RACE for Results: Accelerating Knowledge Adoption to Improve Quality

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RACE for Results Accelerating Knowledge
Adoptionto Improve Quality

• Lessons Learned from a Childrens
  Hospital Alliance

Donna Payne, Sr. Vice President, CHCA Janet
Guptill, President, KM At Work, Inc. ACHE 2007
Congress on Healthcare Leadership March 21, 2007,
New Orleans
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Knowledge Transfer Improves Hospital Performance

• Strategy Drives Approach
• Informal peer networking builds a culture of
  sharing and collaboration
• Formal collaboratives are needed to create
  immediate results
• Systematic rewards and support are needed to
  spread initial results
• Knowledge Transfer involves Technology,
  People/Process, and Strategy
• Technology enables information sharing and people
  directories
• People processes ensure productive interaction
  and knowledge exchange
• Strategy determines impact measures and ensures
  organizational momentum
• CHCA Case Study Results
• 42 childrens hospitals participate in 30 peer
  networking forums, regularly sharing improvement
  tools and resources, exchanging best practices
  and learning from industry experts
• 18 childrens hospitals averted 13,478 adverse
  drug events (ADEs), representing 2.7 million in
  net savings, and reduced PICU blood stream
  infections (BSIs) by 57
• More than 60 intensive care units are working to
  sustain and spread improvements in ADEs and BSIs
  based on the initial collaboratives work

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Knowledge Transfer Building Blocks at CHCA
Peer Networking Performance Improvement Spread
TECHNOLOGY Online communities Peer group meetings Collaboratives C, C, c RACE for Results Juried annual award
PEOPLE PROCESS Teleconferences List serves Forum directors Special reports Benchmarking PDSA approach Results reported to peers and executives Dedicated PI staff Awards process with external judges Peer reviewed publication Ambassador program External published results Real time tools and resources
STRATEGIC IMPACT Individual employee improvement in productivity Satisfaction individual hospital improvement in results Organization-wide improvement, e.g., cost reduction, error reduction, safety improvement Accelerate improvement Safe, efficient and effective Focus on spread Knowledge available when you need it Best practices Peer assistance
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Knowledge Transfer to Improve Performance A
Case Study

• 42 non-competing hospitals US, Canada
• 14 billion combined revenue (1)
• Average per member revenue of 330 million
• If Fortune 500 would be ranked 142
• IDN influence
• 500,000 inpatients 10 million outpatients (2)
• 102,000 employees (2)
• gt20,000 pediatric physicians (5,162 medical
  specialists1,985 surgical specialists(2))
• Top 5 among U.S. health systems/IDNs
• Sources (1) Estimated from Goldman Sachs report
  to CHCA, July 2004 (2) Estimated from personnel
  report in AHA Guide 2003/ 2004

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RACE for Results Accelerating Knowledge
Adoptionto Improve Quality

• Peer Networking
• Performance Improvement
• Spread

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Peer NetworkingCreating a Connected Culture

• How CHCA Forums Accelerate Knowledge Exchange and
  Build Connections

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Peer Networking Builds Loyalty

• The Opportunity
• The combined knowledge and expertise of all the
  member hospitals is tapped when a new manager
  comes on board
• Centralized knowledge space limits brain drain
  due to turnover and retirements
• CEO turnover is 30 annually industry wide
  higher among departmental managers
• Average hospital staff age is 50 getting new
  employees trained quickly is critical
• Online communities among peers limits
  re-inventing the wheel each time an issue is
  faced
• The Relevance
• Employee satisfaction drives customer
  satisfaction and market share
• Employee productivity drives operating cost and
  margin
• Results
• 42 childrens hospitals participate in 30 forums
  representing over 2600 executives/managers.

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Peer Networking Forums are Highly Active
2006 Hospital Participation in Forums
Ambulatory 22 Materials Management 33
Cardiac 28 OR Directors 31
CFO 40 PACT 34
CHAPs 17 Patient Financial Services 21
CIO 36 Payor Contracting 33
CNO 40 Pediatric Practice Exec. 22
COO 40 Pharmacy Buyers 40
Corporate Compliance 28 Pharmacy Directors 39
Customer Service 20 PHIS 37
Dietary 33 Physician Relations 22
Executive Dialogue 40 Quality and Safety Leaders 42
Facilities Management 33 Radiology Directors 33
Health Information Mgmt 33 Respiratory Directors 32
Home Care 17 Risk Managers 25
Human Resources 32 SMAC 30
JCAHO 35 Social Work Community 15
Lab Directors 32 SPBD 28
Overall 2006 satisfaction 5.24 of 6.0 (87)
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Peer Networking Forums webpage
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How does it work?

• Internet site for Forum members only
• Exclusivity, confidentiality, knowledge of
  colleagues
• Dedicated staff facilitator Supports 3-5 Forums
  depending on content knowledge and required
  expertise
• Share documents, post weblinks, initiate
  discussions, find resources
• Technology combined with meetings keeps the group
  connected
• Teleconferences, webcasts, bi-annual meetings
• Ad hoc conversations, focused research, group
  problem-solving
• Rapid response to posted questions
• Benchmarking and identifying variation

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How can you learn from this?

• Upgrade intranet to include 2-way communication
  capabilities
• Incorporate suggestion box for online idea
  submissions
• Utilize team e-rooms for special projects or
  cross-facility peer group networking
• Institute employee email system and instant
  intranet access to facilitate organization-wide
  communication
• Reinforce a culture of connectivity
• Post meeting materials and minutes online before
  and after
• Incorporate online learning tools where
  appropriate
• Exclusively utilize email and intranet site to
  keep employees current on organization-wide
  strategies, department-specific issues, or for
  shift scheduling
• Potential reward
• Reduces error, reduces time spent searching for
  solutions to common issues, improves employee
  satisfaction, facilitates employee professional
  development
• Reinforces organizational strategy and
  performance goals

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Performance ImprovementThe Power of
Collaboratives

• How CHCA Collaboratives Accelerate Adoption

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Collaborative Reduces Adverse Drug Events

• The Opportunity
• ADEs occur in 6 to 10 percent of hospitalized
  patients
• Narcotics among highest risk for errors for
  children
• 50 percent of ADEs related to narcotics
• 5.2 narcotic-related ADEs for every 100 patients
• The AIM Statement
• Reduce the occurrence of ADEs related to opioid
  and non-opioid narcotics by 50 percent
• Results
• 18 childrens hospitals averted 13,478 ADEs,
  representing 2.7 million in net savings
  (CHCA-approved methodology)

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Collaborative Reduces Adverse Drug Events

• Hospital Teams
• Atlanta
• Birmingham
• Buffalo
• Cincinnati
• Columbus
• Corpus Christi
• Dayton
• Fort Worth
• Kansas City
• Miami
• Nashville
• New Orleans
• New York/Morgan-Stanley
• New York/Komansky Center
• Orange
• Palo Alto
• Pittsburgh
• St. Petersburg

• 16 teams (89) had a reduction in ADE rate
• Average among teams with a reduction 64
  reduction
• Average for all teams 49 reduction
• 11 teams (61) had at least a 50 reduction in
  ADE rate

BETTER
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Collaborative Reduces Adverse Drug Events

• Developed new tools and knowledge to detect
  adverse events
• 3 new trigger tools have effectively prevented
  adverse events
• 15 pediatric triggers improved detection of ADEs
  by 22x
• 8 triggers increased narcotic ADE detection
• 16 neonatal triggers improved detection of ADEs
  by 12x

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Adverse Drug Event Collaborative webpage

• Add ADE Collaborative screenshot

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Collaborative Reduces Blood Stream Infections

• The Opportunity
• Catheter-associated blood stream infections
  (BSIs) are a serious threat to patients safety
• Areas of highest risk for BSIs include PICU,
  NICU, CICU, and Hematology/Oncology
• The AIM Statement
• Reach zero tolerance for BSIs among targeted
  patient populations
• Results
• 18 childrens hospitals reduced BSIs in the PICU
  by 57
• Hospitals prevented 112 BSIs resulting in nearly
  1 million in estimated net cost savings
• Accelerating a goal One PICU has been BSI free
  for 563 days as of 9/20/06

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Collaborative Reduces Blood Stream Infections
Includes only hospitals with a reduction in
Catheter-related BSI rate
Better


GOAL 50 reduction

• 18 teams (62) achieved a reduction in BSI rate
• Average among teams with a reduction 57
  reduction
• Average for all teams 31 reduction
• 11 teams (38) achieved a 50 reduction in BSI
  rate

Statistically significant improvement plt0.05
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Blood Stream Infection Collaborative webpage
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Surgical Infection Prevention Collaborative

• The Opportunity
• Surgical Site Infections (SSIs) are third most
  frequently reported hospital acquired infection
• 16 percent of all nosocomial infections
• Among surgical patients, 38 percent of all
  infections, 77 percent of deaths for patients
  with SSI
• SSIs increases LOS 7 to 10 days
• In children
• One of the most common indications for operative
  intervention
• 40 to 60 percent of SSIs are preventable
• gt200,000 surgical procedures (n34 hospitals)
• Inappropriate use of prophylactic antibiotic 25
  to 50 percent of operations

Source CDCs National Nosocomial Infections
Surveillance (NNIS)
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Surgical Infection Prevention Collaborative

• The AIM Statement
• Appropriate use of prophylactic antibiotics as
  follows
• Selection 95 percent of procedures will be
  accompanied by prophylactic antibiotics
  consistent with hospital guidelines
• Start time 95 percent of procedures will have
  antibiotic prophylaxis initiated 30-60 minutes
  before the incision
• Re-dosing 95 percent of procedures for which
  re-dosing is indicated will receive a 2nd dose of
  intraoperative antibiotics consistent with
  hospital guidelines
• Post-operative discontinuation 95 percent of
  procedures will have prophylactic antibiotics
  discontinued within 24 hours after surgery
• Skin preparation performed as follows
• Hair removal 95 percent compliance with
  appropriate hair removal (for those patients
  undergoing hair removal)
• Skin antisepsis 95 percent compliance with
  appropriate skin antisepsis
• SIP bundle compliance 95 percent of procedures
  will be accompanied by appropriate prophylactic
  antibiotic use ( selection, timing,
  intraoperative re-dosing if necessary and
  post-operative discontinuation) and appropriate
  hair removal
• Reduce Surgical Site Infection (SSI) by 50 percent

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Surgical Infection Prevention Collaborative
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Surgical Infection Prevention Collaborative

• The Power of Collaboration
• 28 Hospitals set Goal to reduce Surgical Site
  Infections by 50
• 11 outcome, process and balancing measures
• On-line tracking and reporting(July 2006-2007)
• Final Report September 2007

• Hospital Teams
• Akron
• Atlanta
• Birmingham
• Boston
• Chicago
• Columbus
• Corpus Christi
• Dallas
• Detroit
• Fort Worth
• Hartford
• Houston
• Kansas City
• Los Angeles

• Memphis- Le Bonheur
• Memphis - St Jude
• Miami
• Milwaukee
• Nashville
• New Orleans
• New York
• Palo Alto
• Philadelphia
• Phoenix
• Pittsburgh
• Seattle
• St. Petersburg
• Washington, DC

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How does it work?

• Dedicated Performance Improvement staff and
  resources
• Trained in IHI improvement methodology
• Hospitals agree to share results, post data and
  publish results
• Use industry and hospital expert panels to
  validate clinical direction
• Combine research and rapid cycle - essential for
  academic engagement
• Technology tools and partners integral to success
• Knowledge repository available real time
• improvements, tool kits, lessons learned,
  comparative data, audios of webcasts and lessons
  learned
• Strategic partners essential to spreading results
  and gaining credibility
• AHRQ Partnership for Quality Grant helped fund
  participation and training for all 42 hospitals
• Data-sharing agreements developed to expand
  comparative data sets (Vermont Oxford Neonatal
  Network and others)

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How can you learn from this?

• Post performance targets and results on intranet
• Develop online performance reporting capabilities
• Customize for different audiences employees,
  physicians, consumers, board
• Include resources and educational materials for
  ease of access
• Reinforce a culture of transparency
• Engage physicians in research design and
  collaborative process
• Build in research rigor and evidence-based
  medicine findings
• Utilize dedicated PI staff to ensure that project
  leadership is experienced, professional, and
  credible
• Potential reward
• Improves patient safety, reduces operating costs,
  reduces patient errors
• Focuses on organizational performance and peer
  accountability

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SpreadRACE for Results Rewards Initiative

• How Awards Program Achieves Spread and
  Sustainability

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Quality Awards Program Accelerates Spread

• The Opportunity
• Provide an incentive for hospitals to document
  their success in improvement
• Create a competitive and rigorous selection
  process for formal recognition
• Recognize team efforts within organizations and
  accelerate knowledge adoption
• RACE for Results Recognize and Celebrate
  Excellence
• Initiated in 2004 idea of CHCA Vice President,
  David Bertoch
• Judged by recognized national experts
• Awarded to hospital demonstrating sustained
  performance improvement
• Ambassador status includes obligation to teach
  others
• Relay RACE rewards adoption of others successes
• Relay Report sustains focus on spread and
  sustainability

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RACE for Results Award
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RACE for Results 2006 Entries

• Asthma Attack
• Critical Care Units Quality Improvement
  Collaborative Reducing Ventilator Associated
  Pneumonia Rates in Three Pediatric Care Units
• Duplicate Medical Record Number Clean-Up
• Improvements in Beta-Agonist Therapy Practices
• Improving Patient Safety by Decreasing Mislabeled
  Specimens
• Improving Patient Safety by Standardizing the
  Patient Identification Process
• Improving Patient Safety through Reduction of
  Medication Errors
• Increasing ED Patient Care Revenue
• Measuring the Impact of a Short Stay Unit with
  Bronchiolitis/ Viral Pneumonia Patients
• Meeting the Standard of Evidence-Based Asthma
  Care
• Pain Control in Children with Sickle Cell
  Vaso-Occlusive Crisis

• Patient Safety Indicator Validations for
  Application to Unique Pediatric Population
• Preventing Cardiopulmonary Arrest outside the ICU
  Implementation of a Medical Response Team
• RACE for the Gold A Swift Reduction of
  Catheter-Related Blood Stream Infections in the
  PICU
• Reducing Adverse Drug Events related to Opioid
  and Non-Opioid Narcotics in Children
• Reducing Catheter-Related Bloodstream Infections
  in Children
• Reducing Central Line Associated Bloodstream
  Infections in the NICU
• Reducing TPN-Associated Medication Errors Using a
  Multi-Process Approach
• Reduction in Manual Differential Turnaround Time
  for Emergency Room Patients
• Stat Medication Administration Improving
  Timeliness and Patient Safety

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Judged by Nationally Recognized Experts
David Classen, M.D., M.S., Vice PresidentFirst
Consulting Group
Lloyd Provost, M.S., PartnerAssociates in
Process Improvement
Teri C. Simmonds, RN, Partner Safe and
Reliable Healthcare, LLP
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2006 RACE for Results Winners
The Childrens Medical Center, Dayton winner of
the RELAY Award reduced central venous
catheter-associated bloodstream infections by
100.
Childrens Hospital of Omahas Asthma Attack
led to reduced LOS and readmission rates, and
improved medication management.
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RACE for Results Winners
2004 2005 2006 2007
Little Rock Reducing Catheter-Related Bloodstream Infections through Repeated Rapid Cycle Improvements Cincinnati Reducing Cost through Improving Quality Palo Alto Decreasing ADEs By Implementing Safety Best Practices Washington DC Using PHIS to Target Reducing Infections in VP Shunt Surgeries Omaha "Asthma Attack Dayton Reducing Catheter-Associated Bloodstream Infections in Children
11 Entries 12 Entries 17 Entries 30 Entries
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Press Releases

• FOR IMMEDIATE RELEASE
• The Childrens Medical Center of Dayton Reduces
  Infections and Wins National Award
  for Excellence
• DAYTON, OH (March 30, 2006)
• The Childrens Medical Center of Dayton (Dayton
  Childrens) has received a national quality and
  safety award from Child Health Corporation of
  America (CHCA), a business alliance of 42 of
  North Americas leading childrens hospitals. The
  distinguished RACE for Results award recognizes
  and celebrates excellence in performance
  improvement within childrens hospitals.
• Dayton Childrens earned a 2006 RACE for
  Results award for its success in reducing
  bloodstream infections in the Pediatric Intensive
  Care Unit (PICU). The hospital collaborated with
  28 other childrens hospitals to pursue an
  improved care system for children requiring
  treatment involving central venous catheters, a
  serious threat to patients safety. The result
  was a 100 percent reduction in infections the
  hospital has gone a full year without a single
  central venous catheter-associated bloodstream
  infection in their PICU!
• We are honored that our efforts to improve
  safety have been recognized by our peers, the
  leading childrens hospitals in North America,
  said David Kinsaul, President and CEO of Dayton
  Childrens. And were very motivated by the
  improved quality of care weve been able to offer
  our patients. Weve already started spreading
  this improvement to other areas of our hospital.
• Dayton Childrens was selected for the
  prestigious RACE for Results award by a panel
  of independent national quality and safety
  experts. Children's Hospital of Omaha was also a
  recipient of a 2006 CHCA RACE for Results award.

FOR IMMEDIATE RELEASE Asthma Best Practices Wins
Childrens Hospital Omaha
National Award for Excellence OMAHA, NE (March
29, 2006) Childrens Hospital in Omaha, announced
today that it is a recipient of a national
quality and safety award sponsored by Child
Health Corporation of America (CHCA). The
distinguished RACE for Results award recognizes
and celebrates excellence in performance
improvement within childrens hospitals. The
award is given by CHCA, a business alliance of 42
of North Americas leading childrens hospitals,
to childrens hospitals that demonstrate
significant and sustained improvements in care
through the use of CHCA data and improvement
resources. Childrens Hospital earned a 2006
RACE for Results award for its work in
improving care for children with asthma. By using
national asthma and steroid data, Omaha began a
series of projects to help implement new
treatment guidelines and restructure their
Respiratory Care Department. These projects
helped to reduce unnecessary time spent in the
hospital and return visits after being discharged
from the hospital. We are honored to be
recognized among our peers, the leading
childrens hospitals in North America, for our
efforts in making asthma care more safe,
effective and efficient, said Gary Perkins, CEO
of Childrens Hospital Omaha. This particular
improvement is just one in a series of
improvements to change the way we care for
children. Childrens Hospital was selected for
the prestigious RACE for Results award by a
panel of independent national quality and safety
experts. The Childrens Medical Center of Dayton
was also a recipient of a 2006 CHCA RACE for
Results Relay award.
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RACE Results in Performance Improvement
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How does it work?

• Formal RACE for Results awards program
• Formal application process with strict submission
  requirements
• External judges panel representing industry
  experts in quality and patient safety
• Results announced at award ceremony during annual
  Quality Safety Meeting
• Winners required to serve as Ambassadors during
  subsequent year to teach techniques and encourage
  adoption of proven practices
• Formal marketing campaign to publicize event
• Emails, posters, web notices to promote the
  competition and publicize winners
• Email-based Relay Report to report progress as
  proven practices are replicated across the
  alliance
• Resources and contacts posted on the intranet to
  facilitate connections and encourage adoption
• Benchmarking reports regularly published to
  document improvements

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How can you learn from this?

• Walk the Talk
• If you are serious about knowledge transfer and
  adoption of proven practices, develop programs
  and tools to facility this activity
• Start with the strategy and invest in the
  technology
• Redefine job roles and incentive structures to
  reward collaboration and knowledge adoption
• Create a culture of connectivity
• Online spaces for collaboration and informal
  conversation - Get ready for the MySpace
  generation
• Incorporate web thinking into every communication
  intention
• Build web-based tools into every job in the
  hospital, make it part of the way work gets done
• Measure the results
• Tie collaboration activity to attainment of
  strategic goals
• Publicly celebrate successes
• Learn from failures focus on continual
  improvement

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Knowledge Transfer Building Blocks
Peer Networking Performance Improvement Spread
TECHNOLOGY Create MySpace for your employees, physicians, and customers Create public campaigns for targeted improvement goals Publish results on the hospital website customize for each audience
PEOPLE PROCESS Create online people directories, create peer group moderator roles, highlight personal success stories Develop a dedicated PI staff this may incorporate Six Sigma, IHI Collaboratives, etc or may be internally developed Incorporate proven practice sharing into annual awards ceremonies, dept budget reviews, employee performance reviews
STRATEGIC IMPACT Enhanced employee satisfaction and productivity, strong customer satisfaction scores Focused improvement in targeted areas, e.g., patient safety, financial performance, wait times, turnover, etc. Faster decisions, quicker adoption of proven practices, rapid innovation absorption
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Questions?
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Contact us for further discussion

• Donna Payne, Sr. Vice President, CHCA
• Donna.Payne_at_chca.com
• 913-262-1436
• Janet Guptill, President, KM At Work, Inc.
• Janet.Guptill_at_kmatwork.com
• 314-963-7710