1 / 26

Cooley Dickinson Hospital Quality Transformation

Cooley Dickinson Hospital Quality Transformation. June 23. 2009. Context/history New mission/vision/values/goals Clinical Microsystems improvement HR Value Chain Related Quality activities References. Cooley Dickinson Quality Transformation. A Decade Focused on Survival 1988-1997.

loring
Download Presentation

Cooley Dickinson Hospital Quality Transformation

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. Cooley Dickinson HospitalQuality Transformation June 23. 2009

  2. Context/history New mission/vision/values/goals Clinical Microsystems improvement HR Value Chain Related Quality activities References Cooley Dickinson Quality Transformation

  3. A Decade Focused on Survival 1988-1997 • Entire senior management team turnover • Three days in cash 1988 • Multiple reductions in force • 1990 financial break even • 1993 Joined Dartmouth Hitchcock Alliance • 1995 Midsize Comeback Hospital of the Nation – by AHA and Coopers and Lybrand

  4. Financial Stability Shifted Focus to Quality 1998-2005 • 1998 CEO developed relationship with Dartmouth Institute faculty – Paul Batalden • 1999 RIF creates Medical Staff reaction on quality • 2000 Restructured board to focus on quality • 2002 Joined IHI Impact Network • 2003 Recruited VPMA/Senior Director of Quality/8 staff • 2004 Developed vision to BECOME a Model Community Hospital • Joined the IHI 100,000 Lives Campaign on Day 1 of the campaign

  5. New Mission, Vision, Values, Goals Mission: To provide our patients and communities with the best health care in the most appropriate setting • Vision: To Become a Model Community Hospital • Providing the best health care • in the most appropriate setting • Continuously improving care • Sharing lessons learned Values: Build PartnersExtend TrustChange NowOwn ItModel ExcellenceExceed Expectations

  6. CDH measurement framework

  7. Aspiration Be a model community hospital Deliver on exceptional standards for quality and safety Develop cutting edge improvement knowledge (learn from others and develop new) Teach other community hospitals how to improve FY 2007 2 Year Objectives (Overall) Quality: (See goals agreed with BCBSMA) Service: Patient satisfaction to 90th percentile Flow: Reduce inpatient ALOS from 10% above Medicare to below Medicare Financial Viability: Reduce costs by $4m per year for each of 3 years, 3% surplus annually Growth: 6% increase in inpatient and outpatient per year. What is the Bold Aim?Aspirations and Goals – CDH • Safety and Quality Goals • (as agreed with BCBSMA) • Eliminate adverse events • Readmissions reduced by 41% to 6.7% • Reduce adjusted mortality rate from 1.1 HSMR to .8 • Patient satisfaction to 90th percentile from 15th • Emergency department length of stay reduced by 27% to <2 hours from 2.8

  8. Acute care Chronic care Preventive care Palliative care Functional Biological Expectations Functional Costs Biological Satisfaction Costs A “Generic” Clinical Microsystem Model Satisfaction of need, monitoring, assessment of outputs Initial Work-up, Plan for care Entry, Assignment Orientation Disenrollment Beneficiary knowledge, including knowledge of life while not in direct contact with the health care system

  9. Patients Purpose Processes Professionals Patterns

  10. Environmental ServicesPre-Microsystem team Ave. 65 min. Ave. 14 min.

  11. Nursing slow to call ES for room turnover Team cleaning inefficient Lack of consistency in room cleaning methodology Rush to finish & turn over room decreased cleaning time Insufficient “dwell time” for chemicals (need 10 minutes to be effective) Microsystem team discoveries

  12. Environmental ServicesPost Microsystem team Ave. 38 min. Ave. 24 min. http://dms.dartmouth.edu/cms/resources/stories/

  13. Getting StartedDeveloping Internal Expertise • January 2007 - Three QI Department staff attended a week-long “Coach the Coach” training program • Senior Leaders committed to providing the resources to train two Clinical Microsystem Teams • May 2007 – West 2 and Emergency Department teams began a six-month journey learning Clinical Microsystems methodology

  14. Wave 1 May 2007

  15. 50% reduction in call bell volume by anticipating patient need Well attended Interdisciplinary Rounds – yes, physicians participate! Redesigned the Plan of Care and the Education Record to be more meaningful and reduced from 11 pages to 4 pages High-quality E.D. hand-off to inpatient units Quick-Reg. and Bedside Registration in the E.D. Shift Huddle 98% of unit staff said that on-unit communication was excellent - baseline, only 21% We Saw Real Results and True-Believers Were Made

  16. Wave 3 June 2008

  17. Cooley Dickinson Hospital: The Road to Achieving the Vision Continued Microsystems/Mesosystem Development to Achieve Best Practices 100% of the Time, Zero Defects, Continuous Improvement and Model Community Healthcare 2010 Continued Microsystems Development Including Supporting Microsystems eg Dietary, HR, Laboratory Initiate 6 Mesosystem teams for disease processes (CHF, etc.) 2009 Fall Six Additional Microsystems Teams for a total of 16 VNA/Hospice, CDPA, West 5, Critical Care, Telemetry, Stroke(Meso) Years 1-5+ Building Key Capabilities & Infrastructure Coaching, Improvement Education, Charters 2008 Years 1-5+ Cross-Cutting Process Improvement Meso and Macro Systems HR, IT, Data Reports, Leader Development Summer Two Microsystems Teams: Case Management and Readmission Team Mesosystems Change: Computer System Spring Six Microsystems Teams: North 3, Childbirth, Environmental Services, Centralized Scheduling/Registration, Perioperative Services, Senior Leadership Team 2008 Two Clinical Microsystems Teams: West 2 & ED Transformational Change Needed to Engage Medical/Hospital Staff on Quality & Data 2008 2007 2006

  18. “LEAN” Mesosystems Teams Congestive Heart Failure GI/Bowel Procedures Major Joints Obstetrics Pneumonia Psychosis . Next Wave

  19. Blue Cross Blue Shield MALEAD dashboard

  20. Build PartnersI reach across boundaries to collaborate with othersExtend TrustI extend trust and commit each day to be worthy of yours.Change NowI encourage and embrace change and consistently ask what else can I do to achieve CDH goals.Own ItI step up and take responsibility for our results.Model ExcellenceI seek and provide feedback and coaching, lead by example, and share my knowledge to achieve our desired results.Exceed ExpectationsI create a positive experience for every patient and family. HR Value Chain: Our Values

  21. Human Resource Value Chain “BECOME a Model Community Hospital” • Recruit • Process to Apply for Privileges to Practice at CDH • Prescreen to Organizational Values of BECOME (Mesosystem) • Hiring Smart (Microsystem) • Evaluate • Talent Management System • √Professional Demonstration of Contribution to CDH • √Acknowledge Contribution to CDHCC & Profession • √Evidence of Competence through Exemplars • √360 Review • √BECOME • √Safety & Quality Contribution • Select • Select for match for BECOME values • Hiring Smart • Match Core Competencies (Technical/Behavioral to job Develop Ongoing Competencies (Technical & Behavioral) Leadership Development Improvement Courses First Break All The Rules Microsystems Tools/Techniques Culture of Accountability Just Culture (7 Tests for Just Cause Course) Career Development • Orient • (Employee & Management) • CDH History • Competency Based • Expectations • BECOME Values • Code of Conduct • Microsystems/Teams

  22. Recruit top talent Select the best and brightest Orient to CDH and Values Develop to improve performance Evaluate to provide feedback and coaching Human Resource Value Chain:Concept sources

  23. Meanwhile, IT implementation Summer 08 • eClinical Works (EMR) • Eclipsys Base System • Orders and Results • Laboratory System • Blood Bank System • Pharmacy Medication Management System • Materials Mgt System Fall 08 • Clinical Documentation • CPOE Winter 08 • Endoscopy system • ED system

  24. “C” Suite LedFrontline Led/Microsystems We’re already excellent100% EBM, 0 defects SiloTeam Your ProblemMy Responsibility Board Oversight Board Engagement Flavor of the MonthBuild on the vision/compass Simulate union seniority HR Value chain, performance Data as “needed” Transparency Framework Changes

  25. References on microsystems http://www.lj.se/info_files/infosida35111/part_1_july_2008_joint_commission_article2.pdf • http://www.jcrinc.com/cmmon/PDFs/Pubs/Periodicals/S4-JQPS-10-08-godfrey.pdf CDH Environmental Services video example http://dms.dartmouth.edu/cms/resources/stories IHI Whole Systems Measures White Paper (CDH as example) http://www.ihi.org/IHI/Results/WhitePapers/WholeSystemMeasuresWhitePaper.htm

  26. LEAD grant/BCBS/Truepoint/partner orgs. The Dartmouth Institute/faculty IHI Partners in Leadership/Oz All of the staff, starting at the front lines on through the medical staff and board Contribution acknowledgements

More Related