1 / 55

Transforming Healthcare to Achieve High Reliability

Transforming Healthcare to Achieve High Reliability. Mark R. Chassin, MD, FACP, MPP, MPH President and CEO, The Joint Commission KalDer 22 nd Annual Quality Congress Istanbul, Turkey November 13, 2013. What is The Joint Commission?. Private and not-for-profit

lela
Télécharger la présentation

Transforming Healthcare to Achieve High Reliability

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Transforming Healthcare to Achieve High Reliability Mark R. Chassin, MD, FACP, MPP, MPH President and CEO, The Joint Commission KalDer 22nd Annual Quality Congress Istanbul, Turkey November 13, 2013

  2. What is The Joint Commission? • Private and not-for-profit • Roots go back to 1917: American College of Surgeons created first program to set standards for hospitals and inspect them • Hospitals and other health care organizations pay us to evaluate the way they provide care • Joint Commission customers (2013): • US: 20,000+ health care organizations • JCI: 600+ organizations in 59 countries

  3. Joint Commission US Customers Program2012 Ambulatory Care 2034 Behavioral Health 1987 Certification 2861 Home Care 6163 Hospitals 4454 Laboratory 1632 Long Term Care 974 Total 20,105

  4. What Does The Joint Commission Do? 1. Create and continuously update evidence- based safety and quality standards 2. Develop and deploy the most effective survey methods for onsite evaluation 3. Create and maintain most effective system of quality measurement in hospitals 4. We are also an improvement organization: creating and delivering quality solutions

  5. What Accreditation is Not • Accreditation is not a guarantee that: • No errors will occur • Preventable complications will never harm patients • High quality care will always be delivered to every patient • Accreditation cannot solve all our quality and safety problems

  6. 456 patients notified

  7. 141 patients notified

  8. Current State of Quality • Routine safety processes fail routinely • Hand hygiene • Medication administration • Patient identification • Communication in transitions of care • Uncommon, preventable adverse events • Surgery on wrong patient or body part • Fires in ORs, retained foreign objects • Infant abductions, inpatient suicides

  9. How Have Others Done It? “High reliability organizations” manage very serious hazards extremely well What do they all have in common? Highly effective process improvement Fully functional safety culture Discover and fix unsafe conditions early In health care, we most commonly react after patients are harmed

  10. High Reliability Science Research has defined how HROs produce sustained excellence over time No health care organizations function at this high level of sustained safety No guidance on how to transform organizations from low to high reliability We have created a roadmap for health care to get to high reliability

  11. High Reliability Healthcare Our team has learned a lot by working with experts from HROs in many fields (aviation, military, amusement parks) We have created a model for healthcare Leadership, safety culture, RPI New resources, tools, and strategies Some hospitals and systems are beginning to commit to the goal

  12. Joint Commission High Reliability Resource Center

  13. Milbank Q 2013;91(3):459-90

  14. Robust Process Improvement Systematic approach to problem solving: (RPI = lean, six sigma, change management) The Joint Commission has adopted RPI Improve processes and transform culture Focus on our customers, increase value The Joint Commission is adopting all components of safety culture We measure RPI and safety culture and report on strategic metrics to Board

  15. What Can RPI Help You Do? • In general, lean tools help identify wasted steps in processes that can be eliminated • Reducing time, saving money • 25% of nurses’ time to give medications • Six sigma tools focus on reducing the rate of unsatisfactory outcomes (or “defects”) • Reduce frequency of surgical infections • Improving pain management • Change management is always essential

  16. Center for Transforming Healthcare www.centerfortransforminghealthcare.org

  17. Center for Transforming Healthcare Using RPI together with leading US hospitals and health systems to solve most difficult quality and safety problems Project topics: 2009-10: hand hygiene, wrong site surgery, hand-off communications, SSIs 2011: safety culture, preventable HF hospitalizations, and falls with injury 2012: sepsis mortality, insulin safety 2013: C. difficile prevention

  18. Participating Hospitals Atlantic Health Barnes-Jewish Baylor Cedars-Sinai Cleveland Clinic Exempla Fairview Floyd Medical Center Froedtert Intermountain Johns Hopkins Kaiser-Permanente Mayo Clinic Memorial Hermann New York-Presbyterian North Shore-LIJ Northwestern OSF Partners HealthCare Sharp Healthcare Stanford Hospital Texas Health Resources Trinity Health Virtua Wake Forest Baptist Wentworth-Douglass

  19. Current State of Quality • Routine safety processes fail routinely • Hand hygiene • Medication administration • Patient identification • Communication in transitions of care • Uncommon, preventable adverse events • Surgery on wrong patient or body part • Fires in ORs, retained foreign objects • Infant abductions, inpatient suicides

  20. The Way We Do Improvement • Usual approach: best practices, toolkits, protocols, checklists, “bundles” • Typical best practice is “one-size-fits-all” • Can produce modest improvement • Difficult to get to zero • Difficult to sustain • The “one-size-fits-all” approach works well only for simple problems that do not vary • Toughest problems are not simple

  21. A New Way is Delivering Results Complex processes require more sophisticated problem-solving methods Three crucial and consistent findings: Many causes of the same problem Each cause requires a different strategy Key causes differ from place to place RPI = lean, six sigma, change management Producing next generation best practices Solutions customized to your causes

  22. Some Important Causes of Hand Hygiene Failures 1. Faulty data on performance 2. Inconvenient location of sinks or hand gel dispensers 3. Hands full 4. Ineffective education of caregivers 5. Lack of accountability  Each requires a very different strategy to eliminate

  23. Causes Differ by Hospital Each letter = one hospital

  24. Wrong Site Surgery • Joint Commission Universal Protocol 2003: a simple, one-size-fits-all best practice • Today: Best estimate = 50 per week in US • Center project found many more risks: • Scheduling: 39% of cases • Pre-op area: 52% of cases; 25% with multiple risks • OR: 59% of cases; 32% with multiple risks

  25. Risks of Wrong Site Surgery • Scheduling: incomplete data, verbal requests, lack of standardization • Pre-op area: missing documents, inadequate patient ID, time pressures lead to rushing, non-surgeon marks site, marking inconsistent, use of non-approved markers • OR: mark covered by drapes, distractions, time out performed without full participation, staff are not empowered to speak up, verification omitted with multiple procedures

  26. Risks of Wrong Site Surgery Vary By Organization scheduling Pre-op

  27. Reducing the Risks Hospitals and ASCs targeted specific interventions to the risks they uncovered Relative Risk Reduction Scheduling: 46% Pre-op: 63% multiple risk cases 72% OR: 51% multiple risk cases 75%

  28. Results are Consistent • More sophisticated improvement methods (RPI) required for complex problems • Identify specific causes and how they vary among different organizations • Target interventions to specific causes • Avoid “one-size-fits-all” solutions • Same findings for every problem tackled: wrong site surgery risk, SSIs, patient falls • This is the Center’s unique capability

  29. Targeted Solutions Tool (TST) Web-based tools: secure extranet channel Educational, no jargon, no special training Guides users to customized, proven solutions Targeting only your causes means you don’t use resources where they aren’t needed 2010: hand hygiene: 2012: wrong site surgery and hand-off communication Pilot tested hand hygiene internationally; working to make available to JCI hospitals

  30. Hand Hygiene TST: 3 Years • 849 projects are using interventions • Baseline = 58% (n = 110,255)* • Improve = 84% (n = 584,025)* • UnitBaselineImprove • Adult critical care 62% 80% • Emergency dept. 51% 80% • Adult med-surg 51% 84% • Long term care 61% 86% • 20% have improved to greater than 90% *p<0.0001

  31. Healthcare-associated Infections (HAIs) are an Enormous Quality Problem ...and cost many billions HAI Mortality rate = 5.8% 99,000 $28-34 billion HAIs occur frequently... Patient deaths attributable to HAIs (US) Costs of HAIs per year in the US 1,700,000 Documented cases of hospital HAIs annually (US) Hand hygiene failure is a major contributor to HAIs Source: Klevans et. al . Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep (2007); 122(2):160-166; CDC "The Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Prevention," R. Douglas Scott II, March 2009

  32. Improving Hand Hygiene Reduces HAIs Hand hygiene affects all HAIs • C diff, MRSA, other MDRO • Urinary tract (CAUTI) • Central line (CLABSI) • Ventilator pneumonia (VAP) • Average TST improvement • 35% drop in HAIs • Impact is substantial

  33. Using the TST Prevents HAIs, Saves Lives, and Avoids Millions in Costs ...saving thousands of lives2... 1,450 Hospitals using the TST have prevented tens of thousands of HAIs1 Lives saved by hospitals using the Hand Hygiene TST 25,000 ...and saving hundreds of millions of dollars in direct medical costs Number of HAIs prevented by hospitals using Hand Hygiene TST $300-650 million Costs saved by use of the TST Hand Hygiene tool Over 250 organizations have employed the TST Hand Hygiene tool to reduce the risk of HAIs in their facilities (1) Ranges from 18,000 – 30,500 (2) Ranges from 1,050 – 1,800 Note: Impact estimates through the end of 2012; Includes 196 organizations using the TST since May of 2010 with >100 observations; Impact estimates exclude ambulatory care facilities employing the TST Source: The Center for Transforming Healthcare TST user survey, BCG analysis

  34. Impact of TST on Typical US Hospital 300 Beds 600 Beds Expect 1100 HAIs/yr Annual impact: 388 fewer HAIs 24 lives saved $7.5M cost avoided TST improves HH, reduces HAIs by 35% • Expect 555 HAIs/yr • Annual impact: • 194 fewer HAIs • 12 lives saved • $3.7M cost avoided

  35. Used TST to achieve >95% hand hygiene compliance Bloodstream infections fell by 2/3

  36. C. Difficile Rate Declines as Hand Hygiene Improves Hand Hygiene Compliance (%) C. difficile Cases (per 1000 patient days)

  37. C. Difficile Rate Declines as Hand Hygiene Improves Hand Hygiene Compliance (%) C. difficile Cases (per 1000 patient days)

  38. MRSA Rate Decreases as Hand Hygiene Improves Hand Hygiene Compliance (%) MRSA Cases (per 1000 patient days)

  39. MRSA Rate Decreases as Hand Hygiene Improves Hand Hygiene Compliance (%) MRSA Cases (per 1000 patient days)

  40. Memorial Hermann’s Story: Getting to Zero • 12 hospital system in Houston • Leadership committed to high reliability • Embarked on culture change initiative • Participated in CTH hand hygiene project • 2010: MH committed to use TST to improve hand hygiene throughout their system • Baseline (150 inpatient units) = 44% • Range (12 hospitals): from 23% to 65% • Aim: to exceed 90%

  41. Jt Comm J 2013;39(6):253-57

More Related