Paula Raggiunti

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QUALITY SAFETY Indicators
Paula Raggiunti Acting Director, Quality
Patient Safety October 14, 2008
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Vision
Canadas Leader in complex care and complex
rehabilitation the new frontier of health care
Mission
Change the world for people living with complex
chronic disease and disability
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Four Key Outcomes

• Reduce the burden of complex, chronic disease
• Improve the quality of life of and promote
  wellness for individuals living with chronic
  disease
• Create, share and disseminate new knowledge
• Drive societal and health system change

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Bridgepoint Hospital

• Publicly funded, University of Toronto-affiliated
• In-patient care
• Ambulatory and day services 20,000 visits
  annually
• 479 beds 367 complex 112 rehabilitation
• 1,100 employees
• 400 volunteers
• Ethnically diverse

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The Third Frontier of Health Care (Today to the
future)

• The Health Status Reality for Society
• One in five Canadians over 40 have
• 3 or more chronic diseases
• One in three Canadians over 60 have 3 or more
  chronic diseases
• 70 of all health system costs relate to chronic
  disease

• The Health System Focus
• Prevention and management of chronic disease
• Longitudinal care
• Patient as partner

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Making Healthcare SaferA Conceptual Model
(Baker Norton, 2001)
ERROR REDUCTION
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Canadas Leader Strategy
Bridgepoint Commitment

• Put Quality Safety First Everyday!

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Mission To change the world for people living
with complex chronic disease disability.
Vision 2015 To be Canadas leader in complex
care complex rehabilitation the new frontier
of health care.
V5.1
OUTCOMES
REDUCE The Burden
IMPROVE Quality of Life Promote Wellness
CREATE, Share Disseminate New Knowledge
DRIVE Societal Health System Change
OPTIMIZE The Patient Experience
Care Delivery
Teaching
Research
Policy
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2
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Achieve Volume Service targets
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Change the Way People Think Act
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Bridgepoint Hospital
Embrace Live Well as part of care
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OUR CORE BUSINESS
Influence Health System Priorities Decisions
Deliver Team Care
Partner with Patients
Bridgepoint Community Programs
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50
Integrate Care Across the Continuum
Set the Standards Models for 3rd Frontier Care
Implement the CDM Model
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Bridgepoint Centre for Research, Education
Policy
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Turn Care into Knowledge
Turn Knowledge into Care
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Leverage Information Apply Knowledge for Best
Care Service
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Become a Teaching Organization
Become a Research Organization
Put Quality Safety First Everyday
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Organizational Capabilities
Resource Management
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Enable Great People to do Great Things
Harness the Full Potential of Information
Technology
Create Financial Capacity
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Transform Our Site into a Community Focal Point
Be Accountable
Build our Brand
Be a Great Partner
Optimize Resource Allocation Management
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Being the Best
Informed, Activated Patient
A Prepared, Proactive Team
THE CORE PRINCIPLES
Live Well
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Quality Safety Framework
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Quality Safety Program Mission Best Quality
Best Safety
Quality Safety Program Vision 2010 A vibrant
quality safety program that is embraced and
lived by all.
Bridgepoint Quality Safety Program
V3.1
Outcomes
Put Quality Safety First Everyday
Be Accountable for Quality Safety
Teaching
Research
Care Delivery
Internal Processes (Service Excellence
Positive Patient Experience)
Bridgepoint Hospital
Provide Accessible Seamless Care Service
across the Continuum (Continuity of Services,
Population Focus, Accessibility, Safety)
Deliver Client-Centred Care Services (Client-Ce
ntred Service)
Bridgepoint Community Programs
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10
Bridgepoint Family Health Team
Ensure a Healthy Safe Operating Work
Environment (Safety, Work Life)
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Bridgepoint Centre for Research, Education
Policy
Leverage Information and Develop Apply
Knowledge for Best Quality Best
Safety (Effectiveness, Population Focus)
50
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Resource Management
Organizational Capabilities
Enable Proactive Quality Safety Leadership
(Effectiveness, Population Focus)
Ensure Best Use of our Resources to Support
Quality Safety (Efficiency)
(Proactive Supportive Organization)
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15
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Build a Quality Safety Culture (Safety,
Effectiveness, Work Life)
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Enable Great People To Achieve Best Quality
Safety Results (Effectiveness)
Build Infrastructure to become Canadas Leader in
Best Quality Best Safety (Effectiveness)
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20
10
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THE QUALITY SAFETY PROGRAM CORE PRINCIPLES
Operate in a No Blame Environment
Embrace New Ideas Innovation
Safety Quality Everyones Job!
Being the Best
Informed, Activated Patient
A Prepared, Proactive Team
THE BRIDGEPOINT CORE PRINCIPLES
Live Well
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Strategy Maps.

• It uses the same framework as the balanced
  scorecard
• Its a one page document that describes how your
  organization creates value and contributes to
  the achievement of the overall strategy
• It provides a picture of your strategy
• It provides a uniform consistent way of
  describing your strategy
• A visual representation of the cause effect
  relationships between the components of your
  strategy (your theory of how the business works
  the story of your strategy)
• It provides teams with a tool to discuss the
  direction priorities of their organization/work
• The strategy map provides a bridge between an
  organizations strategy and its strategic
  measures (i.e. the balanced scorecard)
• The strategy map provides the link between
  strategy formulation strategy execution
• Strategy Focused Business Solutions Inc.

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Quality Safety Strategy
Mission

• Best Quality Best Safety

Vision 2013

• A vibrant Quality Safety Program that is
  embraced and lived by all.

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Outcomes What are we striving for?
2 Outcomes

• Put Quality Safety First Every day
• Be Accountable for Quality Safety

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Core Principles
3 Core Principles that underlie Quality and
Safety at Bridgepoint

• Operate in a No Blame Environment.
• We will create an environment where people feel
  safe in reporting errors, actual or potential.
  Reducing errors requires that we depersonalize
  them, investigate root causes and look for
  appropriate systems solutions. This does not
  imply tolerance for poor performance or
  negligence.
• Safety Quality Everyones Job!
• Everyone at Bridgepoint is responsible to make
  sure that the work and care environment and
  processes are as safe as they can be everyday.
  Everyone feels accountable for this and
  continuously looks for ways to improve service
  and care delivery to make our quality and safety
  focus a reality.
• Embrace New Ideas and Innovation.
• We continuously seek to improve the quality of
  care and service by testing new and innovative
  approaches to improving quality and safety.

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Quality Safety Strategic Objectives
Build a Quality Safety Culture Enable Great
People to achieve best quality safety results
Enable Proactive Quality Safety Leadership
Build Organizational Capabilities
Ensure best use of our resources to support
quality safety Build Infrastructure to become
Canadas Leader in Best Quality Best Safety
Manage, Monitor Invest in our Resources
Leverage Information, Develop Apply
Knowledge for Best Quality and Best
Safety Ensure a Safe Operating Work
Environment Deliver Client Centered Care
Services Provide Accessible Seamless Care
Service Across the Continuum
Embed Quality into Care Delivery
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Making Healthcare SaferA Conceptual Model
(Baker Norton, 2001)
ERROR REDUCTION
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Determining Priorities - Sample
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Making Healthcare SaferA Conceptual Model
(Baker Norton, 2001)
ERROR REDUCTION
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INDICATOR
INDICATOR
A measurement tool, screen or flag which is used
as a guide to monitor, assess and improve the
quality of client care, support services, and
organizational functions that affect client
outcomes.
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Linking indicators to Strategic Objectives (IHI
Model for Improvement)
1. What are we trying to accomplish?
2. How will we know a change is an improvement?
(Indicators)
3. What changes can we make that will lead to
improvement?

• Put Quality Safety First Everyday! This will
  be achieved by
• Ensuring a safe operating work environment
• Delivering client centered care service
• Providing accessible seamless care service
  across the continuum
• Building a Quality Safety Culture

Patient Falls (total severe)
Slips/Trips/Falls (staff) C-Difficle/MRSA/VRE Hand
Hygiene Compliance Unexpected Deaths 911
Transfers Patient Physical Verbal Aggression
Code White Code Yellow Level 3 Medication
Reconciliation (Admission) Adverse Medication
Errors Overexertion injuries (staff)
Needlestick Injuries (staff) Rehab Patient
Satisfaction Continuity Transition CCC Pain
Rehab Pain Complaints ADL Improvement (CCC)
Hospital beds occupied by ALC Overall LOS
Efficiency Rehab Patient Days RUG Weighted
Patient Days Near Misses/Good Catches
Falls Prevention Program Routine Practices
Campaign Nurse Call System Code Blue/AED
Training Personal Safety/Zero Tolerance Policy
Education Code White Program Patient
Satisfaction Priority Project Continuity
Transition Pain Project Patient Flow Project
(Admitting) Patient Safety Culture Survey Patient
Safety Policy Good Catch Program/Education Leaders
hip WalkRounds
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2007/08 Corporate Measures Quality Safety
Put Quality Safety First Everyday 8
Mandatory Training Program Attendance Rate 5
In-Patient Outcome Quality Index 40
Safety Index 30
BCR Care Goal Attainment 25
Day Treatment Re-integration Outcomes 0
ADL Improvement Index 40
Skin Ulcer Prevention 10
Pain Management Index 20
Nosocomial Colonization Rate 30
Patient Incident Index 50
Lost Days Per WSIB Claim 20
Staff Incident Index 30
Rehab LOS Index 40
CCC Improvement in ADLs 60
CCC Pain Management Rate 60
Rehab Pain Management Rate 40
Patient Actions 33
Patient Aggression 20
Lost Days
WSIB Claims
Code Yellows 35
Needle Sticks 33
MSK Rehab LOS 50
Medical Neuro Rehab LOS 50
CCC 911 transfer rate
911 Transfer Rate 45
Overexertion Injuries 34
Rehab 911 transfer rate
CCC 911 transfer count
Rehab 911 transfer count
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Corporate BSC Quality Safety Indicators
Our Core Business 52
Care Delivery 35
Put Quality Safety First Everyday 8
of Falls
Near Misses/ Good Catches
Medication Reconciliation at Admission
Nosocomial Rate MRSA/VRE
C. Difficile Rate
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Quality Committee of the Board
Put Quality Safety First Everyday 8
Near Misses/ Good Catches
Medication Reconciliation at Admission
of Falls - severe (Patient) Slips/Trips/Falls
(Staff)
Nosocomial Rates MRSA/VRE/ C-difficile
Hospital Beds occupied by ALC patients
Positive score on "Continuity and Transition"
section of Rehab patient satisfaction survey
Unexpected Deaths (CCC Rehab)
CCC Pain Rehab Pain
Rehab Patient Days RUG Weighted Patient Days
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Integrated Quality Safety Committee In addition
to the Board Quality Safety Indicators.
Put Quality Safety First Everyday
Overexertion Injuries
Needlestick Injuries
Hand Hygiene Compliance
Patient Physical Verbal Aggression Incidents
w Patients w Staff
Code White
Adverse Medication Errors
911 Transfers
Complaints
New Ulcers Stage II or Greater
Code Yellow Level 3
Overall LOS Efficiency Overall FIM Score
Change Overall ALOS (all RCGs)
ADL Improvement - CCC
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Definitions
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Quality Safety Program Mission Best Quality
Best Safety
Quality Safety Program Vision 2010 A vibrant
quality safety program that is embraced and
lived by all.
Bridgepoint Quality Safety Program
V3.1
Outcomes
Put Quality Safety First Everyday
Be Accountable for Quality Safety
Teaching
Research
Care Delivery
Internal Processes (Service Excellence
Positive Patient Experience)
Bridgepoint Hospital
Provide Accessible Seamless Care Service
across the Continuum (Continuity of Services,
Population Focus, Accessibility, Safety)
Deliver Client-Centred Care Services (Client-Ce
ntred Service)
Bridgepoint Community Programs
10
10
Bridgepoint Family Health Team
Ensure a Healthy Safe Operating Work
Environment (Safety, Work Life)
15
Bridgepoint Centre for Research, Education
Policy
Leverage Information and Develop Apply
Knowledge for Best Quality Best
Safety (Effectiveness, Population Focus)
50
15
Resource Management
Organizational Capabilities
Enable Proactive Quality Safety Leadership
(Effectiveness, Population Focus)
Ensure Best Use of our Resources to Support
Quality Safety (Efficiency)
(Proactive Supportive Organization)
5
15
5
Build a Quality Safety Culture (Safety,
Effectiveness, Work Life)
35
Enable Great People To Achieve Best Quality
Safety Results (Effectiveness)
Build Infrastructure to become Canadas Leader in
Best Quality Best Safety (Effectiveness)
50
20
10
10
THE QUALITY SAFETY PROGRAM CORE PRINCIPLES
Operate in a No Blame Environment
Embrace New Ideas Innovation
Safety Quality Everyones Job!
Being the Best
Informed, Activated Patient
A Prepared, Proactive Team
THE BRIDGEPOINT CORE PRINCIPLES
Live Well
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Quality Safety Indicators
Next Steps

• Continue to build the Program/Unit Dashboard
• Build the infrastructure within Units/Departments
  for the regular review of Quality/Safety
  Indicators and improvement activity/plans
• Unit/Program Quality Councils
• Safety Committee
• Set Performance Targets work with our peers to
  standardize metrics and establish benchmarks
• Develop an organizational performance reporting
  cycle

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Quality Safety Indicators
Key Learnings

• Less is more (focus).the vital few.
• Make clear the definition
  (numerator, denominator, data
  source)
• Tie measures to overall strategy for Quality
  Safety
• Engage stakeholders early in the process
• Cascade measures appropriately