TAKING TRANSFORMATIONAL CHANGE TO SCALE: REDUCING MRSA AND OTHER INFECTIONS 5 th National Pay for Performance Summit: Mini Summit IV: Tools and Strategies to Support Transformational Change San Francisco, CA, March 8-10, 2010 Brad Doebbeling, MD, MSc Professor of Medicine, Epidemiology, & Biomedical Engineering, Indiana University School of Medicine Senior Scientist, IU Center for Health Services Research, Indianapolis VA COE, Regenstrief Institute, Indianapolis Award Number: HHSA290200600013I, Task Order No. 4
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Taking transformational change to scale:Reducing MRSA and other infections. 5th National Pay for Performance Summit: Mini Summit IV: Tools and Strategies to Support Transformational Change San Francisco, CA, March 8-10, 2010
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TAKING TRANSFORMATIONAL CHANGE TO SCALE:
REDUCING MRSA AND OTHER INFECTIONS
5th National Pay for Performance Summit:
Mini Summit IV: Tools and Strategies to Support Transformational Change
San Francisco, CA, March 8-10, 2010
Brad Doebbeling, MD, MSc
Professor of Medicine, Epidemiology, & Biomedical Engineering, Indiana University School of Medicine
Senior Scientist, IU Center for Health Services Research, Indianapolis VA COE, Regenstrief Institute,
Indianapolis
Award Number: HHSA290200600013I, Task Order No. 4
Acknowledgements Funding from AHRQ
Testing Techniques to Radically Reduce Antibiotic Resistant Bacteria HHSA2902006000131 (Completed)
Healthcare Associated Infections (HAI) Initiative Assessment Program HHSA290200600013I (Current)
Implementing and Improving the Integration of Decision Support into Outpatient Clinical WorkflowHSA2902006000131(Current)
Funding from AHRQ and CDCTesting Spread and Implementation of Novel MRSA-
Reducing Practices HHSA290200600013 (Current)Thanks to our collaborators, partners, providers, patients!
Capacity for Impact High priority project to avert illness, suffering,
and death
Unique International Collaborative Learning community of practice (7 hospitals) Electronically and culturally interconnected International consortium
“Collaboration” – What does it mean? “Coming together is a beginning. Keeping
together is progress. Working together is success.” – Henry Ford.
“Teamwork divides the task and multiplies the success.” - Unknown
“Teamwork is the ability to work together toward a common vision; the ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” – Andrew Carnegie
Infection control a regional problem, requiring coordinated effort
Created citywide electronic notification system to prospectively track all known patients with MRSA
Track over 17,000 patients with a h/o MRSA infection or colonization across Indianapolis.
Delivered 2698 admission alerts on patients with a history of MRSA, 19% from another institution.
20 infection control providers (ICPs) spanning 16 hospitals
Kho, Lemmon, Dexter, Doebbeling AMIA 2008
Alerts
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Alerts
An Operational Citywide Electronic Infection Control Network
% of Coded Segments in the Technical Sub-Section by Themes & Sites
Jumped in the deep water with 20 minutes of training
Transmission Disaster Response Teams Transmission Disaster
Response Teams D&ADs dialogues and
leader rounds linked with specific transmission cases to build collective mindfulness within and across units.
Sharing Results Community
briefing Making sense
of maps on the units
Clinical leaders
Admin leaders
Where am I? Is our network smarter than MRSA?
Social Network Mapping + Culture Survey Dreaming up
& researching questions
Social networking software
Creating a “family of measures”
Social Network Analysis Reveals communicative
patterns of complex groups and teams
Identifies the strength and frequency of connections
(e.g., with whom and how often do you communicate about reducing MRSA)
Describes current network in general & MRSA Bundle implementation in particular
Whom would you like to include or see involved in future MRSA prevention work?
Organizational Benefits of Change Staff developed skills and
processes
Documented, standardized processes
Isolation signs and chart stickers
Documented protocols for Active Surveillance & Prevention
Patient, family and staff education materials and methods
Partnering in Data Collection, Analysis,
Reporting Document impact in standardized language
Characterize efforts and strategies that work and disseminate nationally
Engagement of teams & coaches planning and conducting
Dissemination strategies- capturing stories, social networks, engagement, outcomes
Document ROI Impact
Reduction in MRSA isolates in an ICU
Literature Cost Savings (per Infection):
$ 6,916 - $35,000
Active Surveillance & Precautions Cost: Max $ 610 per infected patient (10%)
Methods challenging
Working with teams (& CFOs) to capture these data in meaningful way
Source: The Impact of Methicillin Resistance in Staphylococcus Aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges, Cosgrove, et al, February 2003
Vision for Data Services – R&D Needed
Increased use of Electronic Data
Less effort on SurveillanceMaximize return on surveillance efforts
More effort on active InterventionResults Oriented
Actionable Information &Value-added services
Standardized, Accurate Measurement
Optimized Outcomes- Clinical & Financial
Conclusions Start small, build on success. Organizational change & sustainability
strategies needed. Change initiatives need both top-down
support and bottom-up engagement. Collaboratives foster teamwork! Resource and data intensive. Enthusiasm builds from within
because redesign teams own it! Informatics tools helpful –needs
R&D
“Collaboration” – What does it mean? “Alone we can do so little; together we can do so
much.” – Helen Keller “Strength is derived from unity. The range of our
collective vision is far greater when individual insights become one.” – Andrew Carnegie