Cathy Grossi and Becky Steward Illinois Hospital Association The Quality Colloquium

1. Innovation, Advocacy, and Lessons Learned: How IHA Implemented a Patient Safety Learning Collaborative Cathy Grossi and Becky Steward Illinois Hospital Association The Quality Colloquium Harvard University August 21, 2006

2. About “Land of Lincoln” Illinois Facts: • 5th most populous state (12.5 M) • 25th largest (57,918 sq. miles) • Agriculture • Springfield / Chicago • 200+ Hospitals • Academic Centers (19) • S & R (90) • CAH (51) • Top 3 employer in 48 / 102 counties • 1.6 Million inpatients • 4.9 Million ED • Medicare (40%) / Med (13%) • Uncomp care – $1.2 B

3. Illinois Hospitals Hx - Partners in Quality: • Perinatal: 10 Networks / 148 Hospitals • Newborn Hearing Screening: 144 report • Metabolic Screening: Expanded testing (6-30) • EMS / Trauma: 11 Regions / 67 Hospitals • EMSC: 11 Regions / 206 Hospitals • Organ / Tissue Donation & Transplant • Communicable Disease • Cancer Registry

5. Patients at Risk Hospitals Harm: • Medical Error • Inadequate Staffing • Poor Infection Control Practices

6. PoliticalLandscape 2002 Springfield’s “New World” Order: • Democratic sweep of state government • New Governor, Democrat • Leadership of the General Assembly • Largest turnover of state legislators in 25 yrs • 46 new legislators (29 in the House, 17 in the Senate) • Union-friendly environment

8. IHA Collective Initiative Multiple Objectives: Internal improvement + Advocacy & leadership

9. Medication Safety Slam Dunk: • 4 Billion prescriptions/yr • 20% of medical errors • 2 to 7 per 100 hospital admissions • ADE – 1 to 5 day extended LOS • Up to add’l $9000 cost

10. Proactive Focus Criteria: • Addresses issue of public concern • Contributes to real improvement • Reasonable and fair to providers & public • Operationally feasible • W/in provider control & consistent w/accred • Offers measurement activity Drive results bigger than one organization

11. Addressing the Issue Develop, adopt and/or support efforts for: • Pt Safety Organizational Framework • Hospital Compliance/Consumer Guide • Medication Safety Initiative • Simulation Training (Team Skills) • Networking Roundtables

12. Organizational Framework * • From accreditation, gov’t, literature & member sources • Approved by IHA Board in May, 2003 • IHA web site: Pledge Participants • Member Pledge: 188/194 Hospitals (97%) Advocacy: On-going Leadership effort * Available at www.ihatoday.org

13. IHA Resource Guide * Update–In-Progress: • IHA Quality/Patient Safety Data Guide • Federal/state/private activity • Hard copy/PDF format • Initial distribution: Mid-Quarter 2004 • New section - Publicly available hospital info * Available at www.ihatoday.org

14. IHA Medication Safety From Medication Safety To Patient Safety Learning Collaborative

15. Behind the Scenes Med Safety = Do a Collaborative (2003-2004): • Learning curve • Business plan • Internal marketing • Job description • Recruitment • Marketing plan • Project management tool

16. Just in Time Project Development : • Phases (Pre-work, learning sessions, video-conferences, site visits, showcase conference): • Marketing Budget & Contracts • Speakers Materials & printing • Registration Evaluations • Meeting logistics Revision • On-going Focus: • Dedicated manager • Faculty advisors • Online Forum • Measurement Strategy • Participant Feedback & Reports • PSLC Visibility

17. IHA Patient Safety Learning Collaborative Three Aims: • Individual Hospital Improvement • Aggregate Hospital Improvement • IHA Process

18. The Constant Challenge Balance

19. Unique Illinois Patient Safety Nexus Coalitions Illinois Hospitals Safety Champions PSLC Quality Oversights Regulatory & Legislative Other States Patients & Families Media

20. Becky Steward, BSN Manager, Patient Safety Learning Collaborative

21. Concept to Implementation Framework Model for Improvement • Learning from Leaders • A tool and a philosophy

22. Establish Foundation Advisors and Facilitators • Role • Involvement Speakers • Criteria • From external to internal

23. Build Infrastructure Develop • Measures and tools * • Processes Staff • Labor intensive • FTEs * Available upon request

24. Build Infrastructure Preparation • Content • Materials and resources • Evaluations

25. Build Awareness Marketing • Audience • Message points • Non-competitive • Size

26. Bring Program to Participants Overview 2005 Participants • Health System 1 • Hospitals 25 Geographical cross-section • Northern 10 • Central 7 • Southern 9 Staffed beds • Less than 100 2 • 101 – 300 17 • 301 – 500 4 • More than 500 2

27. Three Distinct Phases • Pre-work • Action • Sharing

28. Phase One: Pre-work Engage Participants • Letter • Conference call * • Baseline data collection * * Available upon request

29. Critical Elements Build Relationships • Access • Follow-through Manage expectations • Tracking tool * * Available upon request

30. Phase Two: Action Information and Networking • Learning Sessions • Videoconferences • Issues and adjustments • On-line Forum • Site visits

31. Unify Diverse Groups Techniques • Unlabeled profiles • Of cameras and candy • New ways to use data

32. Each event involves one or more handoffs 2004 IHA Data, Participants 2006

33. Imagine the number of handoffs Are we lucky? Or are we safe?

34. Humor Imagery

35. Facilitate Communication On-line Forum • Limited to participants • “Voice from which I speak” • Enable direct contact

36. Assess Progress Monthly reports • Succinct • Inherent value • Challenges Measuring progress • Data • “Are you done yet?”

37. Innovation in Measurement * Progress over time No Process Process Established Healthy Hospital in Jan-05 Healthy Hospital in Jun-05 Healthy Hospital in Sep-05 Level 1 Level 2 Level 3 Level 4 Level 5 Having preliminary discussions Developing initial tool / process Testing tool / process on pilot units, collecting preliminary data Expanding use beyond pilot units, collecting / reporting data Implementation across organization, monitoring data * Available upon request

38. Provide Feedback By facilitators Reports to participants • Individual • Aggregate

39. Excerpt – 2005 Final Report

40. Excerpt – 2005 Final Report

41. Excerpt – 2005 Final Report

42. Excerpt – 2005 Final Report

43. Phase Three : Sharing Outcomes Congress October 18, 2006 Bloomington, IL Highlights: • Attendance • Engagement Challenges Beyond Illinois

44. Elements for Success Common Themes • Commitment • Expectations • Resources • Composition • Effective meetings • Small tests of change

45. Unique Challenges in 2006 Unique Challenges in 2006 Building on 2005 • 17 of 26 return • Experience Breaking new ground

46. 2006 - Handoff Communication Participants • Health Systems 4 • Hospitals 21 Geographical cross-section • Cook County 15 • Northern 10 • Central 6 • Southern 10 Staffed beds • Less than 100 4 • 101 – 300 26 • 301 – 500 9 • More than 500 2

47. Adjustments in 2006 Master calendar / timeline Role changes Changes to reporting Size

48. Save the Date! IHA Safety Connections: Relaying the Lessons Learned November 14, 2006 Hilton Hotel Lisle / Naperville Registration limited www.ihatoday.org

49. “It's a job that's never started that takes the longest to finish.” J.R.R. Tolkien British scholar & fantasy novelist (1892 - 1973)

50. Questions?