Value Maximization

Prioritizing Patient Safety

The Value Maximization leaders are considering participating in a 2-year Patient Safety Culture Collaborative.  This educational collaborative opportunity allows member health systems to be trained, mentored and coached by Terry Khan from VHP and Thomas Peterson, M.D. and Sue Teman from DeVos Children's Hospital.  Additionally, the Patient Safety Culture Collaborative will have direct consultative support by HPI (Healthcare Performance Improvement, Virginia Beach, Virginia).

Aiming for High Reliability

After two years, each member could transform their hospital(s) into a high reliability organization (HRO).

At the core of HRO's are five key concepts that are the basis for all "improvement initiatives:"

• Sensitivity to operations. Preserving constant awareness by leaders and staff of the state of the systems and processes that affect patient care.  This awareness is key to noting risks and preventing them.
•  Reluctance to simplify. Simple processes are good, but simplistic explanations for why things work or fail are risky.  Avoiding overly simple explanations of failure (unqualified staff, inadequate training, communication failure, etc.) is essential in order to understand the true reasons patients are placed at risk.
• Preoccupation with failure.  When near-misses occur, these are viewed as evidence of systems that should be improved to reduce potential harm to patients.  Rather than viewing near misses as proof that the system has effective safeguards, they are viewed as symptomatic of areas in need of more attention.
• Deference to expertise. If leaders and supervisors are not willing to listen and respond to the insights of staff who know how processes really work and the risks patients really face, you will not have a culture in which high reliability is possible.
• Resilience. Leaders and staff need to be trained and prepared to know how to respond when system failures do occur.

Applying high reliability concepts in your organization does not require a huge campaign or major resource investment.  It begins with leaders at all levels beginning to think about how the care they provide could become better.  Participation in the VHP Patient Safety Culture Collaborative will lay cultural framework and enhance the knowledge that safe, high-quality and efficient care is received by each of your patients. 

The cost of just one average hospital acquired infection is $25,000 - Source (AHRQ 2007).

Clinical Leaders Streamline Stroke Care to Achieve Savings 
 

Successful stroke treatment and recovery demand timely intervention, which can be achieved with streamlined operations, staff commitment and strong leadership.

The membership of the VHP Clinical Stroke Leaders Team includes:

• Clinical Nurse Specialists
•  ED Directors
•  Quality Improvement Specialists
•  GVSU Researcher/Instructor
•  Regional Clinical Operations Manager
• Manager of Michigan Department of Community Health.

The primary goal of this team is to review and improve the processes of care in the Emergency Department (ED) when the patient arrives with and without ambulance support and transport.  

Every VHP hospital has a "stroke team" that responds to stroke patients upon arrival.  Communication and coordination among all stroke team members and making stroke care a priority 7 days a week is vital to effective care. 

Door- to-Needle Time

Length of Stay (LOS) and cost per case are greatly impacted by how quickly initial treatment begins.  "Door-to-Needle" time or how quickly ischemic stroke patients receive thrombolytic therapy (typically tissue plasminogen activator or tPA) after they arrive in the ED is the key measure of how efficient a hospital's stroke team functions.  The national target is 60 minutes or less; however, close to one-third of stroke victims receiving thrombolytics do not get tPA in that window. 

Analyzing the efficiency of each step from Door-to-Needle time can be a great way to identify bottlenecks.  The Clinical Stroke Leaders are reviewing the nine (9) key processes of stroke care in the ED and sharing methodologies, order sets, pathways, data and success stories.  Their goal for this year is to increase the administration of tPA for all ischemic stroke patients by 2%.  They are using the VHP Ischemic Stroke Dashboard to measure their success.   

The average cost of an ischemic stroke patient admission is $9,100 with a 5.6 LOS (source -Agency for Research and Quality (AHRQ 2007).

Community Leaders Focused on Delivering the Stroke Message

While the clinical leaders work on improving processes of care for the patient experiencing a stroke, the Community Health Improvement Directors and Managers are focused on delivering a message to the community regarding stroke.  Local high schools were invited to participate in a YouTube contest that conveyed two messages: 

1. The signs and symptoms of a stroke using the FAST model.
2. Call 911. 

We are currently accepting videos from high schoolers.  Our goal is to have a winner named in May to coincide with National Stroke Month.

Twenty-five percent (25%) of people experiencing a stroke will die in the 1st year.

Thirty-one percent (31%) will require assistance with ADL (Activities of Daily Living).

Fifteen percent (15%) will require institutionalization after hospitalization.

(Quinn 2009)

Diabetes Leadership Clinically Integrate Best Practice Across Member Organizations

Even though Diabetes may be #7 on the list of causes of death, did you know that as high as 20% of your inpatient population on any given day has diabetes? We read about the increasing prevalence of the disease and experience the challenges in supporting patients with diabetes.

VHP is initiating a strategy to clinically integrate best practice for diabetes across our member organizations.  The goal is to identify leaders within the organization who will implement best practice strategies in a variety of departments.  We have asked each organization to identify a Best Practice Officer (someone to lead the initiative) coupled with an Executive Sponsor.  The role of the Executive Sponsor is to support the change efforts and serve as a mentor to the Best Practice Officer.

VHP will kick off the project in the summer of 2011. 

The logo serves a dual purpose:

 1.  It is in the shape of a readout from the glucometer to signify a good goal for our blood sugar.

2.  100 also means reching our goals at 100%

VHP Continues to Advocate for Health Issues

 
 Value Health Partners is busy in Lansing.  The legislature is deciding next year's budget and we are advocating for our health issues.  VHP continues to make progress on the disproportionate share issue (DSH) and has attracted additional supporters. 

VHP also monitors the Certificate of Need (CON) process and is a strong supporter.  VHP's own Chip Falahee, Sr. VP Legal and Legislative Affairs from Bronson Healthcare Group, is currently a member of the Michigan CON board.  Chip is a good guide for us and adds his insight to our discussions.

-- Nursing Executive Tool 

The Nursing Executive Tool or NEXT is available at no cost on www.valuehealthpartners.org.

This is a career development tool originally geared for nurses but can easily be adopted for anyone in a leadership position.  It is in a wiki format so you can add good resources that you have found and would want to share with others.  A development plan to print the tool is also available.  

 The 6 core competencies include:  

• Self Awareness and Professionalism  - Explore how you discover where you should grow, such as how you conduct yourself, what preparation have you completed and/or are considering, and how you advance your management practice.  
• Knowledge of the Health Care Environment  - Nurse leaders must have a sophisticated knowledge base of issues inside the hospital such as clinical care, models of care, evidence based practice, patient safety and more.  Externally, nurse leaders must understand health care economics, policy  and the driving forces of health care in the community they serve.
• Strategic Vision and Business Skills - Setting a vision for the  organization requires a current view of the landscape and how trends will impact the system.  Business concepts and mentors help guide the way.
• Risk taking - Leading requires taking people in a new direction.  The ability to take risks can start with an idea and then be supported with data.  This section prompts you to think about areas you would like to improve within your area.
• Communication and Relationship Building - The ability to deliver and receive messages is  much more complex  in executive roles.  Networks, messages, decision making, conflict resolution and public speaking are all areas that leaders must be highly competent.
• Leadership Skills -  Explore ways to lead inside and outside the organization.

VHP 2011 Administrative Professional Conference

May 20, 2011