Managing a Hospital and the Role of the Hospital Pharmacist2/13/07

Preston M. Simmons MHA FACHESenior Associate Administrator, UWMCClinical Assistant Professor, UW Dept. of Health Services

Total Number of All U.S. Registered * Hospitals 5,756

Number of U.S. Community ** Hospitals 4,936

Number of Nongovernment Not-for-Profit Community Hospitals 2,958

Number of Investor-Owned (For-Profit) Community Hospitals 868

Number of State and Local Government Community Hospitals 1,110

Number of Federal Government Hospitals 226

Number of Nonfederal Psychiatric Hospitals 456

Number of Nonfederal Long Term Care Hospitals 118

Number of Hospital Units of Institutions(Prison Hospitals, College Infirmaries, Etc.) 20

Source: American Hospital Association Oct 2006

Total Admissions in All U.S. Registered* Hospitals 37,006,027

Total annual expenses for All U.S. Registered* Hospitals $570,534,159,000

Hospitals are like townsHow?

ComplexPoliticalContainedTransient PopulationsAir, food, water, waste, insect/rodent control, police,

specific programs, construction, public safety, internal and external relationships and impacts, etc.

Highly regulated, highly visibleHighly ValuedOne of the Most Complex (and Exciting) Businesses to run bar none

Major Departments and Processes (just a few)

•Medical Staff

•Nursing

•Essential Services

•Support Services

•Finance Functions

• Accounting/Billing

•Planning Functions

•Quality and Organizational Effectiveness

•HR and OD&T

•……….

UW Medicine Organization

CEO UW Medicine/Dean UWSOM

UW Board of Regents

UW President, Provost, Executive Vice

President

UW/King Co./HMC TrusteesManagement Contract

HMC Trustees

HMCUWMC

UWPNTrustees

UWPN UWPFHCRC

CHRMC

NWH

Other Academic Affiliations

(Academic/Clinical Affiliations)

King County

SCCA Board

SCCA CUMG

UW Medicine Board

UWMC-specific Committees:

Joint Conference, Facilities, and Finance

UW Medicine-level Committees: Executive, Planning, and Compliance

UWPTrustees

CUMGBoard

General InformationLocation: University of Washington campus in SeattleBeds: 470Type: Licensed, comprehensive medical care facilityNational Ranking: Among the top ten medical centers in the United States as rated by U.S. News & World ReportPatient Focus: Patients benefit from state-of-the-art care, an advanced-trained staff, and a commitment to quality and valueTeaching Role: One of two major teaching hospitals for the University of Washington School of Medicine.Research Role: Site of a national Clinical Research Center and other major clinical research programsMedical Staff: Nearly 650 attending physicians which are faculty members at the University of Washington School of Medicine.$586,000,000 in Operating Revenues in FY06 and $568,000,000 in expense. Approximately 3,800 FTEs on staff.

About UWMC

Mission

Care for patientsProvide primary, secondary and tertiary care services Serve as a teaching and research resourceAssure long-term stability in thedelivery of healthcare

Vision

To be regional leaders in primary care

To be the Northwest’s most valued source for advanced specialized care and innovations in health care practice

To be known for its responsiveness to the needs of the people of the region for superb, cost-effective, appropriate and accessible medical care

StrategicPlanning

Faculty andStaff Focus

Customer/Market Focus

• Patients• Students

ProcessManagement

LeadershipOrganizationalPerformance

Results

Measurement, Analysis, and Knowledge Management

Organizational Profile:Environment, Relationships, and Challenges

2006 Criteria for Performance ExcellenceBaldrige National Quality Program

120

85

85

450

90

85

85

Baldrige Health Care Criteria Framework: A Systems Perspective

Pharmacists are key members of the Health Care Team.A Balanced Scorecard approach

Patient SafetyAccessSatisfaction/ServiceCostOutcomes

University of Washington Medical CenterConceptual Diagram: Measure Alignment

Executive Quality Council(EQC)

UWMC Operating Plan

Patient SafetyP1 - Patient FallsP2 - Drug Events

P3 - Surgical Infections

SatisfactionS1 - Patient

S2 - EmployeeS3 - Physician

AccessA1 - AdmissionsA2 - Clinic Visits

A3 - ALOS

CostC1 - Days in AR

C2 - Operating IncomeC3 - Cost Per Case

Outcomes/OtherO1 - SIP

O2 - ReadmissionO3 -HF Core Meas

PCS Dashboard

PP

A

S

CC

OOO

Surg Svcs Dashboard

PP

AAA

SS

CC

OO

Lab Med Dashboard

PPP

AAA

SS

CC

OOO

Pharmacy Dashboard

PP

AAA

SS

CC

OOO

PathologyDashboard

PPP

AAA

SS

CC

OOO

Imaging Dashboard

PPP

AAA

SS

CC

OOO

Svc Lines Dashboard

PP

A

S

C

Ambulatory Dashboard

PPP

AA

S

CC

OOO

Finance Dashboard

PPP

A

SS

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MQICDashboard

S

C

Integrated Medical Center Measurement Data ***********************************************************

Measurement attributes attached to Patient Encounters or Operating Departments

P1 P3 P2 P3 P1P2

P3

A3

A1 A1 A1 A1A2A2A3 A2

S1 S1S1 S1S2

S2 S2 S2 S2 S2 S2S2 S2 S3

C1 C3

O1

C2C3

O1 O1O2 O2

O3O3

Allergy Documentation

Adverse Drug Reactions

Patient Safety Access Satisfaction Cost Clinical/FunctionalOutcome

Wait Time

ACC

Staff Satisfaction

Late Charges

Supply Costs-Inventory-Contracts-Formulary-Drug Waste

Warfarin Related Bleeding

Meets or exceeds target

Within 90% of target

Less than 90% of target

No target set

Infrequent measure

Improvement from last report

Decline from last report

No change from last reportCONFIDENTIAL: This document has been created as part of a Quality Improvement Work Product at the University of Washington Medical Center under the protection of RCW 4.24.250 & 70.41.200(3).

NPSGAbbreviations

Sterility Testing

Refill Authorizations-Turn Around Time

NPSGHigh Alert Meds

Medication UseEvaluation

UWMC Pharmacy Services Quality Dashboard

December 2005

Dave Leonard

Role of the Hospital Pharmacist

Patient Safety – National Agenda Items –What's Hot

JCAHO2007 Hospital National Patient Safety Goals

Goal 1 Improve the accuracy of patient identification.Goal 2 Improve the effectiveness of communication among

caregivers.Goal 3 Improve the safety of using medications.Goal 7 Reduce the risk of health care-associated infections.Goal 8 Accurately and completely reconcile medications

across the continuum of care.Goal 9 Reduce the risk of patient harm resulting from falls.Goal 13 Encourage patients’ active involvement in their own

care as a patient safety strategy.Goal 15 The organization identifies safety risks inherent in its

patient population.

100,000 Lives CampaignDeploy Rapid Response Teams…at the first sign of patient declineDeliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle”Prevent Surgical Site Infections…by reliably delivering the correct perioperative care Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

Role of the Hospital Pharmacist

Heart Attack Care Quality MeasuresHeart Failure Care Quality MeasuresPneumonia Care Quality MeasuresSurgical Infection Prevention Quality Measures

Role of the Hospital Pharmacist

CMS Core Measures

Role of the Hospital Pharmacist

AccessImportance of convenient and timely access by patients to RxsInpatient, outpatient, mail order, drive through, on-line, hospitals have them all.

Role of the Hospital Pharmacist

Satisfaction and ServiceWho is your customer?

PatientsEach otherOther CliniciansVisitors and the community

What should you measure?Customer satisfactionYour employee satisfaction – They are correlated

How do you build trust with Your customerAccountability – do what you say you will doValues

Role of the Hospital Pharmacist

Cost (and creating value)When your responsible for a budget bigger than most small hospitals.Example UWMC Pharmacy – $72,803,592 Million Net Revenue and $46,908,514 Million Expense for FY2006 ………and growing. Supply cost was $35,424,727 .

Role of the Hospital Pharmacist

OutcomesHow Pharmacy leads the Rx effectiveness and efficiency effort

P&T committeesClinical PathwaysAppropriate ordering –right drug –right time – JIT interventionContracting/charges – business perspectiveEducation –tools – formularyPDCATechnology

How do you measure your success – many ways Results - BenchmarkingADRs and ADEsTestingOperational/clinical measures – TATs, functional outcomesLook for levels, trends, comparisons, Gaps and linkages to desired objectives

Role of the Hospital Pharmacist

Bottom Line

Pharmacists are key members of the Health Care Team

andWe need you on our team

Source : The Gallup Poll 2006 Ethics Survey

Role of the Hospital Pharmacist

Role of the Hospital Pharmacist

Questions?

What Models Will be Successful for Health Care in the Future

What Skill Sets do I need to be successful?

How will I contribute to improving the Health of the Nation?

Can we afford to do business as Usual?