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Albert W. Wu, MD, MPH Johns Hopkins Bloomberg School of Public Health
Leuven, 17 January 2017
Impact of Human Resource Management on
Patient Safety: Lessons from Johns Hopkins
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The Big
Picture
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Overview
• Managing for Safety and Quality
• Quality Indicators
• Clinical Communities
• Investigating Incidents
• Safety Rounds
• Patient Safety Research
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Quality &
Safety at
Johns
Hopkins
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Armstrong Institute Mission
Purpose Driven:
We partner with patients, their loved ones and all
interested parties:
• To end preventable harm,
• To continuously improve patient outcomes and
experience: and
• To eliminate waste in health care delivery
Principles Led:
• I am humble and curious
• I respect, appreciate and help others
• I am accountable for continuously improving
myself, my organization, my community
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How We Realize Our Goals
• Advance science of patient safety and quality
• Build organizational capacity for improvement through training and supportive infrastructure
• Design, implement and evaluate interventions
• Inform policy
• Listen, learn and share
6
Quality & Safety
RESEARCH
Quality & Safety
OPERATIONS
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JHM Organizational Chart
7
Schools
Hosp
itals
Affiliates
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Quality & Safety at JHM
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JHM Quality and Safety
Governance Structure
JHM AI Patient Safety and
Quality Board Committee
Armstrong Institute
Inpatient Hospital
PediatricsPopulation
HealthHome Care
Johns Hopkins
International
Ambulatory Practices
Ambulatory Procedures
JHM PerformanceSubcommittee
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JHM Quality, Safety & Service
Executive Council Goal:
• To develop system-wide infrastructure to align existing processes and initiatives to achieve consistency, continuity, and coordination across affiliate organizations and evaluate and improve quality of patient care and outcomes
Objectives:
• Use metrics to track performance & improve outcomes
• Data collection and review ~ every 6 months
• Share best practices and lessons
• Identify policies and process improvement initiatives
• Review and approve the resources needed
• Facilitate timely communication
• Demonstrate effective implementation
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Framework for Improvement
Pronovost in press
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AI Business Process Review
Committee
13
LEAN
Analytics
Marketing and
Communications
Learning and
Development
PATIENTSAFETY
EXTERNAL REPORTING
PATIENT EXPERIENCE VALUE
Strategic Partnerships
Research
HEALTHCARE EQUITY
Infection Prevention
MEASURESRisky providers, units & systems
WORKCUSP
Mindful organizing
Culture measurement improvement
Event reporting
Safety case
MEASURESSurvivalPSI/HACHAIRankings
WORKPMO
Work teams
Robust Process Improvement
A3 Project management
MEASURESCAHPSNarrativesGrievances
WORKCommon language
PFACs
Include patients
Patient and families education
Care coordination
Family involved in decision-making
MEASURES stratified byRaceEthnicityPrimary language
WORKMeasure development
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Indicators
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Johns Hopkins Health System
Accountability Model
15
Performance below target for 1 month or 1 performance period (ex: 1 quarter)
• Local champions to form performance improvement team• Review data and investigate defects• Identify barriers and implement targeted interventions
Performance below target for 2 months or 2 performance periods
Performance below target for 3 months• Department Director / MD champion present to local Hospital Quality and
Safety Board (Trustee chair and President sign QI plan)• President presents to JHM Quality Safety Board Committee
• PI Team presents to local hospital quality council and President/ CEO• President meets with appropriate clinical director and PI team • President presents plan with timelines to JHM QSS Executive Committee
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Nine
Core
Measures
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Clinical Communities
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Clinical Communities?
• Clinical communities are self-governing networks with broad entity representation who come together to identify and achieve goals related to quality in healthcare
• Patient-centered Strategic Objectives:• Eliminate preventable harms• Continuously improve patient outcomes and experience• Reduce waste in healthcare delivery• Standardize care through best practices/pathways
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Clinical Communities
Framework
• Led by local physicians (1 academic lead, 1 community lead) with interdisciplinary membership that includes patients and families
• Set and communicate clear goals and measures
• Create infrastructure (PMO) – provide vertical support for project management, peer learning, analytics, and robust process improvement
• Work collaboratively on quality improvement projects, empowered to make changes
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Clinical Communities
Framework
• Work towards standardizing evidence based practice through protocols to reduce variation in care
• Partner with value analysis and finance teams to reduce over-utilization in supplies, imaging, medications and laboratory costs, and pursue opportunities to negotiate reduced prices in these areas
• Share results frequently for data transparency
• Implement accountability / sustainability model
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Clinical Communities
21
Hospital
Directors
Quality & Safety
Board
ICU Clinical
Community
Hospitalist
Community
Medication
Safety
Community
Post
Anesthesia
Community
Hospital A
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Clinical Communities Support
• Lean• Informatics• Measure development• Financial analysis• Human factors• Teamwork• Safety culture• Implementation• Ethnography• Protocol development• Supply chain
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Clinical Communities
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▪ Joint Replacement
▪ Blood Management
▪ Spine
▪ Surgery
▪ Cardiac Surgery
▪ ICUs
▪ Congestive Heart Failure
▪ Diabetes
▪ Palliative Care
▪ Cardiac Rhythm Management
▪ Hospitalists (EQUIP)
▪ Stroke
▪ Craniotomy
▪ Psychiatry and Behavioral Sciences
▪ Patient and Family Centered Care
▪ Patient Centered Care/Maternal
Health
▪ Cleaning, Disinfection, Sterilization
▪ Medication Safety
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Clinical Community Savings
• Ishi et al. 2015
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The Comprehensive Unit-based
Safety Program (CUSP)
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Changing the Culture, One Unit
at a Time
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CUSP Growth
27
0
50
100
150
Total CUSP Teams at JHM
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Training to Building
Capacity and Capability
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Armstrong Institute
Learning Model
29
JHM/AI develops integrated safety and quality development programs for organizations worldwide
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Available Trainings
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RCA(s) at Johns Hopkins
• Sentinel Event RCA
• Mini-RCA, Concise Incident Analysis
• CUSP (Comprehensive Unit Based Safety Program) defect investigations
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Sentinel Event Action Items
Progress Report• Sentinel Events with all action items completed since last
meeting
• - #, topic, date of event, champion
• Sentinel Events with Open Action Items
• Incomplete RCAs
• Completed Root Cause Analysis Reports
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Mini RCA and Event Analysis
• Concise Incident Analysis (CIA)
• Purpose: to facilitate a more streamlined process for analyzing no or low-harm incidents that occur in healthcare, including the development of effective actions for improvement
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When is CIA Appropriate?
• Incidents that resulted in no or low harm to the patient
• Incidents primarily limited to one work area, division, or department
• New incidents for which a comprehensive analysis was recently completed
• Initial review to determine whether or not a comprehensive incident analysis is warranted.
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Safety Rounds
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75% wanted prompt debriefing for individual or group/team)
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R.I.S.E.
Resilience In
Stressful Events
Pager: 410-283-3953
“Provide timely support to employees who encounter
stressful, patient-related events”
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Summary
• Operating Management System for Safety
and Quality
• Quality Dashboard
• Clinical Communities
• RCA + Concise RCA
• Learning at Multiple Levels
• Safety Rounds
• Staff Support
• Patient Safety Research
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[email protected] @withyouDrWu