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Volume 2015, Issue 1 Michigan Quality News
Save the Dates:
April 23-24, 2015 NAHQ’s National Quality Summit Leading Care Transitions: Improving Quality & Safety Across the Healthcare Continuum Hyatt Regency Philadelphia at Penn's Landing Philadelphia, PA October 12-13, 2015 MAHQ’s Annual Conference Topic: TBD Amway Grand Plaza Hotel in Grand Rapids, MI
October 13-14, 2015
CPHQ Review Course Amway Grand Plaza Hotel in Grand Rapids, MI
Inside this issue:
President’s Message 1
News: NAHQ News & News From the Field 2
What’s Happening in Lansing 3
On the National Scene: Public Policy Updates 3
Topics of Interest 4
Quality: Culture of Quality 5
Leadership: Leader Rounding 6
Publications & Reports 7
2015 MHA Patient Safety & Quality Symposium 8
2015 MAHQ Board of Directors 9
MAHQ President’s Message
Vision: MAHQ will be the leader and source of expertise in healthcare quality in Michigan.
Mission: MAHQ is dedicated to improving the delivery of quality healthcare by promoting the professional development of our members and keeping them in the forefront with changes that are occurring in healthcare.
MICHIGAN QUALITY NEWS THE JOURNAL OF THE MICHIGAN ASSOCIATION FOR HEALTHCARE QUALITY
Wrestling with Readmissions
Have you ever been reviewing cases and thought if I only had the staff I could have prevented that readmission? Have you anxiously awaited the monthly data only to have your hopes crushed by rising numbers? Well you are not alone.
According to an article written by Kelly Gooch (Kelly Gooch, 2015) CMS has found the same thing. In 2011 CMS devel-oped the community-based care transitions program test to help reduce the number of hospital readmissions. Preliminary results show only four out of the 48 sites saw significant re-ductions in readmissions rates compared to 2010. The article about this study did not offer any explanation on why, but that is the big question.
Why does it seem that no matter how hard we try to reduce readmission we are not gaining ground? Christopher Cheney explains, in his February 5, 2015 article titled “Readmissions Responsibility Extends Beyond Hospitals,” that the responsi-bility is not solely the hospitals (Christopher Cheney, 2015). He states that 58% of the total variation in reported 30-day readmissions is attributed to the county where the hospital is located. The three key characteristics that drive this variation are:
Sociodemographic
Living alone
Education levels
Access to care
The number of quality nursing
homes in the county
Density
Quality
Nursing home density and quality were more significant factors than the socio-demographic ones.
Starting in 2018 CMS is expected to hold skilled nursing facilities ac-countable for readmissions.
What do we do? We need to look beyond our hospital walls and en-gage the community. We need to partner with our skilled nursing facil-ities to help reduce readmissions and improve care. One hospital in Minnesota (Park Nicollet Methodist Hospital) (Ayla Ellison, 2015) developed a program with the local firefighters. Within 24 hours of being discharged the patent receives a visit from a local firefighter. The fire-fighters check:
If the patient knows what medications to take and if they
have any pill holder.
Have follow-up visits scheduled.
Bob Sturza CSSGB, ASQ-CQA
MAHQ President
MICHIGAN QUALITY NEWS Page 2
What’s New at NAHQ
National Quality Summit: Leading Care Transitions: Improv-ing Quality & Safety Across the Healthcare Continuum
When: April 23-24, 2015
Where: Hyatt Regency Philadelphia at Penn's Landing, Philadelphia, PA
Join your colleagues who are working through the challeng-es of safely transitioning patients along the healthcare con-tinuum.
This 2-day quality summit led by Eric Coleman, MD MPH, developer of the Coleman Model of Transitions, will ad-dress the complexities of improving outcomes during transi-tions.
Because space is limited, please register now to ensure your place. Choose whether to attend live in Philadelphia or though virtual attendance. Know of others who should par-ticipate? Share this message and encourage them to join us.
Please contact NAHQ Member Services at 800.966.9392 or [email protected] with questions.
If you are looking for methods to increase your knowledge of quality improvement, consider becoming a member of the National Association for Health Care Quality.
Join NAHQ now.
News From The Field
Diane Sypien, our MAHQ secretary, just completed the IHI Open School courses.
She used these courses as a 2014 goal in her professional development plan for her annual review.
If you belong to NAHQ, the IHI Open School courses are free. If you do not
belong to NAHQ, the subscription to complete the IHI Open School is $300. The credits can be used for RN licen-sure and CPHQ certification.
Read more about the IHI Open School under Topics of Interest, page 4, in this journal.
Jason Gillikin, our MAHQ president elect, will be attending the 2015 Na-tional Quality Summit: Leading Care Transitions in Philadelphia this coming April.
Read more about the summit on this page.
Know what systems to be aware of and when to call if
they have them.
Have enough food in the house for the next few days.
Have smoke detectors and the house does not have
any hazards.
Since the pilot began the firefighters have visited 144 pa-tients. 39 of these patients were helped with follow-up care, medication concerns, social services, or food. (Minnesota Hospital Association, 2015)
Are you ready to think outside the box and your walls to reduce readmissions?
References
Ayla Ellison. (2015). How Fire Firefighters are helping one Minnesota hospital reduce readmissions. ASC Communica-tions.
Christopher Cheney. (2015). Readmissions Responsibility Extends Beyond Hospitals. Health Leaders Media.
Kelly Gooch. (2015). Early evaluation shows lack of suc-cess in government lab experiment to reduce readmissions. ASC Communications.
Minnesota Hospital Association. (2015). 2014 Community Benefit report Minnesota's hospitals: Strengthening healthy communities. Minnesota Hospital Association.
President’s Message (continued)
Submit your news about you or your organization to [email protected]. NAHQ and MAHQ news will also be shared in this section.
Check the Job Opportunities at our website.
MICHIGAN QUALITY NEWS Page 3
What’s Happening in Lansing
Reported by Sam Watson MSA CPPS
On the National Scene...Public Policy Updates
January 14, 2015
Health-Law Test To Cut Readmissions Lacks Early Results By Jay Hancock, Kaiser Health News
Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmis-sions produced significant results compared with those from sites that weren’t part of the $300 million program, according to partial, early results. The closely watched program is one of many tests to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act.
Read more on the topic at Kaiser Health News (KHN), a nonprofit national health policy news service.
January 8, 2015
Statements by Secretary Lew and Secretary Burwell on preparing for the upcoming tax season
In preparation for the 2015 tax filing season, the U.S. Department of Health and Human Services and the Treasury Department are putting in place resources to provide tax filers with the information and resources they need to get their questions answered.
More Health Coverage and Federal Income Tax information is available by clicking here. Consumers can also visit HealthCare.gov/taxes for additional resources.
As we enter into the new year, we have heard from Governor Snyder in his State-of-the-State speech about the consolidation of the Depart-ment of Human Services and the Department of Community Health to streamline state operations and improve outcomes for citizens being served.
Governor Snyder presented his draft for the state budget the week of February 9 with an anticipated $500 Million shortfall. The shortfall is linked to historical tax credits that have resulted in lower state reve-nues. Initial indications are that healthcare may be in line for cuts as a result of the shortfall, including graduate medical education.
An important part of the budget is related to a ballot proposal set for May to increase the sales tax from six to seven percent to provide funds to fix Michigan roads as well as increase support for education.
On a more positive note, the Healthy Michigan effort to expand Medicaid has reduced the number of un-insured by half. Each enrollment period continues to grow the number of people covered by healthcare insurance.
There have been some changes in Lansing.
Representative Mike Callton was appointed chair of the House Health Policy, replacing term-limited Representative Gail Haines. Senator Mike Shirkley was appointed chair of the Senate Health Policy Committee, replacing Senator Marleau.
MICHIGAN QUALITY NEWS Page 4
Topics of Interest
NAHQ members now have access to the IHI Open School through a generous grant from MIDAS+ in memory of Dr. Christopher Jonas Heller.
The IHI Open School is a unique, integrated educational community for students and health professionals across mul-tiple disciplines.
A range of online courses are currently offered in the areas of quality improvement, patient safety, and leadership.
Each course takes roughly 1–2 hours to complete and con-sists of several lessons taking 15–30 minutes each. CPHQ credit can be earned for courses offered through Dr. Heller Memorial.
Learn more about Dr. Heller and visit the IHI Open School to get started.
IHI Open School Certificate of Completion- Basic Level
The IHI Open School offers a basic certificate of completion for users who want formal recognition for their participation. Earning a certificate boosts your own skills — and proves to employers that you’re serious about changing the system for the better. Required courses include the following:
Improvement Capability
Leadership
Patient Safety
Quality Cost and Value
Person- and Family-Centered Care
Triple Aim for Populations
Learn more about Dr. Heller and visit the IHI Open School to get started.
Join NAHQ now.
Michigan CPHQ Certificants
2013
Kenneth Appleby Diane Barton Michael Bekheet Carl T. Berendsohn Julie Bey Anne Cantrell Cyd Dewaha Corrine Holdridge Roberta Ardis Houchen
Connie Kemme Doris Monroe Thomas Mulligan Margaret Posch Allison L. Windas Rush Cynthia Schultz Gina Schutter Shelley Smith Katheryn Spirito Sandra Zuiderveen
2014
Mousa Al-Abbadi
Rebecca Fear
Luann Huizinga
Cindy M. McDonald
Matrina Andrea Poston
Robin Sarkar
Michelle VanPatten
Erik Wilson
Congratulations to you all!
Message to All MAHQ Members
Please update your MAHQ website profile. Our files are
only as accurate as the data provided to us. Go to the
MAHQ website to review your profile by clicking here.
MICHIGAN QUALITY NEWS Page 5
Culture of Quality
Excerpt from Forbes Insights: Culture of Quality: Accelerating Growth & Performance in the Enterprise
In the study summary, Stephen Hacker, Board of Directors Chair of the American Society of Quality (ASQ) writes: At one end of the continuum are organizations where the quali-ty program is perceived as no more than a set of slogans. At the other end, each and every employee from entry level to the seat of the chief executive embraces the company’s quality vision, values and goals as a way of life. Where would you place your organization on this continuum? Where must it go to achieve your organization’s objectives and results? A true culture of quality exhibits an array of easily recognizable attributes. Consider examples from companies displaying world-class quality. These organizations can demonstrate that their leadership unwaveringly and visibly supports quality objectives. They are also passionate in their drive to continually identify and address customer needs—often taking extraordinary steps to engage the voice of the customer. From there, the organization’s vision and values are clearly and compellingly stated as well as disseminated throughout the enterprise in everything from formal training to informal conversations in hallways and break rooms. Quality-driven goals are translated into clear performance expecta-tions, all of which are supported by regular organizational per-formance reviews and expressed in business performance reports. World class organizations also work hard to develop the right mix of incentives, including both recognition and awards as well as, in the right circumstances, direct compensa-tion and promotion. Ethical and collaborative behavior become second nature, as does the willingness to pursue innovation and continuous im-provement. From top to bottom and bottom to top, the company becomes a quality-driven ecosystem—from the C-suite to sen-ior leaders, from middle-level managers to all departments, from the supply chain to customers—all working in concert to achieve mutual objectives and improve operations. So where is your organization on the continuum from superfi-cial support to quality as a way of life? Now the question becomes: how much more effective could
your organization become if it were to take steps to enhance its culture of quality? Where to from here? To what degree is yours a culture of quality? The study’s conclusion: A culture of quality features a handful of readily discernible components. These include but are not limited to:
Clearly visible, engaged and unwaivering senior manage-
ment support for quality initiatives.
Clearly articulated vision and values.
Active and ongoing engagement with customers
to continually identify and address current and evolving needs.
Clearly stated quality goals.
Performance expectations for all individuals throughout the
company that clearly link to quality goals.
Appropriate incentives—which can favor monetary or
recognition-based awards, depending on individual circum-stances.
World-class organizations are much more likely than others to exhibit the above components. They are also more likely to view their quality capabilities as a means of creating and sus-taining competitive advantage, leading to stronger profitability. As a result of their significantly greater investment in and com-mitment to quality, these companies are in a better position to:
Pursue continuous improvement and innovation.
Embrace and benefit from enabling technologies.
Optimize risk-taking throughout the enterprise.
The overall state of a culture may be intangible. But the value of taking steps to shift the company or institution toward a more quality-driven culture can be substantial. Organizations should therefore incorporate the lessons outlined above to accelerate growth and performance in their enter-prise. To read the entire study, click here.
You need to define what quality means, define quality goals, disseminate these objectives,
measure group and individual performance and then reward those who are making it happen.
Jeffrey Ray Director of Operations and Quality Strategic Missile & Defense Systems, Boeing Defense, Space Security
MICHIGAN QUALITY NEWS Page 6
Leadership
Excerpt from Quality Progress: Making the Rounds May, 2014
Author: Jennifer Volland, Vice President of Program Develop-ment, National Research Corporation writes: Changes in the healthcare landscape have pressed organiza-tions to seek high-impact strategies for improving care and reducing readmissions. However, often organizations deploy multiple initiatives simultaneously. This makes it difficult to hardwire a process and determine the success of any particular method. This leads to leadership frustration and organizational confusion. Instead, greater focus is needed to align initiatives throughout an entire organization. Hourly rounding is one high-impact strategy that evidence shows drives culture change and improves outcomes. Execu-tive leaders, however, are often removed from this frontline process and lose visibility into the day-to-day patient encoun-ter. To create a culture of transparency and patient-centered care, rounding should expand to all leaders. To understand what is happening within an organization, being visible and actively observing are important. Management by walking around (MBWA) was an approach started at Hewlett-Packard in the 1970s. It was an unstructured approach for gaining employee feedback and engaging managers more di-rectly with the frontline staff. In contrast to MBWA, leader rounding is more similarly aligned with the regular practice of hourly rounding on patients. Hourly rounding ensures that patient needs are quickly met by front-line clinical staff, and has proven in the literature to have a pos-itive impact on patient care delivery and outcomes. A recent literature review of clinical impact cites the following benefits:
83% of studies noted a reduction in patients’ use of call
lights for non-urgent needs, resulting in fewer interruptions for staff during patient care and hallway walk time.
77% of studies noted a reduction in patient falls. Some
facilities also decreased patient restraint use.
88% of the studies noted an increase in patient satisfaction
and willingness to recommend the facility.
Patient pain control was managed better.
Leader rounding takes a similar approach with scheduled exec-utive time and a formalized set of questions asked of the pa-tient. Using a standardized question set allows for internal benchmarking within the organization and the ability to monitor improvement over time. When implemented consistently, leader rounding helps to iden-tify:
Barriers staff members face in their day-to-day responsibil-
ities
Connects and engages the patient with a deeper level in
his or her care through greater involvement,
Helps to proactively identify issues for the patient prior to
discharge.
Leader rounding reinforces a team mentality in which lead-
ership and staff partner to improve the patient experience and quality outcomes.
Gaps in service excellence are more readily identified using a structured approach. Questions used during leader rounding are often based on existing research to remove clinical or ser-vice issues while also building patient trust. Using a standard-ized question set also aligns with bedside scripting. Consisten-cy in language for driving key behaviors and outcomes has been noted as a best practice. Leader rounding helps build an environment of accountability by starting at the top of an organization’s hierarchy. Often, the "what" is not the leader’s challenge; it’s the "how" to effectively implement best practices to obtain the most value. For healthcare, value-based purchasing has increased the dol-lars at stake where leaders must be actively engaged with the frontlines. The perspective that others bring from departments not histori-cally engaged directly in quality at the frontline adds dimension to the organization and connects departments that often are isolated. In this rapidly changing healthcare environment, quality must be owned by the entire leadership team. Having a roadmap helps to ensure not only action but also success. To register to read the entire article, click here.
Rounding has been the key to my success as CEO. How can executives understand the needs of patients, physicians and nurses without interacting with them on a daily basis? When I walk through the hospital, it is a great opportunity to gather information and build
trust by listening and responding to concerns. Rounding takes me beyond the paper dashboard so I can get a true pulse on the health of the organization.
Mike Sherrod, CEO of TriStar Greenview Regional Hospital, Bowling Green, KY
MICHIGAN QUALITY NEWS Page 7
Call for Your Quality Improvement Projects
By Linda Weirauch BSN RN CPHQ
Sharing Your Quality Improvement Projects
In our ever changing world of quality, we are involved in surveillance activities and process improvement projects.
Have you had a memorable process improvement pro-
ject?
Were you ever in a situation where despite best efforts,
the results showed no improvement?
Ever run out of ideas?
We want to launch a section of the Journal that focuses on sharing performance improvement within the quality commu-
nity. This is an opportunity to share your ideas and best practices with others...and even those learnings from pro-jects demonstrating no improvements. We have a wealth of knowledge and experience amongst our members and this is a great opportunity to work togeth-er! Let us publish your successes and learnings. Send your ideas & best practices to Sue Schaeffer at communica-tions @mahq.com.
Governance across the Continuum: Leadership Ac-
countability for Creating Healthy Communities
Date June 2014
Healthcare organizations and their governing boards are now in a new era. Health systems are increasingly accountable for the overall health and well-being of the communities they serve, in addition to the quality and safety of the care they deliver.
For years, healthcare organizations have recognized this shift and begun
to respond. Many organizations have rearticulated their mis-sion and vision statements to reflect the new reality and are pursuing novel strategies to engage in their communities to promote health and healthy lifestyles.
This publication, in partnership with the Institute for Healthcare Improvement, sets the stage for new governance and leadership responsibilities outside the four walls of the hospital. It profiles four unique organizations:
HealthPartners (Bloomington, Minnesota)
Genesys (Grand Blanc, Michigan)
Bellin Health (Green Bay, Wisconsin)
LHC Group (Lafayette, Louisiana)
These organizations have demonstrated new roles in the community and across the care continuum to promote health and access. Then it focuses these different approaches into a discussion framework for boards and senior leaders to develop new strategies for creating healthy communities.
Authored by Dan F. Schummers Chief of Staff, Institute for Healthcare Improvement
Publications
AHRQ Report Defines Elements of High-Quality Emer-
gency Department Discharge Process
A new Agency for Healthcare Research and Quality (AHRQ) report outlines a conceptual framework of the emergency department (ED) discharge process and identifies elements of a high-quality discharge process.
"Improving the Emergency Department Discharge Process: Environmental Scan Report" identifies best practices, tools, strategies, and approaches for addressing problem areas and criteria/outcomes for assessing their effectiveness.
Developed by researchers at the Johns Hopkins University
Armstrong Institute for Patient Safety and Quality in Balti-more.
The report can be used by hospital EDs to identify what con-stitutes an effective discharge process and what constitutes discharge failures.
The report includes a list of socioeconomic or medical fac-tors that increase a patient’s risk for a discharge failure, in-tervention tools or strategies that have been shown to im-prove the discharge process, and screening tools that have been used to predict hospital readmission and ED revisits.
Download a copy here.
Reports
PRESIDENT
Bob Sturza, ASQ-CQA, CSSGB, LGB, MT (SCDSMP)
Covenant HealthCare
PRESIDENT-ELECT Jason Gillikin CPHQ
Priority Health [email protected]
PAST PRESIDENT
Bob Sturza, ASQ-CQA, CSSGB, LGB, MT (SCDSMP)
Covenant HealthCare
TREASURER Linda Weirauch BSN, RN, CPHQ
McLaren Flint [email protected]
SECRETARY
Diane Sypien MSHA, RN, PMP Blue Cross Blue Shield of Michigan
DIRECTOR-BYLAWS
Open Position [email protected]
DIRECTOR-COMMUNICATIONS
Sue Schaeffer MPA, BSN, RN, CPHQ Munson Medical Center
DIRECTOR– MEMBERSHIP Penny Hawkins BS, RN, CPHQ
Munson Medical Center [email protected]
DIRECTOR-Education
Brenda Lawrence MSN, MSA, BSN, RN Detroit Medical Center [email protected]
Find us on the web at www.mahq.com
Michigan Quality News © Michigan Association for Healthcare Quality, 2014
MAHQ Board of Directors 2015
MICHIGAN QUALITY NEWS Page 9