Aligning Forces for Quality: Taking the Next Steps

1. Aligning Forces for Quality: Taking the Next Steps General Overview Presentation Stephanie Sobczak, MS, MBA WHA Manager of Quality Improvement May 1, 2009

2. The Beginning of AF4Q • The initial Robert Wood Johnson Foundation’s Aligning Forces for Quality Initiative focused on three complementary strategies to advance the quality of chronic care provided in physicians’ offices, clinics, and other outpatient settings. • Helping health care providers measure and publicly report their performance; • Helping health care providers improve their own ability to deliver quality care; and • Helping patients and consumers understand their role in recognizing high-quality care. • In 2007, the Robert Wood Johnson Foundation offered the Wisconsin leaders the opportunity to extend the project through April 30, 2011, expanding the focus to acute care.

3. Robt. Wood Johnson’s Changing Approach • RWJ has made a strategic shift away from funding national initiatives and narrowly defined studies to a focus on collaboration between regions and local communities • Wisconsin is just one of three communities (out of 14 nationwide) taking a statewide approach • RWJ gives enormous flexibility to communities and values creativity and innovation • Wisconsin will leverage a “pull” strategy and focus on working with healthcare organizations with a strong interest in the key priorities of Aligning Forces for Quality

4. AF4Q National Areas of Focus “How-to” of quality improvement Language matters Increasing consumer engagement Robert Wood Johnson Foundation Addressing equity Increasing public reporting Nurses leadingthe way on quality

5. Improving Care Across the Continuum “How-to” of quality improvement Focus on better ways to coordinate quality improvement services, and share lessons learned and best practices to increase knowledge and deliver lasting change Increasing consumer engagement Help all stakeholders – consumers, patients, providers, health plans, and employers – understand how better information can improve the quality of care and help consumers take an active role in their own care and make informed choices.

6. Improving Care Across the Continuum Increasing public reporting Support work that explores how to structure and provide reporting systems that resonate with consumers and providers while rewarding high-quality care. • Transparency in the measurement process so both doctors and patients can trust the data • Consumer and provider input into the process to help ensure information is meaningful to consumers and fair to doctors • Help providers improve their own ability to deliver care • Help patients and consumers understand their vital role in recognizing/demanding high-quality care

7. Improving Care Across the Continuum Nurses leading the way • Engage nursing staff, and other bedside care givers, to improve the quality of patient care • Improve the organization of work and use of information technology to increase quality and efficiency • Examine the physical design of hospitals to improve patient satisfaction and quality of care • Build leadership among nurses to create quality improvement champions on the frontline and executive levels of nursing

8. Improving Care Across the Continuum Addressing equity Implement specific efforts aimed at reducing, and eventually eliminating, disparities in care especially those from certain racial and ethnic backgrounds Language matters Ensure that people in all communities with limited English proficiency have access to language services and assistance in clinical encounters when visiting hospitals and clinics

9. One aspect: AF4Q Hospital Collaborative Hospitals in WI will receive contact from RWJ from time to time about these opportunities RWJ has chosen to work directly with hospitals on these initiatives

10. RWJ Hospital Collaboratives Rollout • QI/Nursing Collaborative • Sponsored by AONE and IHI • November 2008 Solicitation • February 2009 Start • (Cohort 2 starts late 2009) • QI/Language Collaborative • Sponsored by GWU • February 2009 Solicitation • June 2009 Start • QI/Equity Collaborative • Sponsored by GWU • February 2009 Solicitation • June 2009 Start These RWJ projects are conducted in parallel with the Wisconsin AF4Q initiatives, but are not directly related, and funds are provided to hospitals separately.

11. To Review: The Big Picture

12. Partners in Aligning Forces for Quality WCHQ Board ofDirectors WHA Council on Medical &Professional Affairs Aligning Forces for QualityLeadership Team Wisconsin Wisconsin Organization ofNurse Executives WHA WIs Quality Steering Committee –CheckPoint WCHQ Ambulatory CareSpecifications Workgroup Consumer Workgroup Rural Wisconsin Health CooperativeQuality Improvement Roundtable Wisconsin HealthInformationOrganization Wisconsin Medical SocietyQuality Forum

13. WHA’s Role in the Wisconsin AF4Q • The extended project includes three additional areas of focus for the acute care setting: • Helping health care providers in hospitals and other inpatient facilities improve the quality of care. • Focusing and strengthening the role of nurse leaders and frontline nurses in quality improvement initiatives. • Developing, implementing, and using performance measures to better capture patient care experiences and reduce racial and ethnic gaps in quality.

14. Where are we today?

15. WHA and WCHQ in partnership Wisconsin AF4Q Leadership Team Cindy Schlough Project Director WCHQ Dana Richardson Project Sponsor WHA Judy Warmuth Project Sponsor WHA Stephanie Sobczak Project Manager WHA (To be named) Project Coordinator

16. General Timeline for AF4Q Initiatives Now through April 30, 2009 (DEFINE Projects & Goals) May 1, 2009 through April 30, 2010 (MEASURE Baselines, CONDUCT Pilot(s) & ANALYZE Results) May 1, 2010 through April 30, 2011 (IMPROVE & HOLD THE GAINS) Phase 1 Phase 2 Phase 3

17. WHA’s focus on AF4Q Initiatives • Year 1 • Report H-CAHPS data on Checkpoint. • Identify nurse sensitive measures based on developed and tested national measures. • Year 2 • Add perinatal measures to Checkpoint & evaluate areas for improvement. • Identify data collection strategy for nursing sensitive measures – (including automation?) • Begin internal data collection for nursing sensitive measures. Performance Measurement & Public Reporting

18. WHA’s focus on AF4Q Initiatives • Year 1 • Evaluate existing &/or develop QI products for nurses, MDs and other bedside practitioners •  Gather baseline data bout QI in Wisconsin hospitals • Year 2 • Implement QI products & resources • Promote use of Quality Resource Website • Conduct QI project to support improvement in HCAHPS results • Disseminate best practices. QI Education & Engagement of Nurses and other bedside practitioners

19. WHA’s focus on AF4Q Initiatives • Year 1 • Identify Nurse Leader QI needs, resources and products. • Year 2 • Implement Nurse Leader resources. • Educate nurse leaders on strategies that increase accountability of nurses to apply QI to daily work. • Disseminate best practices. Quality Improvement for Nurse Leaders

20. Stephanie’s Role as Project Manager • Conduct the project within the parameters of the AF4Q grant budget and service agreement with WCHQ. • Ensure progress is systematic and false starts are minimized. • Document the project according to standard to methodologies (PDSA, DMAIC). • Be accountable for achieving project milestones and expected results. • Bring expertise to the development and implementation of creative approaches to achieving the RWJ objectives. • Ensure that outcomes are first, practical and useful to hospitals and, secondly, might be transferrable to other healthcare settings.

21. Early findings from QI Managers Survey Q: What percentage of responding hospitals ascribe to these improvement approaches? Magnet Status Baldrige/WFA ISO-9000 IHI 90% A: 22% 1% 31% Q: What proportion of responding QI Managers report that their QI projects result in lasting change at least 80% of the time? A: 30.2% Average Success Rate = 67% Q: What percent of responding hospitals have or are in process of implementing a Shared Governance model for nurses? A: 56%

22. Early Survey findings… Q. What are the top 3 barriers listed by responding QI Managers to getting the engagement of front line staff? 1. Too little time at work to participate on teams. 2. Compared to the rest of staff’s work, it isn’t a high priority. 3. Recommendations for new processes and procedures are not followed.

23. “How do we participate?” • You can participate in the Advisory teams at any time: •  Interested in implementing Nurse Sensitive Measures? •  Interested in staff engagement in QI? •  Interested in nursing leaders role in leading QI? •  Interested in change based on patient feedback (HCAPHS) • We will need your feedback and participation on occasion via our AF4Q “Sounding Board”: •  Focus Groups  Materials Review  Phone Interviews • We will need your assistance to test and pilot the deliverables •  Small pilot groups within hospitals, or in groups of hospitals 4. We will ask for your assistance in the broad implementation of the resources and deliverables, in spreading the change, and being an active participant in statewide efforts.

24. What is going on now? Advisory Teams are convening for the 3 main initiatives. Initial commitment is 4 one hour meetings via phone conference. After each phase of meetings next steps are planned with a “Go” or “No Go” decision. On-line Survey of QI Managers has been completed. This establishes a baseline for quality activities in Wisconsin. We collected information from 91 hospitals for a 66% statewide response rate. Additional presentations on the Aligning Forces for Quality grant will continue into May. Information on AF4Q will be posted on wha.org/about/af4q

25. Questions? For more information or to get involved, please contact: Stephanie Sobczak Manager, Quality Improvement ssobczak@wha.org or 608.268.1847

26. Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.