Creating a Culture to Foster Understanding, Quality and Safety

1. Creating a Culture to Foster Understanding, Quality and Safety Michael Spigel, MHA, PT EVP/COO Brooks Health System

2. Brooks Health System • Major provider of Post-Acute Care services through: • Brooks Rehabilitation Hospital – Nations 5th largest freestanding Inpatient Rehabilitation Hospital • Brooks Home Care Advantage – Average daily census over 700 patients, average age 75 • Brooks Skilled Nursing Contract Services – Services to “short-stay” patients and long-term care residents • Brooks Rehabilitation Specialists – “Hospital-Based” Physiatrist’s Practice • Brooks Rehabilitation Network – 27 Outpatient Therapy Centers, delivering over 200,000 visits annually

3. Broad Characteristics Post Acute Care Services • Over 35% Medicare beneficiaries require some level of PAC following acute hospitalization • Origination of Care • Over 48% of Medicare beneficiaries requiring PAC services require more than one PAC service within a 60-day “episode” • Medicare is dominant payer for all post-acute care services • SNF – about 80% • LTACH – about 90% • Home Health – about 70% • Inpatient Rehabilitation – about 65%

4. Catalyst for Change • Increasing scrutiny by CMS of Post-Acute Services • Regulatory changes that would dramatically alter types of patients admitted to hospital from lower complexity to high complexity • Hospital re-design from a traditional, functional model to a programmatic structure centered around five distinct patient populations with a triumvirate leadership model • Identified and deconstructed myths, misinformation, knowledge gaps prevalent among staff • Honest discussions about variations in care…

5. Change • Created a common definition • Quality would be defined as safety, “patients should not get worse from our care” • Outcomes would be defined as what the patient expected from us, the output of our effort • Value would be defined as what those who pay expect from us • Changed the way we measured and communicated our performance • National benchmarks would be a data point, not a target • Established our targets based on the level of our ‘aspiration’, which would coincidently, be best for our patients • In collaboration with hospital Board of Directors, reformatted Board meetings to prioritize discussion on quality, outcome and risk indicators

6. Looking Back…. • Creation of a common language and definitions • Equalizing our internal conversations • Perseverance through the “justification phase” • Use of National Benchmark as data points • Developing metrics and agreement on what data source would be the ‘single point of the truth’ • Aspirational goal setting • All patient feedback is good feedback • Understanding of our role within a system of care