1. M5: Specialty Leaders Brief CAPT Lisa Mulligan BUMED Chief Medical Officer
1 DEC 2017

2. Discussion Objectives
Discuss what Clinical Communities are and how they support the dissemination of new projects/ideas throughout the Enterprise
Understand the role of the Chief Medical Officer (CMO) and how he or she supports the HRO vision
Define the role of the Chief Quality Officer (CQO) and how the position supports CMO activities

3. Clinical Communities Operationalize the pillars of HRO
A Clinical Community (CC) aligns processes, technology, and facility infrastructure in both a horizontal and vertical continuum of care to achieve a patient-centric approach that results in enhanced value, standardization, and improved clinical, operational, and financial outcomes.
Clinical Communities promote collaboration to drive improvements in care across all of Navy Medicine.
Scope
Clinical Communities can encompass Navy Medicine assets at any location, including BUMED, Regional Commands, and all MTFs and their subordinate hospitals and clinics
Accountability
Clinical Communities report on activities to the Collaborative Care Board (CCB) and each Clinical Community has dedicated program management support from BUMED
Readiness
Clinical Communities will provide our clinicians with the tools and knowledge to ensure a ready medical and a medically ready force
Clinical Communities provide channels to elevate and expand ideas for change.

4. Clinical Communities Mission and Objectives
The Clinical Communities Mission
Improve patient safety and quality of care by enabling process improvement, promoting collaboration, expanding knowledge sharing, reducing variation, and implementing leading practices to bolster force readiness and support our clinicians and staff in delivering the best health outcomes for all of our recipients of care.
Clinical Communities Objectives
The objectives below outline the goals that the Clinical Communities structure will pursue to achieve its mission, and are aligned to the three pillars of HRO – Leadership, Robust Process Improvement, and Culture of Safety:
Drive Cultural Change through Championship and Knowledge Sharing
Provide a framework for collaboration between clinicians and staff, and incentivize them to work together with leadership to identify solutions and facilitate the spread of leading practices
Enable Robust Process Improvement and Reduce Unwanted Variation
Promote the identification of issues at the Deckplate and provide the organizational support necessary to develop and share leading practices and continuously improve clinical processes to reduce undesired variation in the delivery of care
Improve Patient Safety, Experience, and Outcomes
Support an integrated care experience that allows for the delivery of coordinated care to all recipients, and the improvement of health and wellness outcomes to bolster force readiness
Implementing Leading Practices
Improving Patient Safety
Driving Cultural Change
Clinical Communities
Leading Adoption
Reducing Variation
Improving Outcomes
Primary Objectives of the Clinical Communities
The improvement of clinical outcomes
The achievement of zero patient harm in all healthcare operations
To establish standardized and evidence-based practices as well as process and outcome measures to assess and monitor system effectiveness
To encourage Clinical Community Leaders and Managers to employ an inclusive and collaborative approach to process improvement and knowledge sharing by working closely with Specialty Leaders, Corps Chiefs and Clinical Subject Matter Experts (SMEs), and other relevant stakeholders
Scope
The Clinical Communities structure applies to Navy Medicine assets, which includes Budget Submitting Office (BSO) 18 entities, Dental Battalions, and Navy Medicine Operational Forces
Accountability
Clinical Communities report on their activities to the Collaborative Care Board (CCB) and each Clinical Community is planning to have dedicated program management support from BUMED

5. Initial Clinical Community List Neuromusculoskeletal
The First Six Navy Clinical Communities
Strategic Goals
Initial Clinical Community List
Women’s Health
Surgical Services
Psychological Health
Dental Services
Operational Medicine
Neuromusculoskeletal
To improve clinical outcomes by establishing new patient safety & quality measures
To achieve zero preventable harm in all healthcare operations by emphasizing attention to detail and optimizing clinical practices
To establish standardized and evidence-based practices as well as process and outcome measures to assess and monitor system effectiveness
To encourage Clinical Community Leaders and Managers to employ an inclusive and collaborative approach to process improvement and knowledge sharing by working closely with Specialty Leaders, Corps Chiefs, Subject Matter Experts (SMEs), and other relevant stakeholders
Six Clinical Communities were identified as priorities for stand-up based on the importance of those clinical areas to Navy Medicine’s Readiness Mission 5

6. Advisory Board Responsibilities
Supporting the Clinical Communities
Specialty Leaders may serve as members of individual Clinical Community Advisory Boards to provide relevant subject matter expertise
Advisory Board Responsibilities
Advisory Board members represent and provide a forum for the various interests of the Sub-communities and Working Groups that fall within the Clinical Community
Members also:
Provide subject matter expertise to members of the Clinical Community
Establish high level goals for Clinical Communities, supports development of additional goals across other Clinical Communities, aligns efforts, communicates effectively, provides resources, and removes barriers to ensure critical structures and systems are in place
Provide feedback on project prioritization
Endorse and support dissemination of information to stakeholder groups
Encourage involvement, cooperation, and participation in all stakeholder activities
Comprised of leaders from all levels of the Enterprise and will reflect key components and areas of focus. Size of the Advisory Board will vary based on the prospective scope of the Clinical Community’s workload
Specialty Leaders are a critical component of Clinical Community membership, their role on the Advisory Boards support Enterprise-wide implementation of patient safety and quality initiatives

7. Clinical Communities in Action

8. A Use Case for Clinical Communities
This journey reflects the ideal future state of Clinical Communities at Navy Medicine. It follows the journey of Surgeon Nancy as she uses Clinical Communities to solve a patient safety problem
ISSUE IDENTIFICATION
01 |
Surgeon Nancy notices an unusual number of post-op infections, and works with her MTF CMO to set up a Healthcare Effectiveness Team (HET) to address the issue.
Practitioner Profile: Surgeon Nancy
The MTF CMO connects Nancy to the Surgical Services Clinical Community, whose Advisory Board informs Nancy about a similar issue resolved at another MTF through an improved pre-op checklist. Nancy then brings this solution back to her Command for potential implementation.
COLLABORATIVE
INVESTIGATION
02 |
SOLUTION
DEVELOPMENT
03 |
Nancy and the HET determine that the new checklist could reduce the risk of infections at her Command, and begin implementing the solution with the oversight of Regional and Command leadership.
“How will Clinical Communities and the new High Reliability Operating (HRO) Model improve my ability to provide quality care to my patients while saving me on time and headache?”
The MTF CMO shares success to the Regions through the Regional Quality Collaborative, and Nancy notifies the Surgical Services Advisory Board of her success and lessons learned. The Surgical Services Chair shares the success at the next Collaborative Care Board (CCB) meeting.
IMPLEMENTING + SHARING SUCCESS
04 |

9. Sample Clinical Community Structure
Inputs received from Community members provided some initial recommendations for building out the support structure of the Community as well as initial priority focus areas
Confirmed/Forthcoming Sub-Community
Surgical Services Advisory Board
Proposed Initiative
Ideas and Scope
Safety / SPD / CSR
Surgical Site Infection (SSI) Improvement
Venous thromboembolis m (VTE) Risk Assessment
Huddle Checklists
Wound Care
OR Dashboard
OR Performance
Ambulatory Surgery Centers Assessment
KSA Development
Perioperative Surgical Home
Staffing Standards
Business Process Standards
Clinical Process Standards
Equipment Standards
Trauma
Operational trauma
Trauma practice at trauma center
Corpsmen trauma training
Best practices
Restorative Care
Emerging medical field
Plan for est. MHS Clinical Community
Clinical architecture
Proposed Future Sub- Communities

10. A Clinical Community Success Story
An example of the positive Enterprise-wide impacts to patient safety and quality can be found with the development of the Postpartum Hemorrhage Bundle
Postpartum Hemorrhage (PPH) Bundle
Issue
Intervention
Impact
The PPH Bundle is undergoing implementation across the Enterprise through the project governance process. This protocol provides the most up to date and standardized approach to prevention, recognition and treatment to support our beneficiaries and bolster our Operational Readiness.
A lack of national consensus on guidelines and significant variation in MTF responses to Postpartum Hemorrhaging across the Enterprise led to increased patient risk and potentially unsafe patient outcomes at Navy Medicine MTFs.
The PPH Bundle is an Enterprise-wide patient safety collaborative initiative that standardizes clinical practices and supplies available for every delivery. 
This toolkit was first developed by utilizing the SWARMing/CAIRS process designed to develop solutions to pressing issues.
The PPH bundle exemplifies the value of deckplate-driven HRO initiatives. Navy Medicine also has opportunities to share similar successes on issues related to Operational Readiness

11. Role of the CMO

12. Monitoring Quality and Safety
The Role of the Chief Medical Officer (CMO)
Purpose of the CMO
Monitoring Quality and Safety
Aligning Practices
The CMO serves as the senior clinical leader for the MTF, Region, and BUMED to enhance collaboration in the implementation of HRO tenets. The CMO will identify and engage with all clinicians and monitor patient safety and quality
The CMO role exists at all levels of the Enterprise to disseminate emerging best practices and solutions, increasing collaboration and improvements in support of HRO
What is the mission of the OCMO?
Why was the CMO role created?
Where does the CMO fit in the Navy Medicine organization?
Roles of the CMO
Provide Clinical Leadership
Deliver high value care while optimizing quality, patient experience, and cost
Champion Change and Growth
Develop initiatives that improve quality and maximize efficient clinical operations
Drive Robust Process Improvements
Monitor results and constantly evaluate the adoption of HRO principles

13. Role of the CQO

14. Roles and Responsibilities Roles and Responsibilities
The CMO and CQO Overview
The Chief Medical Officer’s role compliments and augments the Quality Department’s role
CMO
Roles and Responsibilities
CQO
Roles and Responsibilities
Manages the clinical quality programs, patient safety and performance improvement activities at the MTF
Chairs the MTF QC, overseeing the HETs and participating in the Regional QC meeting
Provides prioritization recommendations on performance improvement activity
Collaborates with and provide input to Regional CMO
Participates on Region and BUMED-level committees, evaluating clinical practice protocols/guidelines
Serves as a voting member of the command ESC and reports to ESC regarding QC initiatives
Serves as the primary clinical advisor to the MTF CO to help align MTF policy with those of the region and BUMED
Prioritize HRO initiatives at Navy Medicine and establish a Joint quality and safety group (J5)
Ensure the full scope of BUMED / DHA’s analytic and data resources are being utilized
Communicate ‘elimination of patient harm’ as top leadership priority
Ensure Tri-ad leaders across the Commands are bought-in and understand HRO Operating Model
Establish robust safety analytics infrastructure at BUMED, which will serve as a model for DHA
Standardize patient safety processes, equipment, and expectations across the Enterprise
Distribute quarterly patient safety report with quality and performance metrics to clinical leaders
Engage BUMED Public Affairs Office (PAO) to communicate HRO principles and initiatives
Integrate HRO / Patient safety principles into Corps school and Nursing school
Require an in-depth understanding of HRO principles for all entry-level Officers
Through collaboration, the role of regulatory accreditation and external quality assurance in the Quality Office is preserved and process improvement tools are added in support of enhanced quality improvement opportunities. There is a gain in internally developed and focused quality improvement resources.

15. Points of Contact
For more resources, access the Clinical Communities milSuite site at:
If you have any questions on these developments or our larger efforts to organize for high reliability, please contact BUMED’s CMO: CAPT Lisa Mulligan or Deputy CMO: CAPT Michele Kane