Thomas Kelley, MD Chief of Quality and Transformation Orlando Health

1. Leading the Way to Better Care: Florida’s Quality Journey Thomas Kelley, MD Chief of Quality and Transformation Orlando Health

2. Session Overview • Describe how Florida’s hospitals worked together to significantly improve care while reducing costs across the state. • Identify the key lessons learned over the five years Florida’s hospitals worked together to reduce readmissions, complications, and infections. • Develop actionable steps for collaboration around quality improvement in their own state.

3. A Look Back: Florida Healthcare Quality Five Years Ago Florida hospitals were the target of criticism for poor health outcomes and high costs compared to hospitals in other states.

4. A Look Back: Florida Healthcare Quality Five Years Ago • Performance based on: • CMS Core Measures • Infection Rates • Mortality Rates • Patient Experience • Management of Chronic Conditions Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports

5. Goal: Improve Care Together Reduce patient harm Tackle high-impact areas Build a better reputation nationally and improve our results Reduce costs Save lives, prevent complications, and help patients return home sooner and stay home

6. Collaborating to Improve Quality • Under the leadership of the 239 member association, hospitals made a commitment to improve care, save lives and lower costs through: • shared successes and failures • the knowledge of experts • the latest evidence-based best practices • a community of trust, communication and collaboration

7. Collaborating to Improve Quality • Why did hospitals choose to work through the Florida Hospital Association? • Provided opportunities for hospitals to work together verses independently • Dedicated staff; provided structure • Resources to effect improvement

8. Florida’s Results: Making a Difference Statewide Surgical Complications Urinary Tract Infections Blood Stream Infections Readmissions 41% 37% 15% 14.5% $15.9 million cost savings $25 million cost savings $6.67 million cost savings

9. The Power of Collaboration:Reduce Readmissions • The Process • Identified critical information needed to transition a patient to different levels of care. • Worked with state agencies to modify existing patient hand offs to ensure smoother transitions. • Explored standardized discharge orders and patient education. • FHA collaborated with: • Agency for Health Care Administration • Florida Association of Directors of Nursing • Florida Department of Elder Affairs • Florida Medical Directors Association • Florida Orthopedic Society Florida was first state to use published “potentially preventable” readmission rates for all hospitals. For the first time, hospitals had meaningful data readily available.

10. The Power of Collaboration:Reduce Readmissions • What We Learned • Data were critical to understanding the problem and identifying barriers • Multi-faceted issue that requires sustained coordination and partnership among hospitals, health plans and other caregivers FHA also worked with the state’s largest health plans to: • understand plan services to help keep people out of the hospital • establish standard methodology for measuring readmissions • explore principles for payment alignment

11. Collaborative on Readmissions • THE FACTS • 107 participants statewide • First to publicly report readmissions rates by hospital • First statewide readmissions program What Florida Did to Reduce Readmissions • Improved discharge instruction • Improved handoff communication • Scheduled follow-up visits • Evaluated end-of-life care

12. Orlando Health: Readmissions Results

13. Improving Surgical Care: Florida Surgical Care Initiative • The Process • Hospitals collected information on patient’s condition prior to operation • Qualified surgical reviewers tracked outcomes 30 days after procedure • Hospital staff called patients as a follow-up Largest statewide surgical collaborative in the nation • 67 hospitals statewide • Piloted in partnership with Florida Hospital Association, American College of Surgeons with support from Florida Blue • Focus on high-impact areas, including surgical outcomes for elderly patients and surgical site infections

14. Improving Surgical Care: Florida Surgical Care Initiative • THE FACTS • 67 hospitals statewide • Piloted in partnership with Florida Hospital Association, American College of Surgeons with support from Florida Blue Preventing Patient Harm • Pilot extended with additional data collection options • Monthly educational meetings focus on topics such as surgical site infections • Continuous shared learning opportunities

15. Reduce Bloodstream and Urinary Tract Infections & Improve Hospital Culture On the CUSP: Stop BSIs and Stop CAUTI • THE FACTS • The On the CUSP initiative launched in 2009 • Engaged 69 units in 35 hospitals in the CLABSI program • Engaged 21 units in 10 hospitals in the CAUTI program • 16 NICUs participated in the Perinatal Quality Collaborative • Florida was one of initial states to participate • Partnership with HRET • Focused on building culture of quality, improving best practices and appropriate use of catheters

16. Orlando Health: CAUTI Results

17. The Tools: CLABSI Top Ten Checklist

18. Orlando Health: CLABSI Results

19. Florida’s Quality JourneyPhase II

20. Eliminating Harm Harm Prevention HRET-FHA Hospital Engagement Network 1,135 Cases of Harm Prevented • THE FACTS • 77 hospitals collaborating, sharing resources and best practicesExtensive education and training programs • Strong leadership engagement and support • Topic specific listservs • One-on-one coaching and support • Tracking monthly progress • Florida hospitals are actively working on improvement initiatives in ten focus areas through this collaborative. • Goal is to reduce patient harm by 40% and readmissions by 20%.

21. Orlando Health: HEN Results

22. Ensure a Safe Reporting Environment & Foster Sharing • PSOFlorida provides an environment where hospitals and physicians may submit data on medical errors and mistakes, learn evidence-based best practices drawn from state and national patient safety data and share insights with peers • Learning and discussion is facilitated through webinars, protected websites, newsletters and research.

23. Five Years Later: We’ve Moved the Needle 2011 Source: Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports 23

24. Lessons Learned • It is possible to achieve statewide improvement, in a state as diverse as Florida • Focusing on improving quality in specific areas of care can lead to meaningful progress • Quality care can cost less • Collaboration among hospitals is the additive that accelerates quality gains • Culture is integral to improving quality • Data are critical to understanding the problem, tracking progress • Partnerships extend quality efforts and increase learning • Greater opportunity ahead by expanding collaboratives to include pre- and post-acute networks

25. Quality Remains the Top Priority • Sustained Board of Trustee Engagement • Focused on statewide data to understand how Florida compares to other states • Identified champions to provide leadership • Refined “advocacy” role to emphasize quality and patient safety • Established a Quality Committee dedicated to promoting improvement in clinical outcome strategies

26. Partners

27. What’s Ahead • Refine data measurements • Expand number of hospitals participating • Sustain improvement

28. Contact Information and Resources Florida Hospital Association 306 East College Avenue Tallahassee, Florida Phone: (850) 222-9800 Fax: (850) 561-6230 www.fha.org Thomas Kelley, MD Chief Quality and Transformation Officer, Orlando HealthThomas.Kelley@orlandohealth.com FHA Five Years of Quality Report: www.fha.org/quality