Quality Improvement in Health Care

1. Nationwide Children’s Sheilah Harrison September 2011 Quality Improvement in Health Care

2. Presentation Overview • My Journey • Nationwide Children’s Hospital (NCH) • Background • Quality Goals • Quality Improvement Services • Heart Center • Quality Improvement Coordinator • Key Measures • Quality Improvement Tools • My Observations on Health Care • Personal Goals to Achieve Success

3. My Journey • Credentials • B.S. Industrial & System Engineering (BS I.S.E.) • Project Management Professional (PMP) • Industry Exposure • Internship at OSU Medical Center • Supervisor in Retail Warehousing • Supply Chain Engineer in Telecommunications • Medical Device Manufacturing • “Offshoring” Financial Processes • Chemical Supply Chain Project Management • Medicaid Project Management in Government • Health Care Quality Improvement

4. Nationwide Children’s Hospital • ~1000 Medical Staff • 7200+ Employees • 124 Specialties on Main Campus • 28 Outpatient Care Centers • 18,472 Discharges • 18,873 Surgeries • 914,456 Outpatient Visits

5. NCH Quality Goals Hospital Acquired Infections • Eliminate Preventable Harm* • Event Reporting System • Non-Punitive Huddles • Preventable Harm Indices • Focus on Numerator Surgical Site Infections Serious Safety Events Medication Errors Pressure Injuries Non-ICU Cardiac Arrests Falls * A condition/event has the potential of being placed upon the Hospital’s Preventable Harm Index (Index”) when the condition/event occurs as the result of a variation from a “best,” and/or “expected” practice.  Such variation of practice does not necessarily equate to a standard of care definition.

6. NCH Quality Improvement Services (QIS) • Organization consists of: • Service Line Coordinators • Clinical Quality • Decision Support • Accreditation • Patient Satisfaction and Grievances

7. Quality Improvement Tools

8. Quality Improvement CoordinatorHeart Center • Monitor and Report on Patient Safety Measures • Manage 10 Blue Chip Goals • Support 40 Others • Facilitate Interventions for Improvements to Patient Care   • Assist Heart Center with migration to standard for measuring quality • Introduce quality tools and terms • Control Charts • Aim statements / Key Driver Diagrams • Baseline data

9. Key Quality MeasuresThe Heart Center • NCH Quality Strategic Goal“Do Not Harm Me” • Central Line Associated Blood Stream Infections • Adverse Drug Events • Prevention of Pressure Ulcers > Stage II THE HEART CENTER STRATEGIC QUALITY GOALS • Improve Chronic Care of High Risk CHD Infants • Optimizing Nutritional Needs for Patients with Congenital Heart Disease • Reduce Mortality and Morbidity in CHD Patients • Blood Conservation in the OR • Anticoagulation Protocol for Post Stage II Hybrid Patients • Create Seamless Hand-offs • OR to Cardiothoracic ICU • Cardiothoracic ICU to Step-Down Unit • Non-Invasive Cardiology Lab to Inpatient Units

10. My Observations of Health Care • Organizational charts • Hard to obtain • Have numerous dotted lines • Absence of clinical project management • Accountability is distributed • Physician support is familiar requirement • Comprehensive patient charts but challenges with trend analysis

11. Personal Goals to Achieve Success • Largest endeavor is to seek trust from staff • Need to create allies that have focus on quality • Need to admit my skill deficiencies • Need not turn away opportunities to help others • Creating strong relationships with physicians • Ensure ideas and tasks have owners • Educate staff with Project Management tools • Address Change Management • Identify areas where data collection can be automated • Model new processes with strawmen

12. Example Communication Dr. Smith: So, I have some questions about the Anti-Coagulation protocol for post-Comprehensive Stage II patients.  I hardly understand the subject matter, but I want to spur conversation among you, Dr. Jones, and any others, so we can further improve our Aim/Driver Diagram.  I think Dr. Jones talked with you about one or more of these questions, but I haven’t heard the conclusion. Should we specify when it is important to monitor fractionated Xavs unfractionated Xa? Should we add TEG evaluation as a key parameter in this document? What information does the D-Dimer count provide, particularly if we do add TEG evaluations? Thanks! Sheilah Harrison, PMPQuality Improvement Coordinator | Heart Center | Nationwide Children’s HospitalTel: 614-722-3198sheilah.harrison@nationwidechildrens.org

13. Quality Improvement in Health Care QUESTIONS?