Presenter NAME Presenter TITLE Presentation DATE

1. Presenter NAME Presenter TITLE Presentation DATE INSERT Hospital Logo Here

2. What is the MHA Keystone Center? • An innovative nonprofit center created by Michigan hospitals and the Michigan Health & Hospital Association (MHA) in March 2003 • Leading by example: hospital participation is voluntary • An element of MHA’s three-part Quality and Accountability Agenda — the other elements being MI Hospital Inform websiteand the MHA Patient Safety Organization (PSO) • Funded by Michigan hospitals, the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan, and federal and state grants • Located at MHA headquarters in Lansing • First of its kind anywhere

3. What Does the MHA Keystone Center Do? • Improves patient safety by reducing/eliminating preventable harm • Improves the quality of health care • Reduces health care costs and hospital stays • Instills a culture of safety, collaboration and mutual respect for all members of a hospital’s caregiving team

4. How Does the MHA Keystone Center Do It? • Brings together hospitals, state and national patient safety experts, and evidence-based best practices to improve patient safety and the quality of care • Uses the collaborative model for transformational change, based on the “Four E’s” of Engage, Educate, Execute and Evaluate • Assembles large numbers of hospitals into a single improvement initiative • Focuses on improving organizational culture using change principles and behavioral science

5. MHA Keystone Center Initiatives • MHA Keystone: Intensive Care Unit (ICU) — 2003 • MHA Keystone: Gift of Life — 2003 • MHA Keystone: Hospital-Associated Infection (HAI) — 2007 • MHA Keystone: Surgery — 2007 • MHA Keystone: Obstetrics (OB) — 2008 • MHA Keystone: Emergency Room (ER) — 2008

6. MHA Keystone: Intensive Care Unit (ICU) The Challenge: • There are nearly 250,000 central-line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs) that occur in ICU patients each year in the United States. • CLABSI and VAP cases lead to longer hospital stays, increased health care costs and a greater risk of patient death. The Response: • Established in 2003 to improve the delivery of care and reduce medical errors in ICUs • Over 18 months, CLABSIs dropped 66 percent • Nearly half reported zero bloodstream infections or VAPs • 2004-2010:More than 1,800 lives saved; 140,700 hospital stay days avoided; more than $300 million in health care dollars saved • U.S. Health and Human Services Secretary Kathleen Sebelius has called Michigan hospitals “one of the leaders” in lowering rates of hospital-associated infections • Featured during the past year by the Cable News Network (CNN), the British Medical Journal, BusinessWeek, Detroit Free Press, Ann Arbor News, Crain’s Detroit Business, andother state, national and international media • Remains the most successful regional partnership of ICUs ever assembled in a single patient safety initiative

7. MHA Keystone: Hospital-Associated Infection (HAI) The Challenge: • HAIs account for an estimated 1.7 million infections each year, resulting in 900,000 deaths nationally • $6.65 billion in national health care costs The Response: • Launched in 2007 to eliminate HAIs — CLABSIs and catheter-associated urinary tract infections (CA-UTIs) • Nearly 120 participating hospitals in MHA Keystone: HAI • Indwelling catheter use reported by 33 participating hospitals reduced from 19 to 14 percent between January 2007 and March 2010 • Reporting hospitals saved an estimated 5,200 unnecessary hospital days and $5 million in avoided costs.

8. MHA Keystone: Gift of Life The Challenge: • Thousands of organs are needed to improve or save lives • Donations include pancreases, hearts, lungs, livers, intestines, heart valves, veins, tendons, bones and corneas The Response: • Conversion rate rose from 77 percent in 2008 to 82 percent in 2009 • In 2009, 21 Michigan hospitals achieved and surpassed the 75 percent conversion rate • 288 organ donors, 864 organs transplanted in 2009 • Michigan hospitals’ overwhelming success continues to position them as national leaders • Donor Drive 2010 has increased Michigan Organ Donor Registry sign-ups by 30 percent over 2009

9. MHA Keystone: Surgery The Challenge: • About 320,000 surgeries in Michigan annually • 5% have complications (national estimate) • Mortality rates about 5% when complications arise • Complications add about $250 million in health care costs (in Michigan) The Response: • Eliminate surgical-site infections • Eliminate mislabeling of specimens • Prevent defects in care • Improve culture of safety • Briefings before/after surgery — 443,000 conducted since fall 2007 • Best practices being implemented • More than 100 participating Michigan hospitals

10. MHA Keystone: Obstetrics (OB) The Challenge: • Three injuries occur in every 1,000 births in the United States The Response: • Eliminate preventable harm to mothers giving birth and their newborn babies in Michigan hospitals • Pilot launched in September 2008 at 16 Michigan hospitals and expanded in fall 2009 to most Michigan birthing hospitals • Focus on induction management, labor management/fetal heart monitoring, culture of safety • Apgar scores improved by nearly 51 percent at pilot facilities • Elective inductions before 39 weeks fell to 7 percent from 20 percent, and elective cesarean sections before 39 weeks fell to 6 percent from 24 percent

11. MHA Keystone: Emergency Room (ER) The Challenge: • More people are seeking care in Michigan hospital ERs (cuts to Medicaid and Medicare, more people without health insurance) The Response: • Prevent harm to ER patients by reducing boarding/overcrowding and wait times using evidence-based best practices • Pilot announced in fall 2008 at three Michigan hospitals and expanded statewide in 2009 • Train-the-trainer regional workshops held and a branded Lean facilitator’s guide designed specifically for hospitals • Preliminary results to be available in 2011.

12. MI STA*AR OPTIONAL SLIDE Michigan STate Action on Avoidable Rehospitalizations (MI STA*AR): • Pilot program launched in partnership with MPRO, Michigan’s quality improvement organization, in 15 Michigan hospitals in 2009, in addition to hospitals in Washington and Massachusetts • The goal is to reduce 30-day rehospitalization rates by 30 percent and increase patient and family satisfaction • Standardized data on individual rehospitalization rates has allowed hospitals to implement focused interventions and form cross continuum teams • Second cohort to begin March 2011

13. On the CUSP: StopHospital-Associated Infection (HAI) OPTIONAL SLIDE On the CUSP: Stop Bloodstream Infection (BSI) • MHA Keystone: ICU collaborative model expanded to 10 additional states in February 2009 aiming to reduce the average rate of CLABSIs in hospitals by 80 percent • By July 2010, 698 hospitals in 30 states participating • First two cohorts have reduced CLABSIs by 30 percent On the CUSP: Stop Catheter-Associated Urinary Tract Infection (CA-UTI) • CA-UTIs account for 35 percent of HAIs • On the CUSP: Stop CA-UTI launched September 2010 with hospitals in 10 states participating • Goal to reduce CA-UTI rates by 25 percent over two years

14. MHA Keystone: ICU “Business Case For Quality” OPTIONAL SLIDE The Challenge: • Compare the costs of implementing an MHA Keystone: ICU improvement initiative with the generated financial savings The Response: • Cost-benefit analysis was used for six Michigan hospitals that had participated in MHA Keystone: ICU since its inception • The study, which has been submitted for publication, suggests that initial estimates of cost savings were significant, even when calculated conservatively • Therefore, implementation of the MHA Keystone: ICU program holds considerable return on investment for hospitals

15. Questions For more information about the MHA Keystone Center: Sam R. Watson Executive Director (517) 323-3443 • swatson@mha.org Media questions should be directed to: Kevin Downey Director, Public Affairs (517) 703-8601 • kdowney@mha.org www.mhakeystonecenter.org