Performance improvement webcast harnessing data for powerful performance

1. Performance improvement webcastharnessing data for powerful performance For the Donation and Transplantation Community of Practice August 19, 2014 1:00 PM – 2:30 PM ET

2. Planning committee members • Dina Steinberger, MPH, PA-C – Co-Chair Program Director for Performance Excellence, University of Wisconsin Organ Procurement and Transplant Service Line • Lori Brigham – Co-Chair President and CEO, Washington Regional Transplant Community • LeAnn Swanson, MPH Executive Director, Organ Donation and Transplantation Alliance • Teresa Beigay, DrPH Director of Special Initiatives, HHS/HRSA/HSB/Division of Transplantation • Roxane Cauwels, BSN, MBA DTCP Consultant, Organ Donation and Transplantation Alliance

3. presenters • Lori Brigham President and CEO, Washington Regional Transplant Community • Dina Steinberger, MPH, PA-C Program Director for Performance Excellence, University of Wisconsin Organ Procurement and Transplant Service Line • Robert Glazner Donor Program Data Intelligence Supervisor, Donor Network of Arizona • Kevin O’Connor President and CEO, LifeCenter Northwest

4. objectives • Learn how to objectively analyze data to increase organ utilization • Provide a forum for learning about performance improvement approaches that other organizations have successfully put into practice • Share methods that effectively link quality and performance improvement into day-to-day operations

5. AOPO Survey Results: Current OPO Practice in Identifying Potential Donors Beyond the Definition of Eligible Dina Steinberger, PA-C, MPH Program Director for Performance Excellence UW Health Organ Donation and Transplant Service Line Performance Improvement Webcast August 19, 2014

6. Challenges Across the Nation: Donors, Transplants and Patients Waiting 123,178 waiting list candidates as of 08/05/2014 Based upon OPTN year-end data provided on 08/05/2014. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

7. Major National Increases in NumberOf Organ Donors Per Year

8. “Once you SEE it, you can IMPROVE it.” -Anonymous

9. Survey Background • Widely recognized that the Eligible definition does not capture all “Potential” Donors • AOPO conducted a survey to better understand what OPOs are currently doing • 20 Question Survey distributed July 2014 • Understand if OPOs are collecting data on Potential Donors Beyond Eligible, • And if so, what are they collecting?

10. AOPO Member Survey Results 58 55 51 51 51 (95%) (93%) (92%) (92%) (82%)

11. Three Major Categories of Potential

12. OPO Upper Age Limits (in years) for the 3 Major Groups of Potential: Declared Brain Dead, Consistent with Brain Death, and DCD Number of OPOs

13. Breakdown of OPO Time Limits (in minutes) from Extubation to Asystole for Potential DCDs

14. Number of OPOs Tracking these Outcomes within each of the 3 major groups of Potential: Declared Brain Dead, Consistent With Brain Death, and DCD

15. Preliminary 2013 Data from 11 OPOs 2227

16. Preliminary 2013 Data from 11 OPOs 2227

17. Preliminary 2013 Data from 11 OPOs 3623 (+1396) 2227

18. Preliminary 2013 Data from 11 OPOs 3623 (+1396) 2227

19. Preliminary 2013 Data from 11 OPOs 4706 (+2479) 3623 (+1396) 2227

20. Preliminary Aggregate Data from 11 OPOs2013

21. Impact of Potential Donor Data -“It has provided an excellent way to expand our hospitals perspective on donation potential besides the brain dead opportunities.” -“It opened our eyes to what our real potential donor population was and also showed us how under-performing we really were.” -“It adds a level of accountability and consistency by giving these patients a label…it validated them and uncovered countless opportunities to study various aspects of the donation process. We have shared this new data with all of our hospitals and it is standard on our dashboards. The hospitals have subsequently increased their accountability for every opportunity, every time…it lifts the veil on how they are actually performing.”

22. Key Points • Most OPOs are collecting data on Potential Donors Beyond the Definition of Eligible • While Methodologies and Definitions vary somewhat between DSAs, there are also a lot of similarities (a good starting point) • Preliminary data indicates a significant number of Potential Donors Beyond Eligible

23. Next Steps • Collect outcome data from all participating OPOs • Examine similarities and differences in definitions and methodologies. How close are we to a common approach? • Help to inform policy discussion around Total Potential on the local and national levels • Continue to leverage local performance improvement efforts with hospital partners based on existing Potential donor data

24. Translating Data Findings …into Practice How true donor potential is used to drive performance in an OPO Robbie Glazner Data Intelligence Supervisor Donor Network of Arizona

25. The Missing Link… ANALYSIS! …from gathering to reporting

26. “The goal is to turn data into information, and information into insight.” CarlyFiorina, former President and Chair Hewlett Packard Co

27. …“And the goal is not just insight, but action.” Sara Pace Jones VP of Development and Referral Services Donor Network of Arizona

29. Armed with data, we committed internally at every level to: • Consistently track data that is Real, Right and Relevant • Identify areas for improvement • Strategically partner with hospitals to share in our commitment to relevant process improvement metrics beyond those required for CMS compliance • Provide the right kind of reports to the right people

30. Data Findings

31. Beyond Eligible Analysis (Jan-Feb 2014) (Courtesy: OPTN Region 5 Donor Potential Study)

32. Non-Donor Analysis (Jan-Feb 2014)(Courtesy: OPTN Region 5 Potential Donor Study)

33. BD Analysis (2013 DNA)

34. Potential Donor Decline Analysis

35. Moving from Findings to Practice

36. DMAIC

37. Analysis

38. DMAIC – Insights into Action • After using Huddle Forms and conducting focus group sessions with physicians, the rate at which UMDs took place was reduced. • Key ingredients to a good huddle on every case: • Have open communication • Providing good language for family discussions • Huddle with more than one person at a time

39. DMAIC

42. Armed with data, we committed internally at every level to: • Consistently track data that is Real, Right and Relevant • Identify areas for improvement • Strategically partner with hospitals to share in our commitment to relevant process improvement metrics beyond those required for CMS compliance • Provide the right kind of reports to the right people

43. Data Analysis: Examining the Number of Organs Transplanted AnnuallyKevin O’ConnorPresident and CEOLifeCenter NorthwestSeattle, WA

44. Ken Price, double-lung recipient in 1994, at his donor’s gravesite in 2012

45. Data Sources:Scientific Registry for Transplant Recipients www.srtr.orgOrgan Procurement and Transplant Network www.optn.org

46. 2012 OPTN Strategic Plan:Six Key Goals1. Increase the number of transplants2. Increase access to transplants3. Improve survival for patients with end stage organ failure4. Promote transplant patient safety5. Promote living donor safety6. Promote the efficient management of the OPTN

47. 2012 OPTN Strategic Plan:Six Key Goals1. Increase the number of transplants2. Increase access to transplants3. Improve survival for patients with end stage organ failure4. Promote transplant patient safety5. Promote living donor safety6. Promote the efficient management of the OPTN

48. Ways to increase the number of transplants • Increase the number of donors • Living donation • Kidney paired donation • Donation after Neurologic Death (DBD) • Donation after Circulatory Death (DCD) – especially uncontrolled • Transplant more organs from existing supply • Change incentives and disincentives • Change allocation systems • Reduce discard rates (3967 organs discarded in 2013, over 2700 kidneys) • Improve quality of unacceptable organs – ex vivo organ repair • Improve communication and collaboration between stakeholders

49. Ways to increase the number of transplants • Increase the number of donors • Living donation • Kidney paired donation • Donation after Neurologic Death (DBD) • Donation after Circulatory Death (DCD) – especially uncontrolled • Transplant more organs from existing supply • Change incentives and disincentives • Change allocation systems • Reduce discard rates (3967 organs discarded in 2013, over 2700 kidneys) • Improve quality of unacceptable organs – ex vivo organ repair • Improve communication and collaboration between stakeholders

50. 2013 Record Highs Signified by: Record