Exceptional Value The "New" (Old) Quality & Safety

1. Exceptional ValueThe "New" (Old) Quality & Safety Bob Pendleton, MD Associate Professor of Medicine Chief Medical Quality Officer University of Utah Healthcare

3. U.S. Healthcare Performance Scorecard LAST in OECD in mortality amenable to healthcare 17% thirty-day readmission 440,000 die a preventable healthcare related death each yr. 1:2 patients do not receive basic recommended care $210B wasted annually on unnecessary services Average clinical LOS 5% hospitalized patients will have a medication related adverse event Diagnostic Errors are most common cause of medical errors Wachter RM. Understanding Patient Safety (2012). & McGlynn et al. N Engl J Med 2003; 348:2635-2645; Health Affairs (2008); 27(1): 58-71. The Institute of Medicine (IOM). 2010. The Healthcare Imperative. Therani et al BMJ QualSaf (2103( doi:10.1136/bmjqs-2012-001550.

4. U.S. Spends Most $ on Healthcare of OECD $8,047/person in 2009 19.5% of GDP by 2017 (?) *17.2% in 2012

5. Physicians Police Thyself Medical Licensure Board Certification Peer review M&M Conferences You can’t improve what you don’t measure. Subjective, implicit, focus on outliers 1992 2003 Objective, explicit, move the mean System & Provider Attributable Performance

6. CGCAHP Or Press Ganey HCAHPs Flow (e.g. ED Measures) Hospital Acquired Complication patient access Safety Event Reports utilization appropriateness Patient Safety Indicator (PSIs) SERVICE (S) readmissions SAFE (Q) EFFICIENT (Q) LOS CDC: Hospital acquired Infections mortality VALUE clinical outcomes COST ($) EFFECTIVE (Q) Patient Reported Outcomes EQUITABLE (S) process measures VALUE Measuring Value…

7. Perspective… Died Fall Hip Fracture Mortality Back in Hospital Unplanned Readmission Med Error Poor Handoff Meaningful Use HCAHPs Poor Pain Mgt Foley Not DC CA-UTI SCIP Fallout Hospital Acquired Infxn HCAHPs

8. Who is to blame? System Individual

9. You are at risk of poor choices…. If you are… Hungry/distracted Angry/emotional Late/hurried Tired/fatigued HALT!

12. UUHC: Nationally Ranked Outcomes 1 *Ranking out of >98 National Academic Medical Centers 4 7 9 37 50 20082009 2010 2011 2012 2013 * UHC Quality & Accountability Annual Scorecard

13. % of Providers at 99%tile National Rank % of total providers Medical Practice Survey – providers must have n=30 returned in calendar year National Rank – compared against Press Ganey database: 128,705 physicians

14. What We Expect… • Know your Limits…ask for help • Follow/create Standard work • Communicate, Communicate, Communicate • Value the expertise of the Team • Report errors…you see our opportunities

15. What We Expect… Hospital Acquired Infections Care Transitions- Readmissions Process Measures of Care Communication & Pain Mgt.

16. What We Expect… Pain Management & Patient Safety • ASSESS BASELINE • Pain expectations • Home medications • ASSESS RISK • Correct Patient, Correct Regimen • Avoid multiple short-acting medications • Proper dosing interval • Proper conversion or tapering • ENGAGE WITH EMPATHY • Collaborate with nursing, pharmacy, social workers • Integrate expectations for pain within recovery

17. Exceptional value is our journey and not just a destination.