VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION HOSPITAL ENGAGEMENT NETWORK

BETSY COLE ARCHER, MS, BB (ASCP)

DIRECTOR, PERFORMANCE IMPROVEMENT

CENTER FOR HEALTHCARE EXCELLENCE

ABOUT ME

Master of Science, Virginia Commonwealth University

Transfusion Medicine

Manager, Quality and Patient Safety

Large health system in Virginia (Richmond and Hampton Roads)

Ambulatory Care -> Imaging centers, radiation oncology, urgent care centers, etc.

Director, Performance Improvement

Multiple initiatives that support our vision

Hospital Acquired Infections

Preventable readmissions

Reducing hospital costs through quality improvement

Strengthening hospital performance in penalty programs

Making healthcare safer for Virginians

VHHA - WHO ARE WE?

Virginia Hospital & Healthcare Association

Alliance of 107 hospitals and 26 health systems

The Center for Healthcare Excellence

Improve healthcare by assisting members to achieve top-tier performance in quality, safety, & service

VHHA VISION

Through the power of collaboration, the association will be the recognized driving force behind making Virginia the healthiest state in the nation by 2020.

VHHA MISSION

Working with our members and other stakeholders, the association is to transform Virginia’s health care system to achieve top tier performance in safety, quality, value, service and

population health. The association’s leadership is focused on: principled, innovative and effective advocacy; promoting initiatives that improve health care safety, quality, value and service; and,

aligning forces among health care and business entities to advance health and economic opportunity for all Virginians.

HOW WILL WE ACHIEVE OUR AIM?

COMMITMENT FROM STAKEHOLDERS

Hospital commitment

Patient & Family Engagement

Voice of the patient and family is essential!

Strategic State Partners

Virginia Department of Health

QIN/QIO

National Support

American Hospital Association

EXTERNAL FUNDING…

Center for Medicare & Medicaid Services (CMS)

AHA/HRET & VHHA HOSPITAL ENGAGEMENT NETWORK HEN 2.0

SEPTEMBER 2015 - 2016

SO WHAT IS A HEN ANYWAY?

• Improvement collaborative

• Best-practice incubator

• Community of peers

• Learning cohort

• Quality improvement (QI)

• Clinical content

• Standardized measures and accelerated timeframes

WHY JOIN A COLLABORATIVE?

Best deployed when there is a gap between accepted best practice and current practice

Collaboratives allow participants to:

Spread evidence-based best practices

Shared learning via virtual events

Monitor outcomes through data

Rapid Cycle Improvement (PDSA)

Achieve ambitious project goals…

HEN 2.0 PROJECT GOALS

Reduce Harm by 40%

Reduce Preventable Readmissions by 20%

…by September 23, 2016

3 operational metric categories:

Patient and family engagement

Health care disparities

Engaging leadership and governance

Adverse Event Areas

• Adverse Drug Events (ADE) • Injuries from Falls

• Central Line-Associated Blood Stream Infections (CLABSI)

• Catheter-Associated Urinary Tract Infection (CAUTI)

• Ventilator Associated Events (VAP)

• Venous Thromboembolism (VTE)

• Pressure Ulcers (PrU) • Surgical Site Infections

• Obstetrical (OB) Harm and Early Elective Deliveries (EED)

• Readmissions

• Airway Safety • Clostridium difficile (C. diff.), including antibiotic stewardship

• Culture of Safety, fully integrates patient safety with worker safety

• Severe Sepsis and Septic Shock 12

HOW WILL WE IMPROVE? IMPROVEMENT STRATEGIES

VHHA HEN

36 hospitals committed

Elizabeth City, NC

HOW DO WE KNOW THERE’S A NEED TO IMPROVE?

Perform needs

assessment

Collect baseline

data

Perform gap analysis

Develop change package

IMPROVEMENT STRATEGIES

Education plan: emphasize implementation and doing work instead of planning to do work

Site Visits – Gemba walk!

Measurement System

Access to experts

Listserv & website

Change packages!

Peer to Peer Learning:

IHI Model for Improvement

Our Members!

What have you tried?

What worked?

What were your barriers?

What can your network team help you to overcome?

CONNECTING TO RESOURCES

Webinars for each topic from national advisors

Facilitation of networking and shared learning

VHHA In-person events with Subject Matter Experts

Coaching calls

Regular interaction to keep pace with goals

HOW WILL WE KNOW CHANGE IS AN IMPROVEMENT? MEASUREMENT SYSTEM

USING DATA…

Encyclopedia of Measures

Baseline data collected for each measure

Monthly monitoring data

Real-time improvement

Database allows for graphs, benchmarking, comparisons, and relative reductions

RESULTS NATIONAL AND VIRGINIA HEN RESULTS

WHAT DOES THE AHA/HRET HEN 2.0 PROJECT LOOK LIKE?

1,500+ hospitals across 33 states and one region

Spanning 5 time zones (PR to AK)

HEN 2.0 – HOSPITAL CHARACTERISTICS

FINAL AHA/HRET HEN 2.0 RESULTS TOTAL HARMS PREVENTED AND COST SAVINGS

23

FINAL AHA/HRET HEN 2.0 RESULTS

Core Harm Topic / Measure Hospitals (%)

Reporting Data at Baseline1

Baseline Rate

Apr – Jun 2016 Rate

Relative Improvement2

HEN 1 Ending Rate3

HEN 2.0 Performance Benchmark4

OB Harm: Vaginal deliveries without instrument 719 (94%) 21.56 10.91 -49% 19.53 N/A

Early Elective Deliveries (EED) 722 (94%) 4.02 2.24 -44% 4.89 2.00 PrU: Pressure Ulcer Rate (Stage 3+) 1137 (88%) 1.60 0.91 -43% 1.21 1.49 VTE: Post-Operative Venous Thromboembolism (VTE) 911 (93%) 4.51 2.99 -34% 4.35 N/A

SSI: Surgical site infection rate, all procedures reported 907 (93%) 2.01 1.59 -21% N/A N/A

VAE: Infection-Related Ventilator-Associated Condition (IVAC) Rate 776 (92%) 1.40 1.20 -14% 1.52 N/A

ADE: Adverse drug events, all ADEs reported 1,005 (78%) 1.63 1.44 -12% N/A N/A

CLABSI:Central line-associated blood stream infections per 1,000 central line days

1,007 (98%) 1.00 0.89 -11% N/A 0.21

Falls: Falls w/Injury 1,230 (96%) 0.64 0.60 -5% 0.64 0.50 Readmissions: All-cause, 30-day readmissions 1,225 (95%) 8.51 8.14 -4% 8.78 N/A

CAUTI: Catheter-associated urinary tract infections per 1,000 catheter days

1,260 (98%) 1.02 0.98 -4% N/A 0.27

24

1 The percent reporting represents the number of hospitals reporting baseline data divided by the number of hospitals expected to report data for the topic and/or measure. For example, non-OB hospitals are not expected to report data on EED or OB Harm.

2 Relative improvement calculates baseline compared to the most recent available three-month rate (Apr – Jun 2016).

3 Most current available three-month rate at the end of HEN 1.

4 HEN 2.0 performance benchmarks as released by the Evaluation Contractor September 132016 (PfPPEC_Benchmarks_Sept_2016.xlsx)

VIRGINIA HEN BY NUMBERS

36 • Active Virginia participants

24 • VHHA-provided educational programs

4

• In-person learning sessions • Readmissions & C. difficile • Sepsis • HRO pre-summit event • Patient & Family Engagement

10 • Virtual Shared Learning Events

VIRGINIA HEN RESULTS

199

368

258

311

130

229 194

237

-

50

100

150

200

250

300

350

400

Oct Nov Dec Jan Feb Mar Apr May

Num

ber

of H

arm

s Pr

even

ted

Monitoring Month

Harms Prevented by Month

Number of Harms Prevented

Total Harms Prevented: 1,851 Total Cost Savings: $16,585,917

VIRGINIA RESULTS BY TOPIC

STATE AGGREGATE TOPIC-LEVEL ACHIEVEMENT

NOTE: A topic is considered met if the relative reduction is 17.6% or better (12% or better for readmissions)

Baseline Rate Most Current Q Rate (Mar - May 2016)

Relative reduction

Baseline Data Submission

May Data Submission

ADE 1.67 1.97 18.2% 81% 58% CAUTI 1.17 1.05 -10.1% 97% 100% CLABSI 0.93 0.75 -19.2% 97% 100% EED 2.72 1.25 -54.0% 96% 96% Falls 0.50 0.54 6.7% 97% 83% OB Harm 23.45 6.93 -70.4% 96% 44% PrU (1) 11.96 0.53 -95.6% 106% 52% Read 3.72 4.15 11.7% 97% 8% SSI 2.07 1.95 -5.5% 94% 103% VAE 6.08 5.35 -12.1% 97% 100% VTE 8.28 4.36 -47.3% 97% 46% CDI 0.74 0.88 19.1% 97% 100% SEPSIS 65.77 64.40 -2.1% 11% 8%

We still have work to do!

HOSPITAL ACHIEVEMENTS

10

21 21 22 20 21

30

8

20

26

21

Num

ber

of H

ospi

tals

Mee

ting

Goa

l

Number of Hospitals Achieving ≥ 40% Reduction of Harm (20% for Readmissions)

NOTE: Hospital-level achievement is assessed comparing aggregate data (October 2015 – August 2016) from baseline

THE POWER OF STORIES…

NEXT STEPS HEN UNDERGOES A TRANSFORMATION!