Transparency in Healthcare Quality ReportingEast Midlands, National Health Service

Alide Chase, SVP Medicare Clinical Operations and Population Care November, 2013

Objective

Develop an understanding about the importance of transparency in Quality Reporting in a Healthcare System.

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KP by the Numbers

7 regions serving 8 states and the District of Columbia

More than 9 million members More than 16,000 physicians and 174,000

employees (including 49,000 nurses) 38 hospitals (co-located with medical offices) Almost 600 medical offices and other

outpatient facilities 68 years of providing care

Our Markets and Membership (2012)

Mid-Atlantic Region Washington, DC Maryland Virginia482,000 members

Georgia Region234,000 members

Colorado Region540,000 members

NorthernCalifornia Region3.4 million members

Hawaii Region225,000 members

Northwest Region Portland, OR Vancouver, WA484,000 members

SouthernCalifornia Region3.6 million members

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Our Aspiration

Kaiser Permanente’s Strategic Vision is to be a Leader in Total Health by making lives better.

Total Health is a state of complete physical, mental and social well-being for all people.

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Transparency with Performance…A Challenging Uphill Climb

Health Care

Reporting

PatientsThe PressGov’t Regulations

Consumer Report Websites – (can be scary)More informal sites can publish misinformation. For example, Dead by Mistake

ie’s

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2005

Mid Staffordshire NHS trust inquiry report published• Causing death or harm to a patient 'should be offence'• 'Duty of candour' should be imposed on NHS staff• Senior staff who breach code of conduct 'should be disqualified'• No sacking of 'scapegoats' or reorganising the NHS• Cameron creates new post of chief inspector of hospitals• PM apologises for care scandal at Stafford hospital• Read the key points• Read the main news story: Report calls for sweeping changes• Read more: Mid Staffs hospital scandal: explainer• Read the full report• Read all our Mid Staffs coverage

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Is Transparency a Game Changer?

Agree or Disagree? Serious improvement begins with understanding reality. Transparency

and honesty are not just assets for better health care, they are preconditions (Don Berwick, MD 2009).

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The Benefits of Transparency

Allows demonstration of “Best” Motivates improvement Raises the bar on accountability Enables learning Increases recognition of risk in the microsystem Provides information for decision-making Builds trust Others?

Gains from Transparency

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Risks of Transparency

Personal liability and reputation Organizational liability and reputation

• Inability to close gaps• Managed care liability and medical malpractice• Brand management• Regulatory-related issues

Patients making poor decisions Others?

KP’s Transparency JourneyAudience Past Present Future Opportunity

Patient-Doctor Communications

Organization-Patient Communications

Organization-Staff Communications

Organization-Public Communications

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Patient-physician CommunicationsAudience Past Present Future Opportunity

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KP Guiding Principle re: Communicating about Adverse Outcomes“Patient safety and clinician welfare will be best served if we are honest about unanticipated adverse outcomes with our patients and open with our colleagues and ourselves and that we handle such occurrences with sympathy and empathy for our patients and our colleagues."

Policy Development

Training Modules/

Simulation

Leadership Endorsement

MD Staff Go Thru Training

(Track # Trained)

Event Documentation

Track Conversation

(Loop Closed)

Organization-Patient CommunicationsAudience Past Present Future Opportunity

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Surveys, focus groups …

Story telling, video ethnography, shadowing, touchpoint mapping …

Advisory councils, members on committees, grand rounds, subject matter experts …

Co-designers and partners in creating value and improving quality …

Co-Creating & Co-Designing

Advising &

ConsultingDiving

DeeperGathering Feedback

KP’s Evolution in Integrating Patients and Families

We leverage all these approaches today as we strive to actively listen and partner with our members and their families at every touchpoint in their journey and across all our quality improvement and innovation efforts.

Organization-staff CommunicationsAudience Past Present Future Opportunity

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Organization-staff Communications

Unblinded medical center level data shared with small audiences Near real-time sharing of event-related information, e.g., “days since

last…”

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Inpatient Mortality: All KFH HSMR continues below US Medicare benchmark.

HEDIS: KP performance continues to trend above the national 90th Percentile

Safety: Opportunities exist for SRAE verification incidents, infections, HAPUs, and falls

Service-METEOR: Health Care Rating showed a significant improvement of 3.7 points from the previous year.

Big Q Performance Metrics Top Level or Program View – August 15, 2013

Resource Stewardship: No threshold has been established for this top level metric, commercial HMO risk adjusted selected services cost PMPM.

Equitable Care: The gap between the Black or African American and White rates for 2012 Q4 was 29 points; the disparity has decreased 28% since 2010 Q4..

T JC: The combined TJC composite for all KFH hospitals continues to be less than one point from 100% - the national 90th percentile

Privileged and Confidential 20

Service-HCAHPS: Overall Rating demonstrated a significant 1.2 point increase from the previous year.. Nurse Communication also showed a significant improvement of .8 points from previous year.

Confidential

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Diving a Little Deeper

Patient Safety

Building Blocks

PressureUlcers

Surgical Care Improvement

Program

HSMR All Regions

TJCNational Average

FallsSRAE

Composite

Adult ICU Central Line

Associated BSI

All Cause 30-Day Readmissions

Worker Injuries

May 2013

Hospital Accreditation

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We Report on KP’s Website as WellOrange County - Mortality

We Report on KP’s Website as WellOrange County: The Leapfrog Group - Quality and Patient Safety

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We Report on KP’s Website as WellOrange County – Infections

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Orange County – HAPUs

We Report on KP’s Website as WellOrange County - Service

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In Quality, Quality Improvement and Patient Safety, we’ve come a long way, but there’s a long way to go!