September 2008 Partnership for Health and Accountability The PHA: Where to Next? Vi Naylor Executive...

September 2008 Partnership for Health and Accountability

The PHA:Where to Next?

Vi NaylorExecutive Vice President

Georgia Hospital Association


The PHA Roadmap to Success


Once upon a time….

Georgia Hospital Association established the Partnership for Health and Accountability

Purpose: To promote: Accountability, Best practices, Patient safety and To improve quality of care statewide

Vision:"Stakeholders collaboratively use data to proactively improve quality, patient safety and health, and effectively communicate results across the publics served."


Critical Success Factors

• Long standing good relationships among partners

• Built on existing programs• Involved all from the beginning• Full authority for committees• Utilized provider-driven, non-

punitive public/private effort that fostered learning

• Addressed public and provider needs

• Public recognition


Addressed Public and Provider Needs

Public

Health Education and Public Reports User friendly and readable• State of the Health of Georgia•Hospital Specific Reports: Quality Insights

Provider

Accountability for Patient Safety:

Sharing of Sensitive confidential data

Shared learning opportunities:•Toolkits•Technical Assistance


Positive Recognition


The End Result?

• Award program with recognition from the Governor

• Public Website for consumer information

• Significant reduction in medication errors

• Improved in adherence to evidence-based guidelines

• Sentinel Event Reporting with related Safety Alerts

• Shared Learning


Whew!


Is the Party Over?

The program is now institutionalized – Give us a break!


Now What?

• GHA board agreed to fund on-going PHA initiatives

• We switched focus to the Community Side while maintaining Quality and Safety Initiatives

• Strategically sought grants


Community Outreach

• Grant funding to develop a community based program in chronic care management

• Grant to develop a tobacco-free hospital campus toolkit

• Created Center for Rural Health• Library initiative: “connected the dots” between

the public and their local hospitals• Diabetes and VTE Special Interest Groups


Quality and Patient Safety

• Continued Event Reporting and Safety Alerts and Safe Medication Audio Conferences

• Expanded the Quality and Patient Safety Award program• Created the Hospital Mentor Program• Responded to environmental forces:

– Transparency website– Teams for Infection Prevention Success (TIPS)

• Best Practices PowerHour Plus telnets held monthly• Added resources/toolkits


Clinical Measures

AMI AMI 1

Control Issues

AMI 5

Control Issues

AMI 7

Control Issues

PNE PNE 2

In Control

PNE 3

Control Issues

PNE 5

Control Issues

HF HF 1

Control Issues

HF 2

Control Issues

HF 3

Control Issues

2002 Analysis 2007 Analysis

AMI AMI 1

In

Control

AMI 5

In

Control

AMI 7

In

Control

PNE PNE 2

In Control

PNE 3

In Control

PNE 5

In Control

HF HF 1

In

Control

HF 1

In

Control

HF 1

In

Control


Georgia Progress Lags National Progress

0%10%20%30%40%50%60%70%

80%90%

100%

PN 4 PN 2 HF 4 HF 1 AMI 4 AMI 2

Q3 2003 RateQ1 2008 Rate Q1 2008 Nation


Our Wake-up Call

• US Averages *• National = 84.5%• Top State = 92.9%• Top 10th State =

88.1%

Georgia Status• Average = 81.4% *• Georgia Rank = 46

Georgia Now = 87.1%

Right care every time for targeted core measures: AMI, CHF, PN


Moving Georgia to the Top Ten

What Can Hospitals Do to

Improve?Participate! Participate! Participate!


Increased Participation = Better ResultsParticipation vs. Performance

-2

0

2

4

6

8

10

12

14

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

Performance in ACM and Index

Par

ticip

atio

n (#

Mea

sure

Set

s x

#Qtr

s)

CompositeScore Index Score

Correlation: 0.59Correlation: 0.69


Original Guiding Principles Revisited

• Accountability to the public• Physician is responsible for medical treatment decisions*• Physician performance should be reviewed by physician peers*• Proactive and voluntary• Public and private stakeholders• Continuous improvement rather than a punitive, “name, blame, shame”*• Provides for trust• Resources and buy-in to support a long term commitment – with QI staff• Repository for confidential peer review protected information*• User-friendly feedback reports, but not for CEOs, MDs and Trustees

• Promotes best practices• Educational

*Crucial!


Return to Prior Success

• Build on existing programs

• Involve all from the beginning

• Full authority to committees

• Foster collaboration and shared learning/education

• Public recognition


Moving to the Next Level Top Ten Program

• Step up Trustee Education• Communicate Board’s action• Increase physician and CEO engagement• Invitational Conference: From Worst to First• Create infrastructure to implement Conference

recommendations• Make Quality a standing Board agenda item.• Increase public recognition


Sample data for illustration

purposes only


Change in Reporting


Hospitals meeting the Joint Commission 90th percentile in one or more Appropriate Care Measure

Increasing Public Recognition

JANE JANE Jane Doe

Georgia Hospital

Somewhere, GA

Red Circle = AMIYellow Circle = Heart FailureGreen Circle = Pneumonia


Quality Honor Roll


Engaging Physicians and CEOs

From Worse to First ConferenceRecurring Theme:

Incentivize acceptance and promote implementation of evidence-based practice among the hospital board, CEO, medical and hospital staffs


Right Care Model


Top Ten Organizational Structure


Purpose

Work together in partnership with physicians, hospitals, trustees, and CEOs/Executive Leadership/Front line staff to determine and promote mutually endorsed reliable, systematic processes of care that support “right care every time.”


Physician-Directed “Right Care Every Time”

Use of evidence-based practice to support “right care, every time”

• Systematic reliable process of care such as Medical staff-approved order sets and nurse initiated protocols

• Strategies to recognize and promote physicians’ investment of time in developing processes for outstanding performance.

• Identify obstacles to providing “right care every time”



• Strengthen physicians’ role as the captain of the ship as related to accountability for “right care every time”

• Identify system supports such as “redundancy” and “forcing”

• Provide physician specific real-time data

• Promote the use of performance data in re-credentialing; set targets



Integrate activities and recommendations in partnership with hospital trustee and executive leadership activities

• Promote local Top Ten infrastructure

• Strategies for active engagement of local “voluntary” physicians

• Provide regular CME to address Top 10 strategies through “Physician Power Hour”


Trustees: Institutional Policies/Statements

Assure visibility of the board’s ultimate responsibility for evidence-based practice

• Include adherence to evidence-based practice in contracts

Reinforce physician accountability for evidence-based practice

• Institutional adoption of evidence-based practices

• Performance data for re-credentialing• Recognition program related to evidence-

based practice


Executive Leadership

• Facilitate evidence-based practices

• Multi-disciplinary discussions to determine obstacles and identify supportive system functions to facilitate “right care every time”

• Employ forcing and redundancy strategies


Executive Leadership

• Enhance ability for physician to participate in recommending reliable systematic processes of care

• Concurrent monitoring for real time assessment and completion of missing elements of “right care every time”.

• Physicians real-time feedback data


The Future

QUARTER GA GA NATIONAL TOP STATE RANK RATE RATE RATE_____

Q4 2010 1 95.5 90.2 95.5

Our Vision - 2010

September 2008 Partnership for Health and Accountability The PHA: Where to Next? Vi Naylor Executive...

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