Using Baldrige Criteria to Achieve Performance Excellence ...

Using Baldrige Criteria to Achieve Performance ExcellencePatient Safety Improvement

atSSM Health Care

The Quality Colloquium at Harvard

August 27, 2003Presented by: Andrew Kosseff, MD, FACP

Medical Director of System Clinical Improvement

Agenda

SSM Health Care and MBNQA

Patient safety improvement

SSM Health Care (SSMHC)

Large Catholic health care system - St. Louis21 Hospitals, 3 nursing homes, home health care 4 Midwestern states5000 Physicians23,000 Employees$2 Billion revenue / year

1990 - CQI model adopted

1995 – MBNQA criteria added

1999 – MBNQA applications

The MBNQA Effort

Strong, committed leadershipMission centeredPerseveranceAttention to MBNQA feedback Conviction that the pursuit made us better

The Precursors of The MBNQA

Through our exceptional health care services,we reveal the healing presence of God

SSMHC’s Mission

Attend to our missionHave goals consistent with our missionHave mature improvement processesImplement effective system improvement initiativesUse comparisons to “best in class”

What MBNQA Means to SSMHC

Safety and Clinical ImprovementsSSMHC Clinical Collaboratives

Safety and Clinical ImprovementsSSMHC Clinical Collaboratives

The SSMHC Environment and The Clinical Collaboratives

The mission

The commitment to CQI

Our experience with the IHI Breakthrough Series

The Concept

By working together we can improve systemclinical performance resulting in exceptionalpatient care

Collaboratives 85 collaborative teams

Improving the Secondary Prevention of Ischemic Heart Disease ( Secondary Prevention) - 1/99

Improving Prescribing Practices (IPP) - 5/99

Using Patient Information to Improve Care (UPI) - 11/99

Enhancing Patient Safety Through Safe Systems (EPS) - 3/00

Improving the Treatment of Congestive Heart Failure (CHF) - 11/00

Achieving Exceptional Safety in Health Care (AES) - 1/02

Start of CollaborativeDesign

Collaborative

Prework

Continuous Improvement Phase

Active phase

Send out invitation

Team formation and data collection

Learning session #1

Project work and completion

Learning session #2, 3

Secondary Prevention

Data collection every 3 months

Conference calls every 2

months

CHF

AES

SSMHC’s Safety Improvement History

Pre - IOMIndividual caregiver and entity effortsIHI Collaborative – medication safetySSMHC Clinical Collaboratives

Post - IOMEnhancing Patient Safety Collaborative(EPS)Safety infrastructure changesAchieving Exceptional Safety Collaborative(AES)

Achieving Exceptional Safety in Health Care (AES)

Jan., 2002 .........Goal for the collaborativeTo have each entity adopt and implement 16 + recommended safety practices 3 year collaborative with 22 entities enrolled

16 + Recommended Practices1. Implement a near miss reporting system2. Eliminate dangerous abbreviations3. Design and implement an accurate patient medication list at

admission and discharge and avoid "home" medication and blanket orders

4. Implement an effective disclosure of unanticipated outcomes process

5. Provide and use protocols for high risk medications6. Implement a fall reduction process7. Implement a sentinel event review process8. Establish an entity Safety Center Team


yellow - upcoming collaborative recommended practice black - recommended practice in progress

16 + Recommended Practices9. Provide pharmacy rounding in ICU's10. Implement all recommended safety information technology

advances11. Implement 24 hour pharmacy coverage12. Provide a quarterly "state of safety report"13. Develop a protocol for proper timing of surgical antibiotic

prophylaxis14. Institute a needleless IV system15. Implement a protocol for glucose management of diabetic

patients undergoing surgery16. Implement a surgical site marking procedure to avoid

wrong limb surgery17. Effectively implement all JCAHO National Patient Safety

Goals18. Improve hand washing


Achieving Exceptional Safety in Health Care

Good

Use of Four Dangerous AbbreviationsAve. Performance of Collaborative Entities

0%

5%

10%

15%

20%

25%

Baseline Jan02(20)

March, 02(19) June, 02(20) Sept, 02(18) Dec, 02(19) March, 03(14)

Time of data collection

Per

cen

t u

se o

f D

As

SSMHC use of DAsEliminate “QD” for dailyEliminate “U” for unitsEliminate trailing zerosUse leading zeros


Good

Use of "QD" Instead of DailyAve. Performance of Collaborative Entities

0%

10%

20%

30%

40%

50%

60%

70%

BaselineJan02(19)

March, 02(18) June, 02(17) Sept, 02(14) Dec, 02(13) March, 03(12)


Per

cen

t u

se o

f "Q

D"

SSMHC use of DAs


Good

Use of "Blanket Orders" Ave. Performance of Collaborative Entities

0%5%

10%15%20%25%30%35%40%45%

Baseline 2002 (14) March '03 (16) July '03 (17)


Pe

rce

nt

us

e o

f "b

lan

ke

t o

rde

rs"

SSMHC Use of blanket orders

Near Miss Reporting and Safety Process Changes

Stimulate near miss reportingDemonstrate safety process changesMagnify benefits by collaborative sharing


Near Miss Safety Process Changes

Pharmacy staff re-educated on placement of narcotics in Pyxis

Enforced the transfer checklist that includes the process of discarding old labels on 3ICU

Near miss involving two look alike injectables being next to each other in Pyxis led to moving one of the meds to a different drawer

Separated out the different types of insulin in Pyxis, into different bins so staff are sure to pull the right type of insulin

Reviewing process use to document patient weights; changes recommended are to remove “lbs” and use “kg” on all forms andcomputer systems.


Near Miss Safety Process ChangesLiquid theophylline is available in pharmacy, as only thenonalcoholic type, to prevent the alcohol type being given toinfants/pediatric patients

Orange stripe on NG tube to avoid confusion w/ IV lines

Better identification of patients in “A” bed and “B” bed

Noted confusion re: acute coronary syndrome orders andthrombolytic orders, so revision of orders and education of staff was done

Stopped the practice of staff being able to override the lockout mode on PCA pumps.


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

base

line (

1/99)

April,

99Ju

ne, 9

9Sep

t. 99

June

, 00

Dec., 0

0Marc

h, 01

July,

01Dec

., 01

March,

02Ju

ne, 0

23rd

qrt02

(8)4th

qrt02

(7)1s

tqrt0

3(6)


Per

cent

of M

I pat

ient

s tr

eate

d w

ith L

LA's

SSM average

Benchmark 00

Benchhmark 02

better

8 new entities join

Mehta, RH et al. Quality Improvement Initiative and Its Impact on the management of Patients with Myocardial Infarction. Arch Intern Med. 2000; 160: 3057-3062 Mehta, RH et al. Improving the Quality of Care for Acute Myocardial Infarction. JAMA 2002; 287: 1269-76.

Secondary PreventionPercent of MI patients treated with Lipid Lowering Agents (LLA's)

Average Performance of Collaborative Hospitals

Core measures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

baseline (3-01)July, 01

Dec., 01March, 02

June, 023rdqrt02(11)

4thqrt02(9)1stqrt03(10)


% M

I pat

ient

s di

scha

rged

on

beta

bl

ocke

rs

SSM averageBenchmark00Benchmark 02JCAHO mean

Secondary PreventionPercent of MI Patients Discharged on Beta Blockers

Average Performance of Collaborative Hospitals

better

Mehta, RH et al. Quality Improvement Initiative and Its Impact on the management of Patients with Myocardial Infarction. Arch Intern Med. 2000; 160: 3057-3062 Mehta, RH et al. Improving the Quality of Care for Acute Myocardial Infarction. JAMA 2002; 287: 1269-76.

Core measures

Results of SSMHC’s Collaborative Safety Improvement Efforts

Progress towards safer patient care

Recognition that patient safety is a top priority

Unexpected benefits and adventures

Andy Kosseff [email protected] 608-238-1337

For more detailed information about MBNQA:visit SSM’s website at www.ssmhc.com

or contact Paula Friedman, VP of System Improvement at 314-994-7840

Using Baldrige Criteria to Achieve Performance Excellence ...

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