How to Rank in Top Five Percent of All US Hospitals in Safety – Year After Year Carol Smith, MBA, RN, NEA-BC, Compass Clinical Consulting Tammy Cole-Poklewski, MS, BSN, RN, Cooley Dickinson Hospital Abstract: In today’s rapidly changing environment, nursing leaders need to enlist frontline staff in the quality agenda, focus employees on the organization’s mission, vision and values, and develop accountability systems to improve systems and sustain quality improvements. This presentation maps Cooley Dickinson Hospital’s journey in implementing principles that achieved a ranking in the top 5 percent of all U.S. hospitals in patient safety by Healthgrades® for the past 4 years and a ranking in the top 10 percent in overall value by The Leapfrog Group. Introduction: With the multiple challenges in health care, the time for accountability is now. However, without changes in the systems we use to do our work, we cannot hope to make sustainable improvements at the necessary speed. The purpose of this presentation is to provide the learner a framework for hardwiring accountability structures and processes from the frontline to the C-Suite and to describe how the establishment and implementation of ongoing organizational structural supports create a culture of quality that will sustain improvement. Cascading Accountability Measures from C-Suite to the Front Line This presentation also outlines the changes made at Cooley Dickinson Hospital to accomplish accountability for process improvement at all levels of the organization and to sustain outcomes by utilizing the organization’s values as a mantra to change the culture. Methods and Materials: Evidence-based methods used: • Care Transitions Intervention model • Dartmouth Institute Clinical Microsystems Improvement methodology • The Oz Principle • Nolan’s Execution Model Conclusions: Results: An organizational accountability framework for performance improvement and enlisting frontline staff is necessary to improve the work and to sustain improved quality. Zero defects = Just Say No to Bugs! Creating a feedback loop that provides continual review of process and outcome measures is necessary to assist the frontline staff in evaluating their work and making necessary changes to sustain improvement. Examples of Hardwiring Accountability at the Front Line: References: • Lowering Hospital-Acquired Infections – The CDH Infection Prevention nurses worked closely with the Environmental Staff to standardize cleaning processes and implement the use of ultraviolet light room disinfection as part of the terminal cleaning process. These interventions resulted in a 54% decrease in hospital acquired C. difficile infections, a 58% decrease in MRSA colonization/ infections and a 65% decrease in VRE infections during 2011. Chart 1. Hospital Acquired Cdiff Deaths Chart 3. Acute Care Readmission Rate Chart 2. Hospital Acquired Clostridium difficile Infections 2009- Q3 2012 Chart 4. Heart Failure Readmission Rate – Post Care Transitions Intervention • Decreasing Readmissions for High Risk Patients – In January 2011, Cooley Dickinson Hospital implemented the evidence-based Care Transitions Program™ developed by Dr. Eric Coleman. The CDH mean 30-day readmission rate prior to implementing Care Transitions Coaching was 9.357%. Since April 2011, the CDH mean 30-day readmission rate has decreased to 8.424%. Discussion: At the foundation of the Clinical Microsystems approach to improving healthcare, are the concepts of: 1) frontline staff involvement, 2) rapid-cycle tests of change, and 3) using data to drive the decisions for how to improve. Senior leadership adopted a ZERO defect philosophy. Every employee in an organization must be focused on process improvement in order to achieve sustained outcomes: • All staff have two jobs – “to do their job and to improve their job” • By implementing a framework of accountability at all levels of the organization and reinforcing organizational values, systems and outcomes can be improved and sustained. • A fundamental building block of sustained systems and outcome improvement is the engagement of the frontline staff. • By being transparent with information and giving frontline staff the time and tools and trusting employees to “own it,” they can create processes that far exceed expectations. • Organizational transformation occurs one department at a time. Contact: -Coleman, E. A., Parry, C., Chalmers, S., & Sung-joon, M. (2006). The care transitions intervention: results of a randomized control trial. Archives Internal Medicine, 166, 1822-1828. Retrieved from www.archinternmed.com -Connors, R. (2011). Change the culture, change the game: The breakthrough strategy for energizing your organization and creating accountability for results. New York: Portfolio Penguin. -Connors, R. (2002). Journey to the Emerald City: Implement the Oz Principle to achieve a competitive edge through a culture of accountability. Paramus, N.J: Prentice Hall Press. -Kegan, R. (2001). How the way we talk can change the way we work: seven languages for transformation. San Francisco: JosseyBass. -Nelson, E. C., Batalden, P. B., & Godfrey, M. M. (2007). Quality by design, a clinical Microsystems approach. San Francisco: JosseyBass. -Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. -Peters, T. (1982). In search of excellence: Lessons from America’s best-run companies. New York: Harper & Row. Carol M. Smith, MBA, RN, NEA-BC Tammy Cole-Poklewski, MS, BSN, RN Principal Director of Quality and Patient Safety Compass Clinical Consulting Cooley Dickinson Hospital 2181 Victory Parkway 30 Locust Street Cincinnati, OH 45206 Northampton, MA 01061 513-516-5472 413-582-4736 [email protected] [email protected] compassgroupinc.comcooley-dickinson.org Christine Orlen, Care Transition Coach, left, visits Polly Peterson at Peterson’s home. Photo courtesy of the Daily Hampshire Gazette.