QUALITY TRANSFORMATION NETWORK CASE STUDY UNIVERSITY OF MICHIGAN C.S. MOTT CHILDREN'S HOSPITAL Improving Awareness, Embracing Transparency The PICU at the University of Michigan C. S. Mott Children’s Hospital in Ann Arbor has been a member of the Quality Transformation Network (QTN) of Children's Hospital Association since the project began in 2006. “Before joining the program, we had one central line-associated bloodstream infection (CLABSI) a month,” says Matthew Niedner, M.D., director of quality and patient safety at the PICU. “The rate has generally dropped to a third of what it had been. But statistics are the floor of what we have saved; participation in QTN has had so many more far-reaching benefits. “QTN is much more than just health care professionals working on a specific problem,” he says. It’s teaching, learning and understanding improvement science—learning how to get better at getting better.” Willingness to Embrace Change “Participation in QTN improved awareness of the ways routine practices fail to be met every day,” he says. “The program meant moving to an agreed standard. This involved a change in mindset. Our nurses and doctors had all trained at different periods. The big challenge was to take people with deeply ingrained patterns of practice and modify behavior for current best practice; it required creating a culture that was ready to embrace change.” “The program changed the teamwork and safety climate in the PICU,” Niedner says. “This was a conscious, deliberate direction. Being in QTN created the opportunity and gave skills and insights needed to do a lot of good things. But you don’t automatically get the benefits. You get the opportunity.” Fortunately, the Mott QTN project enjoys wholehearted top-to-trenches support. “The administration looks at bloodstream infection rates and asks, ‘How can we help you fix the problem?’ Then they engage meaningfully in the work,” Niedner says. “They don’t just say, ‘Give us a report.’” Advantages of Membership: Transparency, Advice, Information “Every participant in the network can see everyone else’s data; units identify with other teams,” Niedner says. “I talk with half a dozen units, and we look at data. Also, we have thoughtful discussions about defective data collection and other problems.” Quality Transformation Network Case Studies Page 1 of 2 The transparency principle of QTN “has increased the comfort level of showing others your defects to help fix them, instead of hiding them,” he says. “The goal is teamwork that transcends institutions. Let’s not compete on safety.” QTN tools to help members seek and share advice include meetings, webinars and a Listserv. “The Listserv is helpful for a variety of queries,” Niedner explains. “For borderline cases that barely meet the CDC definition, a Listserv query can ask, ‘Would you call this a CLABSI at your institution?’ There are also nuts-and-bolts questions: ‘Are others having the same problems as we are with such-and-such brand of vascular assistive device?’ With so many units on the Listserv, someone is likely to have an answer.” The network offers opportunities for communicating and for mentoring. For example, within the three PICU cohorts (started in 2006, 2008 and 2009), when there is a turnover in a team’s membership, the newcomers can connect with people who have been in the cohort for awhile. Transparency Within the Hospital Taking a page out of the QTN's playbook, the Mott PICU was a pioneer within the University of Michigan group regarding transparency on adverse events. “Publishing our performance metrics publicly, posting them in the entryway to our ICU, involving families in root cause analyses—all these things have helped our institution become more comfortable with the idea of transparency,” Niedner says. Further, he says, “These practices engender trust. They show that we recognize threats in the care environment. It also empowers patients and families to speak up about concerns, and it creates greater accountability.” Quality Transformation Network Case Studies Page 2 of 2