Leading Transformational Change
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Leading Transformational Change:
The Big Picture
South Carolina Hospital Association
2010 Patient Safety Symposium
Columbia, SC
Maureen Bisognano
Executive Vice President and COO
Institute for Healthcare Improvement
Objectives
After this session, participants will be able
to:
─ Identify key drivers for leaders seeking to
thrive in a new environment
─Define a portfolio of new designs that will
improve patient health and experience and
drive down costs
Health Care Expenditure Out of GDP
Difficulty Getting Care on Nights, Weekends, Holidays Without
Going to the Emergency Room, Among Sicker Adults
International Comparison
Percent of adults who sought care reporting ―very‖ or ―somewhat‖ difficult
2005 2007
United States
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
7681
88 8489 89
99 9788
97
109 106
116 115 113
130134
128
115
65 71 71 74 74 77 80 82 82 84 84 90 93 96 101 103 103 104 110
0
50
100
150
Fra
nce
Japan
Aus
tral
ia
Spa
in
Ital
yC
anad
aN
orw
ayN
ether
lands
Sw
eden
Gre
ece
Aus
tria
Ger
man
yFin
land
New
Zea
land
Den
mar
k
Uni
ted K
ingdo
m
Irel
and
Por
tugal
Uni
ted S
tate
s
1997/98 2002/03
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial
infections.
See report Appendix B for list of all conditions considered amenable to health care in the analysis.
Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization
mortality files (Nolte and McKee 2008).
Mortality Amenable to Health Care
HEALTHY LIVES
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 5
http://www.commonwealthfund.org/Maps-and-Data/State-Scorecard-2009/DataByState/State.aspx?state=SC
South Carolina HSMRs
50
60
70
80
90
100
110
120
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Reg
ressio
n A
dju
ste
d H
SM
R
Year
Regression-Adjusted Hospital Standardized Mortality Ratios (HSMRs) for South Carolina Hospital Referral Regions (HRRs)
Charleston HRR
Columbia HRR
Florence HRR
Greenville HRR
Spartanburg HRR
USA Medicare
So What If . . .
• Together, in this room, we set out to be as
safe as Ascension, or safer?
• Together, we design care across the
boundaries of our buildings?
• Together, we engage all to make our
families, friends, and staff healthier?
• Together, we show Washington that better
care can cost less?
So What If . . .
• Together, in this room, we set out to
be as safe as Ascension, or safer?
• Together, we design care across the boundaries of our buildings?
• Together, we engage all to make our families, friends, and staff
healthier?
• Together, we show Washington that better care can cost less?
Ascension Health’s Strategy
• Health care that works
• Health care that is safe
• Health care that leaves no one behind
─No preventable deaths by July 2008 across
the entire Ascension system
─No preventable harm by July 2008 across the
entire system
Pressure ulcers
Falls with harm
Medical errors
Birth trauma
Mortality Reduction Driver Diagram
Reduce
mortality
by 12%
this year
Primary Drivers
Leadership
Communication
between caregivers
High risk patient care
Intensive/Critical care
Prevention
Secondary Drivers
Analysis of mortality causes
2x2 review of last 50 patient deaths
Global Trigger Tool review of patient deaths in boxes 3
and 4
Board review on mortality
Standardization of patient handoffs
SBAR training for clinical staff & physicians
Multi-disciplinary rounds
Identification of attending physician for all patients
Implement birth bundles
Identification of high risk patients on admission and
during assessments
Rapid Response Team
Increased nursing and physician care
Hospitalists
Multi-disciplinary rounds
Daily goal sheets
Ventilator bundle
Glycemic control
Remote monitoring of patients
Intensivists
Influenza vaccine status of pneumonia patients
Community partnerships to promote care that prevents
critical illness
Eliminate falls with harm
Eliminate pressure ulcers
Perinatal Safety (Birth Trauma)Seton Medical Center – Austin, TX
St. Mary’s Medical Center – Evansville, IN
S t. M a ry 's B ir th T ra u m a s - C Y 2 0 0 5
10 .3 0 %9 .15 % 8 .6 3 %
13 .9 5 %
17 .3 6 %
16 .0 0 %
12 .0 6 % 12 .5 0 %
18 .8 7 %
12 .6 9 %
7 .2 6 %
10 .5 8 %
1.8 2 % 1.3 9 %
2 .9 9 %
1.6 1% 1.9 2 %
0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %0 .0 0 % 0 .7 1% 1.3 2 %
1.2 6 %
0 .7 2 %0 .6 1% 0 .0 0 %
0 %
- 5 %
0 %
5 %
1 0 %
1 5 %
2 0 %
Ja n Fe b M a r A p r M a y Ju n Ju l A u g S e p O c t N o v D e c
2 0 0 5
Pe
rc
en
t D
eliv
erie
s
In s t ru m e n t -A s s is t e d D e l ive rie s S h o u ld e r D y s to c ia B irt h T ra u m a
Alpha Spread Ascension Health System
Birth Trauma Rate
2.52
2.68
1.97
3.03
1.84
2.97
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06Month
Bir
th T
rau
ma
Rate
per
100
0 L
ive
Bir
ths
Birth Trauma Rate per 1000 Live Births Linear (Birth Trauma Rate per 1000 Live Births)
Unfavorable
Favorable
National Birth Trauma Rate = 6.59 /1000
Births
IHI Target Birth Trauma Rate = 3 /1000 Births
Birth Trauma Rate Goal for
Ascesnion Health = 0 /1000 Births
N = Number of Reporting Hospitals
N = 32
N = 36
N = 36
N = 35
N = 33
N = 35
Zero!
Reducing Harm in the ICU
Ventilator Acquired Pneumonia St. Vincent’s Hospital, Birmingham
Alpha Spread Ascension Health System
ICU/CVICU Combined VAP Rate
0
2
4
6
8
10
12
14
16
5/1
/200
4
7/1
/2004
9/1
/2004
11/1
/20
04
1/1
/20
05
3/1
/2005
5/1
/2005
7/1
/200
5
9/1
/2005
11/1
/2005
1/1
/2006
3/1
/20
06
5/1
/2006
7/1
/2006
VA
P r
ate
Per 1
00 V
en
t d
ays
NNIS Average = 4.15 VAP per 1000 Ventilator Days
System Trend VAP Rate
3.03
3.55
2.50
2.25
1.68
2.53
2.63
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06Month
VA
P r
ate
Per 1
00 V
en
t d
ays
Vap Rate per 1000 ICU Vent days Linear (Vap Rate per 1000 ICU Vent days)
NNIS Average = 4.15 VAP per 1000 Ventilator Days
Unfavorable
Favorable
Ascension Health Goal is 0 VAP per 1000 Ventilator Days
N = Number of Reporting Hospitals
N =43
N = 43
N = 43
N = 43
N = 44
N = 42
N =39
Zero!
Reducing Harm in the ICU
Blood Stream Infections St. John’s Hospital, Detroit
Alpha Spread Ascension Health System
BSI Rate
0
1
2
3
4
5
6
7
8
9
10
De
c-0
3
Jan-0
4
Feb-0
4
Mar-
04
Apr-
04
May-0
4
Jun-0
4
Jul-04
Aug-0
4
Sep-0
4
Oct-
04
No
v-0
4
De
c-0
4
Jan-0
5
Feb-0
5
Mar-
05
Apr-
05
May-0
5
Jun-0
5
Jul-05
Aug-0
5
Sep-0
5
Oct-
05
No
v-0
5
De
c-0
5
Jan-0
6
Feb-0
6
Mar-
06
Apr-
06
May-0
6
Jun-0
6
Jul-06
BS
I p
er 1
000 C
en
tral
Lin
e d
ays
NNIS Average = 4.22 BSI per 1000 Central Line Days
System Trend BSI Rate
1.37
1.38
1.69
2.33
1.35
1.74
1.38
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06
Month
BS
I R
ate
Per 1
000 C
en
tral
Lin
e d
ays
BSI Rate Per 1000 CL Days Linear (BSI Rate Per 1000 CL Days)
Unfavorable
Favorable
NNIS Average = 4.22 BSI per 1000 Central Line Days
Ascension Health Goal is 0 BSI per 1000 Central Line Days
N =38
N =39
N = 38
N = 39
N = 39
N = Number of Reporting Hospitals
N =38
N =35
Zero!
Surgical ComplicationsColumbia St. Mary’s – Milwaukee, WI
Sacred Heart Hospital – Pensacola, FL
Columbia St. Mary’s - Milwaukee Sacred Heart HospitalPerioperative Adverse Event (POAE) Rate
Columbia St. Mary's, Milwaukee WI
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Mar
-04
Apr
-04
May
-04
Jun-
04
Jul-0
4
Aug
-04
Sep
-04
Oct-0
4
Nov-
04
Dec-
04
Jan-
05
Feb-0
5
Mar
-05
Apr
-05
May
-05
Jun-
05
Jul-0
5
Aug
-05
Sep
-05
Oct-0
5
Nov-
05
Dec-
05
Jan-
06
Feb-0
6
Mar
-06
Apr
-06
May
-06
PO
AE
Rate
per
Pati
en
t
POAE Rate CL UCL LCL
Perioperative Adverse Event (POAE) Rate
Sacred Heart Hospital, Pensacola FL
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Jan-0
4
Feb-0
4
Mar-
04
Apr-
04
May-0
4
Jun-0
4
Jul-04
Aug-0
4
Sep-0
4
Oct-
04
Nov-0
4
Dec-0
4
Jan-0
5
Feb-0
5
Mar-
05
Apr-
05
May-0
5
Jun-0
5
Jul-05
Aug-0
5
Sep-0
5
Oct-
05
Nov-0
5
Dec-0
5
Jan-0
6
Feb-0
6
Mar-
06
Apr-
06
May-0
6
Jun-0
6
Jul-06
PO
AE
Rate
per
Pati
en
t
POAE Rate CL UCL LCL
Zero!
Pressure Ulcer Prevention
Facility Acquired Pressure Ulcer RateSt. Vincent Hospital, Jacksonville
Overall PU ratio by week
0.38
1.93
2.53
2.11
2.46
0.390.37
0.75
1.90
1.04
3.31
0.36
0.74
1.171.17
1.001.03
2.78
1.47
1.03
0.32
1.01
0.32
0.69
1.68
0.32
0.94
1.65
2.00
1.05
0.69
0.340.33
0.990.99
1.38
0.71
1.05
0.71
1.411.39
0.39
0.00
0.35 0.39
0.75
1.07
0.69
0.37
1.46
0.35
0.67
1.07
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
WE
8/2
9/0
5
WE
9/1
2/0
5
WE
9/2
6/0
5
WE
10/1
0/0
5
WE
10/2
4/0
5
WE
11/7
/05
WE
11/2
1/0
5
WE
12/5
/05
WE
12/1
9/0
5
WE
1/2
/06
WE
1/1
6/0
6
WE
1/3
0/0
6
WE
2/1
3/0
6
WE
2/2
7/0
6
WE
3/1
3/0
6
WE
3/2
7/0
6
WE
4/1
0/0
6
WE
4/2
4/0
6
WE
5/8
/06
WE
5/2
2/0
6
WE
6/5
/06
WE
6/1
9/0
6
WE
7/3
/06
WE
7/1
7/0
6
WE
7/3
1/0
6
WE
8/1
4/0
6
WE
8/2
8/0
6
Alpha Spread Ascension Health System
1 .5 7
1 .6 61 .6 3
1 .3 8
1 .4 1
1 .2 7
1 .4 8
0 .5 0
1 .0 0
1 .5 0
2 .0 0
J a n - 0 6 F e b - 0 6 M a r - 0 6 A p r - 0 6 M a y - 0 6 J u n - 0 6 J u l- 0 6
M o n t h
Pre
su
re
U
lc
er R
ate
p
er 1
00
0 P
atie
nt D
ay
s
P r e s s u r e u lc e r r a te p e r 1 0 0 0 In p a t ie n t D a y s L in e a r ( P r e s s u r e u lc e r r a te p e r 1 0 0 0 In p a t ie n t D a y s )
U n f a v o r a b le
F a v o r a b le
N = 5 0
N = 5 0
N = 5 1
N = 5 0
N = 5 0
N = N u m b e r o f R e p o r t in g H o s p it a ls
N = 5 1
N = 5 0
50 hospitals reporting: Overall Rate 1.38
National Rate:
Zero!
Alpha Spread Ascension Health System
Borgess Medical Center
Non-Critical Care Codes per 1,000 discharges
0
2
4
6
8
10
Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06
NON-CC CODES (per 1000 disch)
Non-Critical Care Code Rate by Month for Reporting Hospitals
3.19
3.07
3.293.23
3.47
3.38
3.25
3.563.50
2.84
2.96
2.85
2.71
2.4
2.6
2.8
3.0
3.2
3.4
3.6
Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06
Rate p
er 1000 D
isch
arg
es
Non-Critical Care Code Rate per 1000 DischargesLinear (Non-Critical Care Code Rate per 1000 Discharges)
favorable
unfavorable
N= Number of Reporting Hospitals
Non-CC Code Rate Goal for
Ascension Health: 0 / 1000
Discharges
n=25 n=27 n=24 n=24 n=22 n=22 n=36 n=34 n=35 n=35 n=35 n=37 n=33
33 hospitals reporting: Overall Rate 2.71
Reducing Harm in the ICU
Rapid Response Teams – Non-Critical Care Codes and RRT CallsBorgess Hospital, Kalamazoo
Error Reduction at Ascension
Pressure Ulcer
Neonatal mortality
Birth Trauma
Ventilator-acquired pneumonia
Falls with serious injury
Blood-stream infections
Preventable Error Reduction in rate
95%
79%
74%
56%
54%
32%
July, 2008 Update: ―A Partial Success‖
• Ascension set a goal of preventing 900
unnecessary deaths by Summer 2008.
• In July, they announced they had, in their
estimation, prevented 2,700 deaths –
three times their stated goal.
Ascension Health: New Aim
Healing Without Harm
by 2014
Palmetto Hospital Mortality Rates
So What If . . .
• Together, in this room, we set out to be as safe as Ascension, or
safer?
• Together, we design care across the
boundaries of our buildings?
• Together, we engage all to make our families, friends, and staff
healthier?
• Together, we show Washington that better care can cost less?
A Case Study From University of
Pittsburgh Medical Center (UPMC)
• Aims in redesigning care for patients
undergoing total joint replacement1. Patient and family education
2. Less invasive techniques
3. Multimodal anesthesia and pain management techniques
4. Rapid rehabilitation protocols
5. Rapid outcomes feedback (from the patients’ and the
providers’ perspectives
6. Creating a learning environment and culture
7. Developing a sense of community, competition and teamwork
among patients and between patients, caregivers and staff
8. Promoting a wellness (rather than sickness) approach to
recovery DiGioia A, Greenhouse P, Levison T. ―Patient and Family-
centered Collaborative Care: An Orthopaedic Model‖.
Clinical Orthopaedics and Related Research. 2007: 463;
pp: 13-19.
Tony DiGioia
Dr. Anthony M. DiGioia III, orthopedic surgeon
and developer of the patient- and family-centered
care program for UPMC, in his office at Magee-
Womens Hospital in Oakland.
A Case Study From UPMC
• New Designs:
─Pre-op testing, teaching
─Coaching meetings with other patients
─Pre-surgery discharge planning
─Strong focus on complete pain management
─―Wellness‖ design in orthopedics unit
DiGioia A, Greenhouse P, Levison T. “Patient and Family-
centered Collaborative Care: An Orthopaedic Model”. Clinical
Orthopaedics and Related Research. 2007: 463; pp: 13-19.
Results
• Safe:
─Mortality rate: 0%
─ Infection rates: 0.3% (0.2% for TKA and 0.7%
for THA)
─Zero dislocations
─SCIP compliance: 98% for antibiotics within one
hour of surgery
DiGioia A, Greenhouse P, Levison T. “Patient and Family-
centered Collaborative Care: An Orthopaedic Model”. Clinical
Orthopaedics and Related Research. 2007: 463; pp: 13-19.
Results
• Effective:
─95% of patients discharged without handheld
assistance directly to home (national rates:
23-29%)
─99% of patients reported that pain was not an
impediment to physical therapy, including
same-day-of-surgery physical therapy
DiGioia A, Greenhouse P, Levison T. “Patient and Family-
centered Collaborative Care: An Orthopaedic Model”. Clinical
Orthopaedics and Related Research. 2007: 463; pp: 13-19.
Results
• Patient-centered:
─ Press-Ganey mean satisfaction score is 91.4% (99th
national percentile ranking) with 99.7% positive
responses to ―Would you refer family and/or friends?‖
• Efficient:
─ Average length of stay:
2.8 days for TKA (national average is 3.9 days)
2.7 days for THA (national average is 5.0 days)
─ One MD able to perform 8 joint replacements before
2:00pm
DiGioia A, Greenhouse P, Levison T. “Patient and Family-
centered Collaborative Care: An Orthopaedic Model”. Clinical
Orthopaedics and Related Research. 2007: 463; pp: 13-19.
Other PFCC Projects at UPMC
• Day of Surgery (UPMC Presbyterian)
• Human Resources – The New Hire Experience (UPMC
Corporate)
• Trauma (UPMC Presbyterian)
• Wayfinding / Lobby (Magee-Women’s Hospital)
• Rheumatology (Children’s Hospital of Pittsburgh)
• Minimally Invasive Bariatric and General Surgery
(Magee-Women’s Hospital)
• Home Health Rehabilitation (Jefferson Regional)
So What If . . .
• Together, in this room, we set out to be as safe as Ascension, or
safer?
• Together, we design care across the boundaries of our buildings?
• Together, we engage all to make our
families, friends, and staff healthier?
• Together, we show Washington that better care can cost less?
Health Outcomes
• 1 in 10 adults in SC has diabetes
• 22% of adults in SC smoke (compared with 18.3% nationally)
• 65.8% of adults in SC are either obese or overweight (compared
with 63% nationally)
• 15.1% of adults in SC report having a disability (compared with
12.8% nationally)
• Mortality rates amenable to health care are 115.5 per 100,000
compared with 89.9 per 100,000 nationally.
• Commonwealth Fund ranks SC 33th in US for Prevention and
Treatment in 2009 (in 2007 was ranked 35th)
What if we started with all health care workers in
out hospitals like Bellin, and then spread to our
families and friends?
Health Navigation: Bellin Health
The new gateway to
Bellin Health.
Personal, tailored
treatment to
individuals’ needs,
learning styles and
lifestyles.
Bellin Health
Cost of Employee Plan vs. AveragesBellin Health
Solutions
Program
Introduced Funded Personal
Benefit Accounts began
($500/$1000)
So What If . . .
• Together, in this room, we set out to be as safe as Ascension, or
safer?
• Together, we design care across the boundaries of our buildings?
• Together, we engage all to make our families, friends, and staff
healthier?
• Together, we show Washington that
better care can cost less?
What If . . .
We took on Tom Nolan’s
challenge to limit spending
growth to 3% per year?
The Triple Aim
Population
Health
Experience
of Care
Per Capita
Cost
The Triple Aim
• Improve Individual Experience
• Improve Population Health
• Control Inflation of Per Capita Costs
The root of the problem in health care is that the business models of almost all US health care organizations depend on keeping these three aims separate. Society on the other hand
needs these three aims optimized (given appropriate weightings on the components) simultaneously.
--- (Tom Nolan, PhD)
HealthPartners
1.0005
0.90889%
37%
0.906
0.926
0.946
0.966
0.986
1.006
4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09
To
tal C
ost In
de
x
9%
17%
25%
33%
98%97%
85%
90%
95%
100%
% patients with Optimal
Diabetes Control* * controlled blood sugar (perICSI guideline A1C changed
from < 7 to < 8 in 1st quarter 2009), BP & cholesterol, AND
daily aspirin use, AND non-tobacco user
% patients “Would
Recommend” HealthPartners
Clinics
Total Cost Index
(compared to statewide average)
< 1 is better than network average
TRIPLE AIM: Health-Experience-AffordabilityHealthPartners Clinics
Domestic Triple Aim Sites
• Hospital-Based Systems
Cape Fear Valley (NC)
Bellin Health (WI)*
Cincinnati Children’s Hospital Medical Center (OH)*
Genesys Health (MI) (Ascension)*
ThedaCare (WI)
• Integrated Health Systems
Group Health (WA)*
HealthPartners (MN)*
Kaiser Permanente, Colorado Region (CO)
Kaiser Permanente, Mid-Atlantic Region (MD)
Martin’s Point Health Care (ME)
Presbyterian Healthcare (NM)
Southcentral Foundation and Alaska Native Medical
Center (AK)
Veterans Health System:
VISN 10—Cincinnati VAMC (OH)
VISN 20—Portland VAMC (OR)
VISN 23—Nebraska, Western Iowa VAMC (NE)
• Health Plans
Blue Cross Blue Shield of Michigan (MI)
CareOregon (OR)*
Eastern Carolina Community Plan (NC)
New York-Presbyterian System SelectHealth, LLC
(NY)*
UPMC Health Plan (PA)
Independent Health (NY)
Wellmark (IA)
• Public Health Department
King County Department of Public Health (WA)
• State Initiative
Vermont Blueprint for Health (VT)*
• Safety Net
Colorado Access (CO)
Contra Costa Health Services (CA)*
North Colorado Health Alliance (CO)*
Primary Care Coalition Montgomery County (MD)*
Queens Health Network (NY)*
• Employers/Businesses
QuadGraphics/QuadMed (WI)*
• Social Services
Common Ground (NY)* Sites that participated in the first phase of Triple Aim Prototyping.
International Triple Aim
Prototyping Sites
• Jonkoping (Sweden)
• NHS Blackburn With Darwen PCT (NW England)
• NHS Bolton PCT (NW England)
• NHS Bournemouth and Poole (SW England)
• NHS East Lancashire Teaching PCT (NW England)
• NHS Eastern and Coastal Kent PCT (South East Coast England)
• NHS Forth Valley (Scotland)
• NHS Heywood, Middleton and Rochdale PCT (NW England)
• NHS North Lancashire Teaching PCT (NW England)
• NHS Medway (South East Coast England)
• NHS Oldham PCT (NW England)
• NHS Salford PCT (NW England)
• NHS Somerset PCT (SW England)
• NHS Swindon PCT (SW England)
• NHS Tayside (Scotland)
• NHS Torbay Care Trust (SW England)
• NHS Blackpool PCT (NW England)
• NHS Bury PCT (NW England)
• NHS Central Lancashire PCT (NW England)
• NHS Sefton PCT (NW England)
• NHS Warrington PCT (NW England)
• NHS Western Cheshire PCT (NW England)
• NHS Wirral PCT (NW England)
• State of South Australia, Ministry of Health (Australia)
• Western Health and Social Care Trust (Northern Ireland)
Last Updated 7/21/09
Thriving Under Reform
Improve Safety
Engage Patients
Improve Efficiency
Leadership
Reduce medical errors and harm
Reduce “never events”
Chronic conditions self-management
Prevention and wellness (start with your staff)
Transparency for high-performing providers
Shared decision making
New models for medically complex patients
Palliative care improvement
Reduce artificial variation (LOS, use rates, readmissions, etc.)
Eliminate “flow faults”
Set a goal of reducing waste by 1-3% of operating expense budget for I year, year on year
Create a culture of getting value for money
Adopt a proactive approach to errors and harm to reduce malpractice claims and costs
Engage the Board
Leadership Driver Diagram for Thriving Under Reform
Thank You!
• Maureen Bisognano
Executive Vice President and COO
Institute for Healthcare Improvement
20 University Road, 7th Floor
Cambridge, MA
mbisognano@ihi.org
617-301-4800
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