Presenter NAME Presenter TITLE Presentation DATE

1. Presenter NAME Presenter TITLE Presentation DATE <<This slide is to be customized by the presenting hospital/health system to include their logo, name of presenter and date of presentation.>> <<Presenter’s Note: When viewing this presentation on a computer, in the “normal view,” located below each slide of the PowerPoint are notes which act as a script for the presenter. To print each slide along with the notes that appear beneath it, select “File,” then “Print,” and then “Notes Pages” from the Drop Down menu asking “Print What:” >><<This slide is to be customized by the presenting hospital/health system to include their logo, name of presenter and date of presentation.>> <<Presenter’s Note: When viewing this presentation on a computer, in the “normal view,” located below each slide of the PowerPoint are notes which act as a script for the presenter. To print each slide along with the notes that appear beneath it, select “File,” then “Print,” and then “Notes Pages” from the Drop Down menu asking “Print What:” >>

2. Our Commitment <<Hospital’s mission/vision statement or stated commitment regarding quality of care>> - <<Hospital CEO/President>> <<Use this opening slide to feature the stated commitment of your hospital/health system to provide the highest overall care to your patients.>> If you prefer, you may echo the MHA’s commitment: “Michigan hospitals are health systems are committed to leading our state toward becoming the national benchmark for health care quality and patient safety in this decade. -The Michigan Health & Hospital Association<<Use this opening slide to feature the stated commitment of your hospital/health system to provide the highest overall care to your patients.>> If you prefer, you may echo the MHA’s commitment: “Michigan hospitals are health systems are committed to leading our state toward becoming the national benchmark for health care quality and patient safety in this decade. -The Michigan Health & Hospital Association

3. Demonstrating our Commitment MHA Keystone Center for Patient Safety & Quality: an entity dedicated to the implementation of evidence-based best practices MHA Patient Safety Organization (PSO): patient safety data collection and analysis organization MI Hospital Inform: comprehensive price and quality information website <<Add additional patient safety and quality efforts in which your hospital is participating, if applicable.>> Our hospital is currently participating in ___ of three quality and accountability efforts administered by the Michigan Health & Hospital Association. These include the MHA Keystone Center for Patient Safety & Quality, an entity dedicated to the implementation of evidence-based best practices; the MHA Patient Safety Organization or PSO, a patient safety data collection and analysis organization; and MI Hospital Inform, a comprehensive price and quality information website. <<Add any additional efforts here.>> Widespread participation in these efforts by hospitals have positioned Michigan as a benchmark for patient safety, quality and efficiency. Now I will take you through the specific patient safety and quality collaboratives in which <<hospital/health system name>> is participating.Our hospital is currently participating in ___ of three quality and accountability efforts administered by the Michigan Health & Hospital Association. These include the MHA Keystone Center for Patient Safety & Quality, an entity dedicated to the implementation of evidence-based best practices; the MHA Patient Safety Organization or PSO, a patient safety data collection and analysis organization; and MI Hospital Inform, a comprehensive price and quality information website. <<Add any additional efforts here.>> Widespread participation in these efforts by hospitals have positioned Michigan as a benchmark for patient safety, quality and efficiency. Now I will take you through the specific patient safety and quality collaboratives in which <<hospital/health system name>> is participating.

4. MHA Keystone Center Created by Michigan hospitals in March 2003 to improve care and reduce costs through the implementation of evidence-based best practices. Brings together hospitals, state and national patient safety experts. Each collaborative implements the Comprehensive Unit-based Safety Program (CUSP) intervention, which integrates communication, teamwork and leadership to establish a culture free of patient harm. Michigan hospitals created the MHA Keystone Center in March 2003 to ensure the best care for the state’s patients and to reduce costs through the implementation of evidence-based best practices. The center convenes hospitals and patient safety experts, resulting in unprecedented collaboration and sustainable results.   Currently, the MHA Keystone Center operates six collaboratives, partners in two national projects and is engaged in one special project. Each collaborative implements the Comprehensive Unit-based Safety Program or CUSP intervention, which integrates communication, teamwork and leadership to establish a culture free of patient harm.   The MHA Keystone Center is a nonprofit organization that has, to date, been funded by MHA-member hospitals, the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan, the Centers for Disease Control and Prevention, also known as the CDC, and the Michigan Department of Community Health. The success of Michigan hospitals participating in the MHA Keystone Center has been reported in the Wall Street Journal, CNN, Newsweek, The New England Journal of Medicine and more. Through the MHA Keystone Center, Michigan hospitals have established themselves as experts in patient safety and quality and take pride in their national leadership on the issue.Michigan hospitals created the MHA Keystone Center in March 2003 to ensure the best care for the state’s patients and to reduce costs through the implementation of evidence-based best practices. The center convenes hospitals and patient safety experts, resulting in unprecedented collaboration and sustainable results.   Currently, the MHA Keystone Center operates six collaboratives, partners in two national projects and is engaged in one special project. Each collaborative implements the Comprehensive Unit-based Safety Program or CUSP intervention, which integrates communication, teamwork and leadership to establish a culture free of patient harm.   The MHA Keystone Center is a nonprofit organization that has, to date, been funded by MHA-member hospitals, the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan, the Centers for Disease Control and Prevention, also known as the CDC, and the Michigan Department of Community Health. The success of Michigan hospitals participating in the MHA Keystone Center has been reported in the Wall Street Journal, CNN, Newsweek, The New England Journal of Medicine and more. Through the MHA Keystone Center, Michigan hospitals have established themselves as experts in patient safety and quality and take pride in their national leadership on the issue.

5. MHA Keystone Center Initiatives Collaboratives MHA Keystone: Intensive Care Unit (ICU) MHA Keystone: Gift of Life MHA Keystone: Hospital-Associated Infection (HAI) MHA Keystone: Surgery MHA Keystone: Obstetrics (OB) MHA Keystone: Emergency Room (ER) National projects On the CUSP: Stop Bloodstream Infection (BSI) On the CUSP: Stop Catheter-associated Urinary Tract Infection (CA-UTI) Special project Michigan STate Action on Avoidable Rehospitalizations (MI STA*AR) The MHA Keystone Center currently operates six collaboratives focused on intensive care units, organ donation, hospital-associated infections, surgeries, obstetrics and emergency rooms. Each MHA Keystone Center collaborative is designed to be replicated by other hospitals and, as a result, On the CUSP: Stop Bloodstream Infection and On the CUSP: Stop Catheter-associated Urinary Tract Infection have expanded nationally with support from the federal government and national health care organizations. In addition, the MHA Keystone Center partners on a special project called the Michigan STate Action on Avoidable Rehospitalizations or MI STA*AR. Funding for the Michigan State Action on Avoidable Rehospitalizations special project is provided by The Commonwealth Fund and the Institute for Healthcare Improvement.The MHA Keystone Center currently operates six collaboratives focused on intensive care units, organ donation, hospital-associated infections, surgeries, obstetrics and emergency rooms. Each MHA Keystone Center collaborative is designed to be replicated by other hospitals and, as a result, On the CUSP: Stop Bloodstream Infection and On the CUSP: Stop Catheter-associated Urinary Tract Infection have expanded nationally with support from the federal government and national health care organizations. In addition, the MHA Keystone Center partners on a special project called the Michigan STate Action on Avoidable Rehospitalizations or MI STA*AR. Funding for the Michigan State Action on Avoidable Rehospitalizations special project is provided by The Commonwealth Fund and the Institute for Healthcare Improvement.

6. MHA Keystone: Intensive Care Unit (ICU) Reduces central-line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP). CLABSI effort saved an estimated 36 lives and $6.4 million from March 2010 to March 2011. VAP effort saved 79 lives and $2.2 million. “Business Case for Quality” study revealed that initial estimates of the lifesaving and cost-saving benefits of MHA Keystone: ICU were roughly $1.1 million per year. A joint septic shock initiative launched between MHA Keystone: ICU and MHA Keystone: ER. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: ICU is reducing the incidence of central-line-associated bloodstream infections or CLABSIs and ventilator-associated pneumonia or VAP in participating ICUs. The effort to reduce CLABSIs resulted in an estimated 36 lives saved and $6.4 million net savings from March 2010 to March 2011. During that same time, the collaborative saved 79 lives and a net savings of $2.2 million by reducing the number of patients experiencing VAP. In addition, a special project called the “Business Case for Quality,” published in the September/October 2011 issue of the American Journal of Medical Quality, revealed that initial estimates of the lifesaving and cost-saving benefits of MHA Keystone: ICU were significant, even when calculated conservatively.   A joint septic shock initiative was launched in March between MHA Keystone: ICU and MHA Keystone: ER. Participating hospitals were encouraged to create an interdisciplinary team and unified approach to the initiative, improving the flow of patients through the hospital by removing the focus on one condition per unit. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: ICU is reducing the incidence of central-line-associated bloodstream infections or CLABSIs and ventilator-associated pneumonia or VAP in participating ICUs. The effort to reduce CLABSIs resulted in an estimated 36 lives saved and $6.4 million net savings from March 2010 to March 2011. During that same time, the collaborative saved 79 lives and a net savings of $2.2 million by reducing the number of patients experiencing VAP. In addition, a special project called the “Business Case for Quality,” published in the September/October 2011 issue of the American Journal of Medical Quality, revealed that initial estimates of the lifesaving and cost-saving benefits of MHA Keystone: ICU were significant, even when calculated conservatively.   A joint septic shock initiative was launched in March between MHA Keystone: ICU and MHA Keystone: ER. Participating hospitals were encouraged to create an interdisciplinary team and unified approach to the initiative, improving the flow of patients through the hospital by removing the focus on one condition per unit.

7. MHA Keystone: Hospital-Associated Infection (HAI) Seeks to prevent HAIs, which occur in approximately one of every 20 hospitalized patients. Interventions to reduce CA-UTI are separated into two prevention bundles. The timely removal of nonessential catheters and appropriate care of necessary catheters. Appropriate placement of catheters and proper insertion technique. Estimated 26 percent reduction of patients with urinary catheters and 30 percent improvement in appropriate use. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> The largest of the hospital collaboratives, MHA Keystone: HAI, seeks to prevent HAIs, which occur in approximately one of every 20 hospitalized patients. These infections are estimated to result in 99,000 associated deaths and $6.65 billion in excess health care costs nationally each year. Development of HAIs puts patients at risk of mortality, longer lengths of stay and higher costs.   Interventions to reduce catheter-associated urinary tract infection or CA-UTI are separated into two prevention bundles. The first bundle involves the timely removal of nonessential catheters and appropriate care of necessary catheters. A second bundle of interventions addresses the insertion of catheters, including both appropriate placement and proper insertion technique.   Hospitals that have implemented the first CA-UTI bundle have experienced a reduction in indwelling catheters from 19 percent to 14 percent between January 2007 and December 2010, resulting in an estimated 26 percent reduction of patients with urinary catheters and a 30 percent improvement in appropriate use.<<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> The largest of the hospital collaboratives, MHA Keystone: HAI, seeks to prevent HAIs, which occur in approximately one of every 20 hospitalized patients. These infections are estimated to result in 99,000 associated deaths and $6.65 billion in excess health care costs nationally each year. Development of HAIs puts patients at risk of mortality, longer lengths of stay and higher costs.   Interventions to reduce catheter-associated urinary tract infection or CA-UTI are separated into two prevention bundles. The first bundle involves the timely removal of nonessential catheters and appropriate care of necessary catheters. A second bundle of interventions addresses the insertion of catheters, including both appropriate placement and proper insertion technique.   Hospitals that have implemented the first CA-UTI bundle have experienced a reduction in indwelling catheters from 19 percent to 14 percent between January 2007 and December 2010, resulting in an estimated 26 percent reduction of patients with urinary catheters and a 30 percent improvement in appropriate use.

8. MHA Keystone: Gift of Life Improves the organ donation process using evidence-based best practice. In 2010, 289 Michigan organ donors contributed 792 transplanted organs. Organ donation conversion rate increased to 83 percent. Donor Drive 2010: Michigan hospitals added 11,800 people to the registry, up from 3,800 in 2009. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> This collaborative brings together Michigan hospitals and Gift of Life Michigan to improve the organ donation processes using evidence-based best practice. These efforts have helped grow the number of people on the Michigan Organ Donor Registry from 482,000 in 2003 to nearly 2.3 million in August, contributing significantly to saving and improving the lives of thousands of residents.   In 2010, 289 Michigan organ donors contributed 792 transplanted organs. Michigan's organ donation conversion rate increased to 83 percent, well above the national standard of 75 percent. In addition, 126 lungs were transplanted from Michigan donors and the state recorded 1,066 tissue donors, surpassing the record previously set in 2007. Michigan ranked in the top 10 for highest number of organ donors and for the most organs transplanted for each type of organ.   As part of Donor Drive 2010, MHA Keystone: Gift of Life participants more than tripled the number of hospital-generated registrations, adding 11,800 people to the registry, up from 3,800 in 2009. The success was achieved through the efforts of Michigan hospitals, the MHA Keystone Center, Gift of Life Michigan and the Michigan Eye-Bank. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> This collaborative brings together Michigan hospitals and Gift of Life Michigan to improve the organ donation processes using evidence-based best practice. These efforts have helped grow the number of people on the Michigan Organ Donor Registry from 482,000 in 2003 to nearly 2.3 million in August, contributing significantly to saving and improving the lives of thousands of residents.   In 2010, 289 Michigan organ donors contributed 792 transplanted organs. Michigan's organ donation conversion rate increased to 83 percent, well above the national standard of 75 percent. In addition, 126 lungs were transplanted from Michigan donors and the state recorded 1,066 tissue donors, surpassing the record previously set in 2007. Michigan ranked in the top 10 for highest number of organ donors and for the most organs transplanted for each type of organ.   As part of Donor Drive 2010, MHA Keystone: Gift of Life participants more than tripled the number of hospital-generated registrations, adding 11,800 people to the registry, up from 3,800 in 2009. The success was achieved through the efforts of Michigan hospitals, the MHA Keystone Center, Gift of Life Michigan and the Michigan Eye-Bank.

9. MHA Keystone: Surgery Focuses on eliminating surgical-site infections, preventing defects in care, eliminating mislabeled specimens and improving the safety and teamwork climate. From January to December 2010, briefings and debriefings were held for roughly 91 percent of surgeries. Collaboration with the MHA PSO. From May 2010 to May 2011, the surgical specimen defect rate decreased more than 50 percent. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: Surgery aims to eliminate surgical-site infections, prevent defects in care, eliminate mislabeled specimens and improve the safety and teamwork climate for the roughly 420,000 surgeries performed in MHA Keystone: Surgery hospitals annually. The collaborative focused on reducing the 5 percent rate of complications and 5 percent rate of mortality as a result of surgical complications, which cost an estimated $250 million nationally each year.   To improve communication among members of the surgical team, briefings are conducted before surgery to confirm the correct patient is in the operating room, to verify the surgical site, to ensure the proper equipment is accessible and to outline possible complications. Debriefings are conducted immediately following the procedure to identify defects and discuss the patient’s future needs, ensuring a smooth transition to postoperative care. From January to December 2010, participating hospitals completed 389,751 briefings and 378,668 debriefings, accounting for roughly 91 percent of the surgeries in participating hospitals during that time period. In addition, MHA Keystone: Surgery continues to collaborate with the MHA PSO to use the surgical data to track outcomes and monitor the effectiveness of briefings and debriefings in reducing harm.   MHA Keystone: Surgery teams are also collecting data on the safe handling of surgical specimens and are working toward improvements in their processes to decrease the number of defects, reduce the risk of misdiagnosis and diminish the potential need for repeat surgery. From May 2010 to May 2011, the surgical specimen defect rate decreased more than 50 percent.<<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: Surgery aims to eliminate surgical-site infections, prevent defects in care, eliminate mislabeled specimens and improve the safety and teamwork climate for the roughly 420,000 surgeries performed in MHA Keystone: Surgery hospitals annually. The collaborative focused on reducing the 5 percent rate of complications and 5 percent rate of mortality as a result of surgical complications, which cost an estimated $250 million nationally each year.   To improve communication among members of the surgical team, briefings are conducted before surgery to confirm the correct patient is in the operating room, to verify the surgical site, to ensure the proper equipment is accessible and to outline possible complications. Debriefings are conducted immediately following the procedure to identify defects and discuss the patient’s future needs, ensuring a smooth transition to postoperative care. From January to December 2010, participating hospitals completed 389,751 briefings and 378,668 debriefings, accounting for roughly 91 percent of the surgeries in participating hospitals during that time period. In addition, MHA Keystone: Surgery continues to collaborate with the MHA PSO to use the surgical data to track outcomes and monitor the effectiveness of briefings and debriefings in reducing harm.   MHA Keystone: Surgery teams are also collecting data on the safe handling of surgical specimens and are working toward improvements in their processes to decrease the number of defects, reduce the risk of misdiagnosis and diminish the potential need for repeat surgery. From May 2010 to May 2011, the surgical specimen defect rate decreased more than 50 percent.

10. MHA Keystone: Obstetrics (OB) Focuses on eliminating preventable fetal and maternal harm due to complications of labor induction and management of the second stage of labor. Resulted in a 51 percent improvement in five-minute Apgar scores indicating the health of newborns. Reduced elective inductions before 39 weeks from roughly 2.9 percent to 1.7 percent and reduced elective cesarean sections before 39 weeks from nearly 17.5 percent to 11.5 percent from March 2010 to March 2011. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: OB focuses on eliminating preventable fetal and maternal harm due to complications of labor induction and management of the second stage of labor. Strategies are incorporated to reduce the number of birth injuries from the current estimate of three injuries for every 1,000 births in the United States. The collaborative aligns with Gov. Rick Snyder’s “dashboard” priority to reduce infant mortality.   MHA Keystone: OB interventions resulted in a 51 percent improvement in five-minute Apgar scores indicating the health of newborns. Participating hospitals also reduced elective inductions before 39 weeks from roughly 2.9 percent to 1.7 percent and reduced elective cesarean sections before 39 weeks from nearly 17.5 percent to 11.5 percent from March 2010 to March 2011.<<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> MHA Keystone: OB focuses on eliminating preventable fetal and maternal harm due to complications of labor induction and management of the second stage of labor. Strategies are incorporated to reduce the number of birth injuries from the current estimate of three injuries for every 1,000 births in the United States. The collaborative aligns with Gov. Rick Snyder’s “dashboard” priority to reduce infant mortality.   MHA Keystone: OB interventions resulted in a 51 percent improvement in five-minute Apgar scores indicating the health of newborns. Participating hospitals also reduced elective inductions before 39 weeks from roughly 2.9 percent to 1.7 percent and reduced elective cesarean sections before 39 weeks from nearly 17.5 percent to 11.5 percent from March 2010 to March 2011.

11. MHA Keystone: Emergency Room (ER) Aims to prevent harm to ER patients by improving safety practices and attitudes, reducing boarding/overcrowding and wait times, and supporting the early treatment of sepsis using evidence-based best practices. Resulted in a 29 percent decline in the rate of patients who left without being seen. MHA Keystone: ICU and MHA Keystone: ER launched a joint septic shock initiative. <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> According to the CDC, there were nearly 124 million emergency department visits in 2008, up from nearly 117 million visits in 2007. An aging population and an increase in uninsured and underinsured residents have resulted in a larger number of patients seeking treatment through the ER, increasing patient stays and overcrowding.   MHA Keystone: ER aims to prevent harm to emergency patients by improving safety practices and attitudes, reducing boarding/overcrowding and wait times, and supporting the early treatment of sepsis using evidence-based best practices. As a result of these efforts, participating hospitals have experienced a 29 percent decline in the rate of patients who left without being seen.   In March 2011, MHA Keystone: ICU and MHA Keystone: ER launched a joint septic shock initiative to implement early identification and treatment of sepsis in the ER using early goal-directed therapy.<<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> According to the CDC, there were nearly 124 million emergency department visits in 2008, up from nearly 117 million visits in 2007. An aging population and an increase in uninsured and underinsured residents have resulted in a larger number of patients seeking treatment through the ER, increasing patient stays and overcrowding.   MHA Keystone: ER aims to prevent harm to emergency patients by improving safety practices and attitudes, reducing boarding/overcrowding and wait times, and supporting the early treatment of sepsis using evidence-based best practices. As a result of these efforts, participating hospitals have experienced a 29 percent decline in the rate of patients who left without being seen.   In March 2011, MHA Keystone: ICU and MHA Keystone: ER launched a joint septic shock initiative to implement early identification and treatment of sepsis in the ER using early goal-directed therapy.

12. Special and National Projects MI STA*AR (special project) Goal is to reduce 30-day rehospitalization rates by 30 percent and increase patient and family satisfaction Participating hospitals received report of statewide rehospitalization rates and hospital-specific rehospitalizations On the CUSP: Stop BSI (national project) Aims to reduce the average rate of CLABSIs by 80 percent CLABSI rates dropped 33 percent On the CUSP: Stop CA-UTI (national project) Goal to reduce CA-UTI rates by 25 percent over two years Began with 12 participating states and, in fall 2011, is expanding to include all 50 states, the District of Columbia and Puerto Rico <<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> Through MI STA*AR, Michigan hospitals, together with community partners, are voluntarily addressing the issues of care coordination and communication among hospitals, patients and doctors that result in avoidable rehospitalizations. The initiative aims to reduce by 30 percent the number of patients who experience avoidable rehospitalizations within 30 days of discharge and to increase patient and family satisfaction with transitions and coordination of care. Sixty-five Michigan hospitals participate in this initiative, which is scheduled to continue through 2013.   In October 2012, health care reform will impose Medicare reimbursement penalties for certain rehospitalizations. Hospitals will not only be penalized for rehospitalizations to their own institution, but also when their former patients are rehospitalized in other facilities. In July 2011, participating hospitals were provided the most complete report, to date, of hospital-specific rehospitalizations — patients readmitted to their hospital or to another hospital — and statewide rehospitalization rates. ___________________________________________________________________________ On the CUSP: Stop BSI aims to reduce the average rate of CLABSIs from the national average of five infections per 1,000 catheter days by 80 percent using the MHA Keystone: ICU model. In September 2011, roughly 1,055 hospitals from 45 states, the District of Columbia and Puerto Rico were enrolled in the effort.   On the CUSP: Stop BSI is scheduled to continue through September 2012 and has already shown measurable success nationwide. In September, the AHRQ released a report showing a 33 percent reduction in CLABSIs among adult ICUs from more than 750 participating hospitals. ___________________________________________________________________________ CA-UTIs — many of which are preventable — account for 35 percent of all HAIs and result in approximately 8,200 deaths and an estimated $565 million in excess costs. On the CUSP: Stop CA-UTI aims to reduce CA-UTI rates in participating ICUs and other clinical units by an average of 25 percent over two years using the MHA Keystone: HAI model. The initiative began with 12 participating states and, in fall 2011, is expanding to include all 50 states, the District of Columbia and Puerto Rico.<<OPTIONAL SLIDE: If your hospital/health system does not participate in this collaborative, you may remove this slide.>> Through MI STA*AR, Michigan hospitals, together with community partners, are voluntarily addressing the issues of care coordination and communication among hospitals, patients and doctors that result in avoidable rehospitalizations. The initiative aims to reduce by 30 percent the number of patients who experience avoidable rehospitalizations within 30 days of discharge and to increase patient and family satisfaction with transitions and coordination of care. Sixty-five Michigan hospitals participate in this initiative, which is scheduled to continue through 2013.   In October 2012, health care reform will impose Medicare reimbursement penalties for certain rehospitalizations. Hospitals will not only be penalized for rehospitalizations to their own institution, but also when their former patients are rehospitalized in other facilities. In July 2011, participating hospitals were provided the most complete report, to date, of hospital-specific rehospitalizations — patients readmitted to their hospital or to another hospital — and statewide rehospitalization rates. ___________________________________________________________________________ On the CUSP: Stop BSI aims to reduce the average rate of CLABSIs from the national average of five infections per 1,000 catheter days by 80 percent using the MHA Keystone: ICU model. In September 2011, roughly 1,055 hospitals from 45 states, the District of Columbia and Puerto Rico were enrolled in the effort.   On the CUSP: Stop BSI is scheduled to continue through September 2012 and has already shown measurable success nationwide. In September, the AHRQ released a report showing a 33 percent reduction in CLABSIs among adult ICUs from more than 750 participating hospitals. ___________________________________________________________________________ CA-UTIs — many of which are preventable — account for 35 percent of all HAIs and result in approximately 8,200 deaths and an estimated $565 million in excess costs. On the CUSP: Stop CA-UTI aims to reduce CA-UTI rates in participating ICUs and other clinical units by an average of 25 percent over two years using the MHA Keystone: HAI model. The initiative began with 12 participating states and, in fall 2011, is expanding to include all 50 states, the District of Columbia and Puerto Rico.

13. MHA PSO Certified in January 2009. Nearly every Michigan hospital is an active member. There are two key functions of PSOs: To allow providers to seek expert help in understanding patient safety events and preventing their recurrence in a protected legal environment. To create a system of data collection to combine and analyze the data and share findings. Currently, there are 81 listed PSOs throughout the country. Shortly after Congress passed the Patient Safety and Quality Improvement Act in 2005, the MHA and its members began exploring the development of a PSO in Michigan. In 2007, articles of incorporation were filed to establish the “MHA Patient Safety Organization” as an affiliated organization within the MHA Health Foundation. Shortly thereafter, bylaws and a board of directors were established. In 2008, the MHA Board of Trustees passed a resolution of formal support for the MHA PSO and established a three-year special member assessment to provide for its financial viability. In late 2008, then-Governor Jennifer Granholm signed into law Public Act 541, and the MHA PSO met the state criteria of a qualified hospital PSO. In January 2009, the federal government released long-awaited implementation rules governing the federal Patient Safety Act, which provided additional guidance and allowed for the creation of a national PSO certification process. In February 2009, the MHA PSO gained certification and engaged a certified vendor, ECRI Institute, to implement a secure Web-based event reporting system. The MHA PSO is certified under the federal Patient Safety Act and is a Qualified Hospital PSO. Currently, nearly every Michigan hospital is an active member of the MHA PSO. There are two key functions of PSOs: to allow providers to seek expert help in understanding patient safety events and preventing their recurrence in a protected legal environment; and to create a system of data collection to combine and analyze the data and share findings. By collecting data from many hospitals, PSOs can identify issues and trends that an individual hospital, with its limited data set, may not detect. It is unlikely that even large, multihospital systems could aggregate data as comprehensively as a PSO that is working with all hospitals in a given state. Currently, there are 81 listed PSOs throughout the country.Shortly after Congress passed the Patient Safety and Quality Improvement Act in 2005, the MHA and its members began exploring the development of a PSO in Michigan. In 2007, articles of incorporation were filed to establish the “MHA Patient Safety Organization” as an affiliated organization within the MHA Health Foundation. Shortly thereafter, bylaws and a board of directors were established. In 2008, the MHA Board of Trustees passed a resolution of formal support for the MHA PSO and established a three-year special member assessment to provide for its financial viability. In late 2008, then-Governor Jennifer Granholm signed into law Public Act 541, and the MHA PSO met the state criteria of a qualified hospital PSO. In January 2009, the federal government released long-awaited implementation rules governing the federal Patient Safety Act, which provided additional guidance and allowed for the creation of a national PSO certification process. In February 2009, the MHA PSO gained certification and engaged a certified vendor, ECRI Institute, to implement a secure Web-based event reporting system. The MHA PSO is certified under the federal Patient Safety Act and is a Qualified Hospital PSO. Currently, nearly every Michigan hospital is an active member of the MHA PSO. There are two key functions of PSOs: to allow providers to seek expert help in understanding patient safety events and preventing their recurrence in a protected legal environment; and to create a system of data collection to combine and analyze the data and share findings. By collecting data from many hospitals, PSOs can identify issues and trends that an individual hospital, with its limited data set, may not detect. It is unlikely that even large, multihospital systems could aggregate data as comprehensively as a PSO that is working with all hospitals in a given state. Currently, there are 81 listed PSOs throughout the country.

14. MHA PSO Data Collection The most prevalent serious adverse events in Michigan hospitals and health systems are falls, medication errors and surgical/invasive procedure errors. Standardized patient alert wristbands. Introduced a wrong-site surgery toolkit. Collected reports of medication-related serious adverse events to identify trends. In the last year, the most prevalent serious adverse events in Michigan hospitals and health systems continue to be falls, medication errors and surgical/invasive procedure errors. Falls have been identified as one of the most difficult patient safety issues to address, because of the multitude of potential causes. The MHA PSO began to address patient falls in 2008 when it led Michigan hospitals and health systems statewide through a process to standardize patient alert wristbands, helping health care employees rightly identify those patients at risk. However, more needs to be done. A total culture of safety that involves physicians, nurses, nonclinical workers, the patient and their family is necessary to prevent falls, and the MHA PSO will continue to explore ways in which Michigan providers can reduce their occurrence. Late in 2010, in partnership with ECRI Institute, the MHA PSO introduced members to a new wrong-site surgery toolkit. The information in the toolkit helps identify process problems and redesign solutions. The toolkit was adopted and implemented by hospitals and health systems statewide and works in complement with MHA Keystone: Surgery. In spring of 2011, the MHA PSO and its membership partnered with ECRI Institute to participate in a national project on medication errors. The effort focused on collecting reports of medication-related serious adverse events from hospitals and health systems to identify trends in this category of error. Specifically, participants were asked to submit 10 medication error reports, with no specific limit on date of occurrence, to allow for analysis of trends and improvements over time. The data submission stage concluded in June. In the last year, the most prevalent serious adverse events in Michigan hospitals and health systems continue to be falls, medication errors and surgical/invasive procedure errors. Falls have been identified as one of the most difficult patient safety issues to address, because of the multitude of potential causes. The MHA PSO began to address patient falls in 2008 when it led Michigan hospitals and health systems statewide through a process to standardize patient alert wristbands, helping health care employees rightly identify those patients at risk. However, more needs to be done. A total culture of safety that involves physicians, nurses, nonclinical workers, the patient and their family is necessary to prevent falls, and the MHA PSO will continue to explore ways in which Michigan providers can reduce their occurrence. Late in 2010, in partnership with ECRI Institute, the MHA PSO introduced members to a new wrong-site surgery toolkit. The information in the toolkit helps identify process problems and redesign solutions. The toolkit was adopted and implemented by hospitals and health systems statewide and works in complement with MHA Keystone: Surgery. In spring of 2011, the MHA PSO and its membership partnered with ECRI Institute to participate in a national project on medication errors. The effort focused on collecting reports of medication-related serious adverse events from hospitals and health systems to identify trends in this category of error. Specifically, participants were asked to submit 10 medication error reports, with no specific limit on date of occurrence, to allow for analysis of trends and improvements over time. The data submission stage concluded in June.

15. MHA PSO Member Value Developed automated data submission. Worked to expand its membership to collect and analyze data for nonacute-care-hospital providers. Educational events on topics including surgical events, radiation dosage and adverse event management. Generally, when MHA PSO members experience a serious adverse event, they must enter data into two reporting systems — their internal data tracking system and the MHA PSO database. Unfortunately, this results in increased burden on staff time and inefficiencies in the reporting process. To create a leaner reporting process and help maximize data submission, the MHA PSO has developed a process that allows member hospitals and health systems to enter data into their internal data tracking systems and have that information transfer automatically into the MHA PSO database. In the past year, the MHA PSO has worked to expand its membership to collect and analyze data for nonacute-care-hospital providers, such as long-term-care hospitals. The MHA PSO has also focused on providing educational sessions on critical topics affecting patient safety, not only in Michigan, but nationwide, including surgical events, radiation dosage and adverse event management. To ensure that the MHA PSO continues its strong, voluntary participation, and to help the entity incorporate other health care providers into its membership, the MHA PSO recently launched its clinical advisory group, which will support the MHA PSO Board of Directors. The advisory group is comprised of select individuals with clinical and/or patient safety and quality experience and expertise who will deliver recommendations and guidance to further enhance patient safety in Michigan hospitals and health systems.Generally, when MHA PSO members experience a serious adverse event, they must enter data into two reporting systems — their internal data tracking system and the MHA PSO database. Unfortunately, this results in increased burden on staff time and inefficiencies in the reporting process. To create a leaner reporting process and help maximize data submission, the MHA PSO has developed a process that allows member hospitals and health systems to enter data into their internal data tracking systems and have that information transfer automatically into the MHA PSO database. In the past year, the MHA PSO has worked to expand its membership to collect and analyze data for nonacute-care-hospital providers, such as long-term-care hospitals. The MHA PSO has also focused on providing educational sessions on critical topics affecting patient safety, not only in Michigan, but nationwide, including surgical events, radiation dosage and adverse event management. To ensure that the MHA PSO continues its strong, voluntary participation, and to help the entity incorporate other health care providers into its membership, the MHA PSO recently launched its clinical advisory group, which will support the MHA PSO Board of Directors. The advisory group is comprised of select individuals with clinical and/or patient safety and quality experience and expertise who will deliver recommendations and guidance to further enhance patient safety in Michigan hospitals and health systems.

16. MHA PSO Safe Tables Convened the first of many planned “Safe Table” meetings, a novel and interactive approach to enhancing the safety and quality of health care. Held for Michigan’s children’s hospitals that specialize in pediatric and neonatal care. Plans to expand to additional hospitals and health systems. This summer, the MHA PSO convened the first of many planned “Safe Table” meetings. A Safe Table is a legally protected shared learning forum, at which health care professionals convene and have an open dialogue about patient safety and quality issues. Candid and transparent discussion is encouraged in this confidential setting, in which, participants share stories of patient safety incidents that omit all patient and provider identity information. The first Safe Table was held for Michigan’s children’s hospitals and hospitals/health systems that specialize in pediatric and neonatal care. With a convening theme of “culture of safety,” the event was attended to capacity and led to enlightened discussion among physicians, nurses, risk managers, social workers and administrators about the issues and errors they face in their units. In the coming months, the MHA PSO will expand the Safe Table concept to additional hospitals and health systems.This summer, the MHA PSO convened the first of many planned “Safe Table” meetings. A Safe Table is a legally protected shared learning forum, at which health care professionals convene and have an open dialogue about patient safety and quality issues. Candid and transparent discussion is encouraged in this confidential setting, in which, participants share stories of patient safety incidents that omit all patient and provider identity information. The first Safe Table was held for Michigan’s children’s hospitals and hospitals/health systems that specialize in pediatric and neonatal care. With a convening theme of “culture of safety,” the event was attended to capacity and led to enlightened discussion among physicians, nurses, risk managers, social workers and administrators about the issues and errors they face in their units. In the coming months, the MHA PSO will expand the Safe Table concept to additional hospitals and health systems.

17. MI Hospital Inform Empowers consumers to make better informed health care decisions. Data on patient satisfaction, surgical infections and the most common causes of hospitalizations. Pricing information. Launched in January 2008, the MI Hospital Inform* price and quality data website addresses the national call for greater transparency in health care. The site is a voluntary effort by the MHA and Michigan hospitals designed to empower consumers to make better informed health care decisions.   MI Hospital Inform publicly provides patients, families, employers and others with information about charges, payments and quality of care at Michigan hospitals, including data on patient satisfaction, surgical infections and the most common causes of hospitalizations (heart attack, congestive heart failure and pneumonia). MI Hospital Inform also includes pricing information on the 50 most frequent Medicare inpatient and outpatient procedures. Specifically, consumers can find the average charge, average payment, average length of stay (inpatient only) and total number of patients treated for each of those procedures at Michigan hospitals. In addition, the website provides aggregate CLABSI data for hospitals participating in MHA Keystone: ICU. *Pronounced “M” “I” Hospital InformLaunched in January 2008, the MI Hospital Inform* price and quality data website addresses the national call for greater transparency in health care. The site is a voluntary effort by the MHA and Michigan hospitals designed to empower consumers to make better informed health care decisions.   MI Hospital Inform publicly provides patients, families, employers and others with information about charges, payments and quality of care at Michigan hospitals, including data on patient satisfaction, surgical infections and the most common causes of hospitalizations (heart attack, congestive heart failure and pneumonia). MI Hospital Inform also includes pricing information on the 50 most frequent Medicare inpatient and outpatient procedures. Specifically, consumers can find the average charge, average payment, average length of stay (inpatient only) and total number of patients treated for each of those procedures at Michigan hospitals. In addition, the website provides aggregate CLABSI data for hospitals participating in MHA Keystone: ICU. *Pronounced “M” “I” Hospital Inform

18. Issues & Opportunities As health care reform takes hold and the delivery system experiences a fundamental shift, no state’s providers may be as well prepared as Michigan’s. Variation Adopting methods that create consistency and reduce variation to the point of appropriateness. Actively pursuing increased hospital-physician alignment. Transparency through MI Hospital Inform. Value-based Purchasing Value-based payment versus volume-based payment. Rehospitalizations As hospital payment incentives move toward rewarding quality versus quantity and value over volume, Michigan looks to the work of the MHA Keystone Center, MHA PSO and MI Hospital Inform to improve the continuum of care.   Variation - While some degree of variation in the use, delivery and cost of services is appropriate, a significant percentage of variation is inappropriate and preventable. The MHA Keystone Center helps create a culture that employs best practices to create consistency and reduce variation to the point of appropriateness. In addition, Michigan is pursuing increased hospital-physician alignment to improve systems of care. Transparency is also vital to reducing inappropriate variation, and MI Hospital Inform allows consumers to compare the price and quality of certain procedures from hospital to hospital. Value-based Purchasing - Health care reform will align financial incentives with positive patient outcomes, rather than number of services provided. The MHA PSO and MHA Keystone Center identify opportunities for improved quality and safety and implement evidence-based best practices that better serve the patient and eliminate unnecessary costs.   Rehospitalizations - Through MI STA*AR, Michigan hospitals and community partners are voluntarily addressing care coordination and communication among hospitals, patients and doctors that result in avoidable rehospitalizations. The voluntary efforts of Michigan hospitals have positioned the state as a benchmark for quality, efficiency and cost and have allowed Michigan’s hospitals to leverage their success to proactively address the provisions embodied in federal health care reform.As hospital payment incentives move toward rewarding quality versus quantity and value over volume, Michigan looks to the work of the MHA Keystone Center, MHA PSO and MI Hospital Inform to improve the continuum of care.   Variation - While some degree of variation in the use, delivery and cost of services is appropriate, a significant percentage of variation is inappropriate and preventable. The MHA Keystone Center helps create a culture that employs best practices to create consistency and reduce variation to the point of appropriateness. In addition, Michigan is pursuing increased hospital-physician alignment to improve systems of care. Transparency is also vital to reducing inappropriate variation, and MI Hospital Inform allows consumers to compare the price and quality of certain procedures from hospital to hospital. Value-based Purchasing - Health care reform will align financial incentives with positive patient outcomes, rather than number of services provided. The MHA PSO and MHA Keystone Center identify opportunities for improved quality and safety and implement evidence-based best practices that better serve the patient and eliminate unnecessary costs.   Rehospitalizations - Through MI STA*AR, Michigan hospitals and community partners are voluntarily addressing care coordination and communication among hospitals, patients and doctors that result in avoidable rehospitalizations. The voluntary efforts of Michigan hospitals have positioned the state as a benchmark for quality, efficiency and cost and have allowed Michigan’s hospitals to leverage their success to proactively address the provisions embodied in federal health care reform.

19. Questions For more information about <<HOSPITAL NAME>>’s quality and accountability efforts: <<name>> <<title>> <<phone>> • <<email>> For more information about the MHA’s quality and accountability efforts: Sam R. Watson Senior Vice President, Patient Safety and Quality (517) 323-3443 • swatson@mha.org www.mha.org Thank you for your time today. It is my/our hope that this brief presentation helped illustrate how Michigan hospitals are leading the nation in patient safety and quality advances through innovative, voluntary and successful efforts. If you have any questions, I/we would be happy to take them.Thank you for your time today. It is my/our hope that this brief presentation helped illustrate how Michigan hospitals are leading the nation in patient safety and quality advances through innovative, voluntary and successful efforts. If you have any questions, I/we would be happy to take them.