In the past, South Carolina hospitals have highlighted their quality and patient safety initiatives with storyboards at the SCHA/SCMA Annual TAP Conference. Storyboards have proven to be a fantastic opportunity to highlight the hard work South Carolina hospitals have done to improve health care across our state.
This year we were eager to learn about your hospital’s innovations in practice surrounding our SCHA Reengineering efforts that showcase creative ideas with measurable outcomes. We asked you to share your stories relating to collaborative team work and/or areas where you have made measurable advancement by improving population health, enhancing the patient experience and/or reducing the cost of care.
We received many wonderful storyboards from hospitals across the state. Four of those hospitals were recognized for their excellence in improving population health, reducing the cost of care, enhancing the patient experience, or teamwork. Read their story:
Innovation to Improve Population Health
Self Regional Healthcare
“Self Cares: Wellness Initiative Paying Dividends at Self Regional Healthcare”
Self Regional Healthcare introduced its Self Cares program in 2008 in an effort to improve team members’ lifestyles and health. Self Cares encourages healthy eating, weight loss, wellness education, health screenings, regular physical activities, preventive medical and dental care, health risk assessments, health coaching and other measures designed to lead team members to healthier living.
More than 1,900 team members now participate. The hospital appears to be getting healthier each year. Health plan expenses are down by more than $5 million for fiscal year 2011 due to Self Cares along with other changes made to the plan. At least five potential catastrophic, costly health issues have been prevented, and 150 of 220 team members who reported they used tobacco have worked with a health coach to become tobacco free. Team members in Self Cares also benefit from lower health insurance premiums and improved prescription benefits.
Innovation in Reducing the Cost of Care
North Greenville LTACH
“Maximizing Resources to Improve Quality”
Small facilities with limited staff and time/schedule resources can improve quality by facilitating participation of frontline staff using a central meeting model. Strategies to improve one quality outcome are often appropriate for other outcomes as well. The overall objectives of the PCQC committee were to standardize all processes, identify every opportunity for improvement, and implement best practice solutions. Focus group champions were instrumental in communicating the committee’s efforts to the frontline staff and providing point of contact education. Frontline staff members quickly identified breakdowns and process work-a-rounds facilitating timely resolution. Real time surveillance was conducted with drill downs of each case which translated into continuously improving processes. Data was posted monthly for staff information and reported via a facility scorecard.
Within a few months rates began to trend down. At the 11th month mark Self achieved reductions between 29.7 and 71.4%. The estimated range of cost avoidance just in device associated infections is approx $306,000-$781,000 with 2-5 lives saved as a direct result of improvements in the quality of care. This centralized meeting model has proven highly effective in facilitating change in Self’s organization. Of critical importance is the engagement of frontline staff from all disciplines to be champions of each effort and bridge the gap between the committee and the bedside.
Innovation to Enhance the Patient Experience
“Reducing Patient Harm Through Transparency and Accountability”
Committed to safe patient care, Palmetto Health has been on a six-year journey to create a culture of safety and evidence based practice where preventable errors and deaths are eliminated. Driving national best practices to the bedside required the creation of an infrastructure where processes and outcomes could be measured, shared, and examined freely and where leaders held each other accountable for progress toward the hospital’s goals.
In conjunction with several national organizations, in 2009 Palmetto Health committed to reducing mortality through the prevention of hospital acquired harm in several key areas:
- Central Line Associated Bloodstream Infections
- Catheter Associated Urinary Tract Infections
- Ventilator Associated Pneumonia
Hospital Acquired Conditions
- Pressure Ulcers
- Venous Thrombo-embolism
In FY 2011 added Average Time to Glucose Recheck after Hypoglycemia
Palmetto Health developed a methodology to track progress monthly against a 12 month baseline. Aggregate data was reported monthly to the Board and was integrated into leader performance evaluation. However, aggregate data did not provide the detail necessary to drive improvement at the unit level.
The Palmetto Health Richland Center for Nursing Excellence and Clinical Outcomes developed a process for reporting progress in harm reduction. Individual unit scorecards of process and outcome measures and harm index spreadsheets roll-up up into department scorecards and harm index. Department Directors’ data rolls up to campus wide spreadsheets. Campus harms are combined as a system harm index monthly.
This process made each Nurse Manager accountable for the harms “assigned” to her area. Just as important, the harm index information resides in a shared drive where any leader has full access to every unit’s status. This transparency allows Nurse Managers to seek mentorship from colleagues who have developed best practices.
How the Harm Index changed Palmetto Health:
- Moved improvement outcomes from the “data black hole” and placed it front and center for all Palmetto Health employees.
- Tied harm reduction to performance evaluation creating “skin in the game” for all leaders.
- Resulted in development of corresponding Staff Nurse Scorecards to monitor compliance with best practices for Patient Safety.
- Expanded to include rates per 1000 patient or device days allowing leaders to compare harm trends both internally and externally. Retained raw number of harms to retain patient-centered focus.
- FY 2010 Palmetto Health Harm Index: 0.91 (9% reduction)
- FYTD 2011 (July): 0.80 (20% reduction)
- 29% reduction over twenty two months.
Innovation in Teamwork
“Every Patient, Every Time”
Thank you to all of the hospitals who submitted storyboards and for all of the hard work that is being done to improve the health and quality of care for our South Carolina citizens! We look forward to seeing more of your stories at next year’s TAP Conference.