Quality & Safety in Health Care

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Quality Safety in Health Care

• Dwight R. Hiesterman, MD
• Mountain-Pacific Quality Health Foundation

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Quality Care is Safe Care
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If we keep doing what we are doing, we will keep
getting what we got!
Yogi Berra
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What is Transformational Change?

• Change which enables a provider to deliver care
• meeting the goals of safety, effectiveness,
• efficiency, timeliness, patient-centeredness,
  equity.
• Results from the implementation of four
  strategies
• Transform organizational culture
• Redesign care process
• Measure and report performance
• Adopt HIT, and use it effectively

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QIO 8th Scope of Work

• Task 1 Clinical Quality Improvement
• 1a - Nursing home
• 1b - Home health
• 1c1 - Hospital
• 1c2 - Critical Access Hospital/Rural
• 1d1 - Physician Practice
• 1d2 - Physician Practice Underserved
• 1d3 - Physician Practice Pharmacy

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Hospital Task 1c1

• Improve by 50, a group of hospitals, on a
  composite of 10 reported measures
• AMI, HF, Pneumonia
• Improve 13 surgical care processes in a second
  group of hospitals
• Infections, CV complications, VTE, VAP, and ESRD
  vascular access

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Hospital Task 1c1 contdSIOC(System
improvement and organizational change)

• Help a 3rd group adopt and use IT
• CPOE, bar coding, telehealth technology
• PPS and CAH
• 15 of hospitals in state

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Hospital Task 1c2 Rural/Critical Access

• Identified Participant Group (IPG)
• Statewide

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Statewide

• Rural performance measures
• Report data on a new set of 12 CAH quality
  measures
• Assist in use of CART
• Document improved patient care on one or more of
  these measures
• ED transfer communication

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Critical Access Hospital Identified Participant
Group

• Organizational Safety Culture Change
• Assess the organizations safety climate at
  baseline and at re-measurement
• Identify an area to focus on to improve
  patient safety

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DOQ-IT objectives

• Provide implementation assistance for small
  medium sized physician practices
• Provide assistance in
• IT adoption decision
• Implementation and workflow efficiencies
• Care management/patient self-management
• Use clinical data reports for improved practice
  performance and outcomes

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Data collection

• Chronic stable coronary artery disease
• Diabetes mellitus
• Heart failure
• Osteoarthritis
• Hypertension
• Prevention measures

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Adding wings to caterpillars does not create
butterflies it creates awkward and
dysfunctional caterpillars.Butterflies are
created through transformation.
- Stephanie Pace Marshall
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Human Resources for Safe Care

• The entire healthcare workforce must be educated
  to
• Provide patient-centered care
• Work as a member of interdisciplinary teams
• Apply evidence to practice
• Adopt continuous improvement of quality and
  performance as baseline workplace behavior
• Use informatics effectively

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Lets talk about leadership The heart of the
matter.

• Its action
• Its real (data, evidence)
• Its situational
• It sees how the future should be
• Its about getting from here to there
• Its about partnering and convening
• Its about communication
• Its about building systems that work
• Its our responsibility
• It has many facets

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The highest quality care is the only care
anyone can now afford.
Quality Improvement Roadmap CMS
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dhiesterman_at_mtqio.sdps.org406 457-5878800
497-8232 ext. 5878
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How Can Rural Hospitals Improve Quality?

• Share information, expertise and resources
• Networks of rural providers
• Participation in statewide improvement
  initiatives

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How Can Rural Hospitals Improve Quality?

• Collect, analyze, and report data
• Must identify the problems before they can be
  fixed
• Allows for comparison to peers
• Information available to consumers

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How Can Rural Hospitals Improve Quality?

• Focus on measures of quality that are important
  in the rural setting

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Next steps

• Local facility protocols for Chest Pain
• Local facility data evaluation and planning
  what barriers to overcome
• Chest Pain Kit
• Training, Equipment
• Feedback Training
• How can we all help remove the barriers?

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Underlying the Recommendations, ACCESS Plus

• Rural communities should focus greater attention
  on improving population health in addition to
  meeting personal health care needs.
• When care cannot be delivered locally, links
  should be established to services in other
  locales.
• The services available in rural communities
  should be based on the population health needs of
  the local community.
• The provision of rural health care services
  should be shaped and guided by local community
  and rural organizations and institutions.

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Underlying the Recommendations (continued).

• Rural health care requires a team of well-trained
  health care clinicians, managers, and leaders
  working together.
• Health care financing should explicitly address
  the special circumstances of rural areas.
• Efforts to develop local and national health
  information technology infrastructure should
  focus specific attention on rural communities.

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How do we adapt our personnel management
approaches?

• Continuous improvement the way we do our work,
  learning all the time
• Participatory, with delegation of authority and
  responsibility to the working level
• Team based
• Decisions at all levels based on real information
  and data
• Use decision support technology

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The ultimate goal is never simply to treat to a
prescribed number, but rather to achieve
excellence by perfecting the care of each
individual.
ACC/AHA/AHRQ/CMS/JCAHO Practice Advisory
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Getting from Here to There some
characteristics of transformation

• Collaboration across the continuum
• Quality and Safety are Job 1
• Interdisciplinary care teams apply evidence and
  informatics
• Transparency
• Decision-making
• Evidence based (real data, information,
  technology)
• Delegated to level of care team
• Accountable to community and employees
• For use of resources
• For effectiveness of processes