting Director IPC, IHS HQ
CAPT Amy Buckanaga, RN, MSN, Director of Quality, Bemidji
Anne Fugatt, IT, PIMC
Kathleen Kimmel, RN, MHA, QFSC, IHS HQ – Co-chair
Kimberly Mohs, MD, Chinle
Joe Bryant, Pharm D., Oklahoma
Christine Gilliam, HACP, Oklahoma
RADM Ty Reidhead, MD, Area Director, Phoenix
Jonathan Merrell, RN, BSN, MBA, Dep. Director Quality, IHS HQ
CAPT Jeff Salvon-Harman, MD, QFSC, IHS HQ
CAPT Nicki Lurie, MD, Senior Advisor, IHS HQ
Darlene Fleischmann, JD, QFSC, IHS HQ
Susy Postal, DNP, Chief Health Informatics Officer, IHS HQ

24. Implementation - Priority 4: Ensure Patient Safety
Just Culture training provided at Santa Fe Indian Hospital and Billings Area Office
WebCident adverse event reporting system upgrade vs replacement project on hold temporarily, anticipate resumption in 2-4 months

25. Implementation - Priority 4: Ensure Patient Safety
Engaging with HealthInsight New Mexico as the single Quality Improvement Organization (QIO) for all IHS hospitals
Partnership to Advance Tribal Health – consortium of QIOs subcontracted to deliver services under the leadership and oversight of HealthInsight NM
Leadership Learning and Action Network (LAN) launched May 3, 2017
AHRQ Culture of Safety Survey piloted at Belcourt, ND
TeamSTEPPS training available
IHI Open School access for all IHS staff being pursued
Single QIO funded solely by CMS (x 3 years) to provide support to IHS hospitals

26. Implementation - Priority 4: Ensure Patient Safety
Engaging with Premier Inc. Hospital Improvement and Innovation Network (HIIN) to reduce Hospital Acquired Conditions (HACs) and Readmissions
Tailoring HACs and related measures to conditions observed in IHS
Support to address underlying contributing factors (e.g. Patient and Family Engagement)
Reducing workload on hospital staff by using National Healthcare Safety Network (NHSN) reported data for Hospital Acquired Infections
Coordinating and collaborating with PATH partners for efficiency and synergy

27. Implementation - Priority 5: Improve Processes & Strengthen Communications for Early Identification of Risks
Quality Managers Listserv created (currently 60+ registrants)
Monthly Area and Service Quality Manager calls for informal communications
Quarterly Brown Bag Webinar series for facility and Area leaders
Increased information sharing up and down the chain
Increasing trust and transparency

28. Future Quality Efforts
GAO Responses/Resolution
Enterprise Risk Management
Quality-Centric Strategic Planning

29. Resources FY 2017 budget update FY 2018 budget update
Appropriations process
Protects resources for direct patient care
Third Party Collections
SDPI
Dear Tribal Leader regarding funds returned to
Treasury _DTLL_UIOLL_FundsReturnedTreasury_ pdf

30. Thank you