Hospital Improvement Innovation Network

Amanda Keilholz, CPHQ Program ManagerJanuary 22, 2019

Agenda Mercy Hospital St. Louis

Huddles and Lean Principles in the NICU HIIN Project Updates

Milestone 9 Stipend Criteria Update — HIIN PFE/Disparity Update

New Recruitment Opportunities HRET/HIIN Virtual Events Upcoming Events Resources

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Featured Speaker

Meagan Gray, MBA, CSSBBManager, Lean Transformation

Mercy Hospital St. Louis

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Huddles and Lean Principles in the NICU-

Mercy Hospital St. LouisMeagan Gray

Manager, Lean Transformation Mercy Hospital St. Louis

January 2019

NICU Background• 100 Bed Level 3 NICU• 220+ Nurses• Multiple disciplines involved

in the care delivery• 8 Pods

2016WHERE WE WERE…

Nursing turnover rate of 65%Overall Teamwork % Excellent PRC

score of 67.2%Patients placed by acuityChallenges with communication and

shared decision making from poor huddle attendance

Leadership team challengesLow morale

Evolution of NICU’s Gemba Huddle

Why?Shared decision making and understanding of goals.

Long history of poor communication amongst NICU team members.

Dreaded term “long hall” still used in reference to conversation with leaders.

Dedicated time for face-to-face communication.Empowers coworkers to make decisions that affect

their work.Encourages coworkers to share concerns and

identify barriers.Celebrate our successes!

When?10:15 (AM and PM)

• Shift change provided very limited time. • Nurses eager/itchy to get assignments and

report• Effort to decrease incidental overtime• NICU schedule revolves around patient feeding

times.• Strategically between busyness of shift change

and decreased numbers during lunch breaks.

Where?In the unit! (board on both towers)

• Patients cannot be left unattended. We knew we couldn’t get 100% of nurses working in a given day, no matter where we met.

• Tried board in lounge. Coworkers identify this space as non-working, safe space and want time spent in the lounge to be protected.

• Tried one board in middle of unit. Very limited attendance as no one works in close proximity to that location.

• Identified need for two boards, one on each tower to reach the most coworkers where they are working.

Who? Every nurse and other disciplines welcome!

Goal is for each nurse and NICU Associate to attend once a week.

Originally only nurses. Value added when multi-disciplinary.

Other disciplines invited and welcome daily. They attend as their schedules allow. Disciplines regularly attending include: therapy, respiratory, social work, care coordination, physicians, pharmacist, infection prevention, pastoral care, and our family advocate.

How?(do we make it work?)

Leadership team committed to making huddles happen EVERY shift.

Every leader participates in LEAN training.Text sent to phones before huddle begins “huddle

on green/yellow” to remind coworkers and let them know we’re about to start.

Recently started tracking attendance. Immediate improvement. Plan to include in AOS goals for FY19.

What?(has been the outcome?)

Coworkers engaged in sharing their ideas and concerns.

Provides structured avenue for communicating important information (safety issues, education, events).

Collaboration between departments.Opportunity to recognize coworkers in front of

their peers.Dialogue!

• Celebrations and recognition

• Top topics• Education• Quality metrics• Innovations and

ideas• Monthly

newsletter

NICUHUDDLE

Innovation Ideas that have come from Huddles Microwaves replaced around unitCar seat hang tagsChanged EVS workflow to better support NICU

workflow (changing trash in evenings)Pull preference listUsing virtual to engage parents/family members

when they cannot physically be hereNew nursing care delivery model based on

feedback from RN’s regarding reasons for disengagement and turnover• Went from a Macro unit with 8 pods to 4 micro

“neighborhoods”

2018WHERE WE ARE NOW…New Leadership Team developed March 2017

• Focus on coaching to Lean principles including respecting every individual, Gemba, gathering input and feedback on process changes from front line coworkers, etc.

Enhanced communication through huddle renovation, Friday updates, and monthly newsletter

Increased co-worker engagementImproved moraleIncrease in quality improvement projectsSignificant movement on 2017 AHRQ Culture of Safety

Survey compared to 2015• 24.6% increase for Supervisor/Manager expectations and

actions promoting patient safety October 2018 Nursing turnover rate down to 15%Overall PRC teamwork % excellent score 73.9%

QUOTESFROM STAFF

“I think the leadership has heard our concerns and is actually acting on it to make things better”

“Changes in leadership have been huge”“Change is never easy but we've adapted

and pulled together as a team to improve the care we give to these babies and families and enhance our nursing environment”

MOVING FORWARD

Where are we going?

Continue to build teamwork and improve culture

Maintain turnover of 15% or lessContinue to receive feedback from co-

workers about process improvements

HIIN Project Updates

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Data Due Dates —HIIN Project Extension

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*Subject to change once extension contract deliverables have been received by MHA.

HIIN Project Reports and Communication Updates

HIIN project reports (HIIN CEO Dashboard and HIIN Improvement Calculator) will be sent to HIIN leads at the conclusion of the program.

The HIIN CEO Dashboard and stipend checks will be sent to HIIN CEOs after the determination of Milestone 9 recipients.

Monthly HIIN email updates will be sent throughout the duration of the project. Please review for pertinent project updates.

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UPDATED:Milestone 9 Stipend Criteria

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What is the Extension Milestone Stipend Breakdown?

Data Due Date Amount When is $

Dispersed Criteria

Milestone 9 March 13, 2019

$750.00 for A/C/C facility and $250.00 for P/L/R facility

March 2019 The hospital has submitted all monitoring data for applicable measures and completed all three Patient & Family Engagement and Disparity surveys. (See next two slides for submission and improvement requirement criteria.)

*Improvement based on 20/12 percent reduction goals as defined by HRET per metric.

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Acute/CAH/Children’s Hospital Criteria Submission of 85 percent or greater of applicable required data AND

hospitals must meet improvement goals on 67 percent or more of all applicable measures. Improvement will be based on data submitted 6/1/2018 – 10/31/2018. All applicable measures must at least have data submitted through January 2019

to be eligible for Milestone 9; AND Submit all three Patient and Family Engagement and Disparity Surveys by

the following dates: November 16, 2018 January 11, 2019 March 8, 2019; AND

On the January PFE survey, your organization must be able to answer “YES” to at least 3 out of 5 metrics or 2 out of 4 metrics, if you do not do planned admissions; AND

Meet “basic” on at least 5 out of 7 disparities metrics on the disparities portion of the January PFE/Disparity survey (HRET HIIN Health Equity Metric Guide)

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Psych/LTACH/Rehab Hospital Criteria Submission of 100 percent of identified measures from

October 2016 – January 2019 Submit all three Patient and Family Engagement and

Disparity Surveys by the following dates: – November 16, 2018– January 11, 2019– March 8, 2019

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PFE/Disparities The following has been removed from the milestone

criteria:You must include at least one of the following engagement components for disparities: At least two registration staff must complete the CHP Disparity and REaL

Data Collection webinar series “sprint.” (Project information forthcoming.)

Management engagement component to disparities (Project information forthcoming.)

Due to unforeseen staffing circumstances at the Center for Health Policy, the CHP Disparity and REaL Data Collection webinar series “sprint” and the management engagement component to disparities has been postponed.

49 participating hospitals completed the January survey; down from the 65 that completed it in November.

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*Checklist will be sent post huddle

webinar.

Disparity Metric Guide Condensed

31*Guide listed in handout pod of webinar platform.

HIDI extracts the data shown for a majority of the measures for our HIIN hospitals. We will be reviewing/validating what is missing from your facility and send out a separate email requesting you submit updated baseline numerator/denominators for any measures we cannot obtain through HIDI.

Baseline Periods for HIIN Extension

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AHA Rural Health Conference The 2019 Rural Health Care Leadership Conference brings together

top practitioners and thinkers to share strategies and resources for accelerating the shift to a more integrated and sustainable rural health system. The conference will examine the most significant operational, financial and environmental challenges and present innovative approaches that will enable participants to transform their organization’s care delivery model and business practice.

Two Missouri hospitals were awarded scholarships to attend the AHA Rural Health Conference and present their storyboard. Cox Medical Center Branson – CDI Ste. Genevieve County Memorial Hospital – Falls

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New Recruitment Opportunities

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UPing the Ante Missouri hospitals drive improvements UP by taking strides to reduce harms through

improvement sprints. Improvement sprints are simple, low-cost ways to apply concentrated effort toward generating improvement over a short time period. Throughout the MHA Improvement Sprints, each UP component will be broken down to support hospitals in policy development, compliance review, and technical and educational resources. Building the three foundational UP questions into the culture of daily practice will simplify safe care, streamline interventions and reduce multiple forms of harm. The UP intervention is a simple, easy-to-accomplish activity for all staff to use with every patient to create highly reliable care.

UP consists of four components: Wake UP promotes prevention of over-sedation. Get UP promotes mobilization of patients. Soap UP promotes hardwiring hand hygiene. Script UP promotes the optimization of inpatient medications.

The UP Sprints began in October 2018 and will continue through March 2019. Hospitals may sign up for the UP Sprints individually, so improvements may be aligned with the current goals of your organization.

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UP Intervention Sprints

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Script UP: • Script UP Webinar Recording • Script UP PowerPoint

Soap UP: • Soap UP Webinar Recording• Soap UP PowerPoint

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LEAN Six Sigma Green Belt Program

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HRET/HIIN Virtual Events

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ADE Relay SummaryThursday, Jan. 31 | 11 a.m. to Noon CT Register here.

HRET HIIN Readmissions | MVP Webinar #5Friday, Feb. 1 | 11 a.m. to Noon CT Register here.

HRET HIIN | Antibiotic Stewardship: Targeting PrescribingFriday, Feb. 1 | 12:30 to 1:30 p.m. CT Register here.

HRET QIN | Falls and Pressure Ulcers WebinarThursday, Feb. 7 | 2 to 3 p.m. CT Register here.

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PVAP Measure Training #1Friday, Feb. 8 | 11-11:30 a.m. CT Register here.

HRET HIIN | CAUTI Fishbowl #3Tuesday, Feb. 12 | 11 a.m. to Noon CT Register here.

PVAP Measure Training #2Friday, Feb. 15 | 11-11:30 a.m. CT Register here.

HRET HIIN | Antibiotic Stewardship: Managing DemandFriday, Feb. 22 | 11 a.m. to Noon CT Register here.

Additional HRET Virtual Events

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Age Friendly Action System’s Community In 2017, The John A. Hartford Foundation and the Institute for Healthcare

Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA), set the bold aim that 20 percent of US hospitals and health systems would be Age-Friendly Health Systems by June 30, 2020. To reach this goal, the Age-Friendly Health System Action Community was developed as an on-ramp for hospital-based teams (e.g., emergency departments, ICUs, general wards, medical-surgical units) and ambulatory care teams (e.g., primary care, specialty care) to test and adopt the 4Ms framework. In September 2018, 124 teams from 70 organizations joined the first Age-Friendly Health Systems Action Community to improve care for older adults. The first Action Community will conclude in March 2019 and the next Age-Friendly Health Systems Action Community will take place from April – October 2019.

To learn more about Age-Friendly Health Systems and the learn how to enroll for the Action Community, click here, Additionally, free join informational calls are available on the following dates: January 30, 2019 (11:00 – 12:00 PM CT) - Register for the meeting here. March 6, 2019 (1:00 – 2:00 PM CT) - Register for the meeting here.

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Upcoming Events

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2 p.m. Tuesday, March 26 Register

2019 HIIN Huddle (Tentative)

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Upcoming In-Person Events

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2019 MHA Quality & Safety Showcase

46Click here to register.

2nd Annual MHA Opioid Summit: Addressing Perinatal and Neonatal Clinical Care Issues Wednesday, February 27 at Courtyard by Marriott in Blue Springs Register on or before Friday, February 15. Reduced Registrant Fee: $125.00

The majority of conference expenses are covered by Missouri's State Targeted Response to the Opioid Crisis Grant and our sponsors. The reduced registration fee covers portions of the provided meal and other amenities that are not allowed to be covered by the grant.

The Opioid Summit is for providers that need evidence-based guidance for treatment of perinatal women with substance use disorders and the treatment of neonates dependent on controlled substances.

Connect and network with community social service providers to improve and sustain coordinated care.

Learn from national and state leaders who have data to demonstrate successful interventions.

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Resources

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SME Monthly Spotlights Adverse Drug Events – Opioid Safety in the

Hospital Falls Prevention Hospital-acquired Infections Patient & Family Engagement Pressure Ulcer Reducing Preventable Readmissions Sepsis VTE Prevention and Management Worker Safety

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Health Care-Based Suicide Prevention

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Monthly Quality & Safety Update The Quality & Safety Update provides health care professionals with up-to-

date information on current quality improvement projects, resources and quality reporting. The newsletter also highlights announcements and upcoming events that could benefit your organization. The January 2019 issue, which spotlights “Reimagine Rural Health,” now is available online.

51Past issues are available on MHAnet.com.

Quarterly Trajectories Trajectories is a quarterly

publication of MHA focusing on progress in quality and population health efforts.

The December 2018 issue focuses on trauma-informed care to improve health and resiliency.

Click here to view all Trajectories.

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New Data Shows Growing Complexity Of Drug Overdose Deaths In America The Centers for Disease Control and Prevention recently released “Drug and Opioid-Involved Overdose Deaths –United States, 2013-2017" which contains final 2017 data detailing the growing number of drug overdose deaths in the United States. The report examines increases in drug overdoses and deaths involving opioids across prescription opioids, heroin, and synthetic opioids other than methadone by demographic and geographic characteristics.

Review the entire report here.

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AHA White Papers Examining Authority, Flexibility to Address Social Determinants of Health in Medicare and Medicaid

Hospitals and health systems are increasingly focused on ways to address the social and economic factors that can affect health and health outcomes for their patients and communities.

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AHA released two white papers examining the current authority and flexibility to address social determinants of health in both the Medicare and Medicaid programs.

The Medicare paper focuses on opportunities to address the social determinants within the Medicare Advantage program.

The Medicaid paper focuses on current authority available in the program, as well as examples of state programs addressing social determinants.

Publications and Resources Health Affairs | Expanding the Serious Illness

Care Team: The Conversation Nurse Model Health Affairs | Effects of Minimum Wages on

Population Health Health Affairs | Managing Diversity to Eliminate

Disparities: A Framework for Health Patient Engagement IT | Verma: Price

Transparency Rule Critical First Step for CMS

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Adverse Drug Events Airway Safety Antibiotic Stewardship Catheter-Associated Urinary Tract

Infection C. difficile Infection Central Line-Associated

Bloodstream Infection Culture of Safety Delirium Exposure to Radiation Falls Malnutrition Multi-Drug Resistant Organisms Pressure Ulcers Readmissions Sepsis Surgical Site Infection Ventilator-Associated Events VTE

Change Packages Change packages are a summary of

themes from the successful practices of high performing health organizations across the country. Developed through clinical practice sharing,

organization site visits, and subject matter expert contributions.

Include a menu of strategies, change concepts and specific, actionable items that any hospital can implement based on need or for purposes of improving patient quality of life and care.

Intended to be complementary to literature reviews and other evidence-based tools and resources.

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ListServ Gain access to other hospitals, national and state

subject matter experts and other resources to avoid reinventing the wheel.

Listserv sign-up is open through the duration of the HIIN. Sign up today!

HRET HIIN topics: ADE, children’s hospitals, data analytics, health care disparities, hospital-wide topics, ICU, infections, Level 1 trauma, patient and family engagement, readmissions, rural/critical access hospitals, sepsis and Spanish.

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Questions?

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Missouri HIIN Team

•Jessica Stultz, R.N., BSN, MHA, CPPS, CPHQ

•Director of Clinical Quality•573/893-3700, ext. 1391•jstultz@mhanet.com

Jessica Stultz

•Amanda Keilholz, CPHQ•HIIN Program Manager•573/893-3700, ext. 1405•akeilholz@mhanet.com

Amanda Keilholz

•Toi Wilde, R.N., BSN, MBA, CPHQ

•HIIN Program Manager •573/893-3700, ext. 1406•twilde@mhanet.com

Toi Wilde

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