Minnesota Hospital Association Wins Dick Davidson Quality Milestone Award

Winner: Minnesota Hospital Association

For 15 years, the Minnesota Hospital Association has committed to being on the leading edge of hospital quality and patient safety. After the Institute of Medicine released its 1999 landmark report, “To Err is Human: Building a Safer Health System,” MHA became the first state hospital association to hire a full-time, dedicated staff member focused on patient safety.

Minnesota was an early leader in developing a unique statewide quality alliance known as the Minnesota Alliance for Patient Safety. This first community partnership grew to include more health care stakeholders in multiple quality and safety initiatives. MHA, along with the Minnesota Department of Health, in 2003 championed a new, public reporting of adverse health events as a learning and improvement system.

Following the creation of the adverse health event reporting system, Minnesota launched a “Call-to-Action” framework to help hospitals improve through easy-to-use road maps that highlight best practices. Call-to-Action road maps are available at no cost on MHA’s website for all interested health care organizations. Member hospitals and health care organizations are recognized with an MHA banner for display in the hospital once a hospital or health system accomplishes 90 percent of the best practices in a road map.

The Call-to-Action framework has proven successful in preventing falls, pressure ulcers and retained objects. A medication safety road map became highly sought after nationally; at least half of all U.S. hospitals have received and benefited from this tool.

In 2011, MHA embarked on the largest coordinated health care quality improvement initiative ever undertaken in the state — the Reducing Avoidable Readmissions Effectively (RARE) Campaign. Using its hospital discharge database, MHA set a baseline for readmissions at the campaign’s outset and then tracked the numbers provided by hospitals that agreed to share their results with others for learning purposes.

“When there’s transparency of data, that tends to motivate folks even more,” says Lawrence J. Massa, president and CEO of MHA, which has 143 hospital and health system members.

Eighty-three participating hospitals and health care organizations focused their work on five areas that contributed to readmissions: comprehensive discharge planning, medication management, patient and family engagement, transition care support and transition communications. By the end of 2012, MHA surpassed its original goal of preventing 4,000 avoidable readmissions, allowing patients to sleep at home 16,000 more nights.

Compared with baseline figures from 2010, hospitals noted a substantial decline in readmissions as they gained expertise in engaging community partners, including nursing homes, home care agencies and ambulatory care to decrease fragmentation in care transitions.

As a result of the RARE Campaign, from 2011 to 2013, Minnesota hospitals prevented 8,773 readmissions, saved more than $70 million and helped patients sleep 35,000 nights at home instead of in the hospital. By the last quarter of 2013, Minnesota hospitals collectively demonstrated a 19 percent reduction in readmissions, when compared with the 2010 baseline figure.

As one of 26 Hospital Engagement Networks created by the Center for Medicare & Medicaid Services’ Partnership for Patients initiative, 115 participating Minnesota hospitals prevented pressure ulcers, falls, health care-associated infections, wrong-site surgeries and adverse drug events; eliminated early elective deliveries; and promoted a culture focused on safety. Between 2011 and 2013, MHA’s Partnership for Patients work resulted in 13,600 fewer instances of patient harm, saving more than $93 million across all 115 hospitals participating in the MHA HEN topics.

Last year, MHA was one of only six “Leading Edge Advance Practice Topics,” or LEAPT, hospital engagement networks named by CMS. The project intensified efforts to address sepsis, employee resilience, and patient and family engagement.

After 12 years of adverse health events reporting, the total number of reported adverse events experienced its largest-ever decline, a 33 percent reduction of pressure ulcers from 2011 to 2013. Retained foreign objects were reduced by 27 percent and wrong body part surgical or other invasive procedures decreased by 36 percent.

“We’ve seen a reduction in overall volumes of adverse events and, in particular, the volume of deaths due to adverse events,” says Steven Mulder, M.D., president and CEO of Hutchinson Health, chair of MHA’s Patient Safety Registry Advisory Council.

“For 15 years, Minnesota hospitals and health care organizations have worked to expand our quality and safety strategy,” Massa said. “MHA has found that transparency of results, sharing best practices, collaboration among partners and our members, and tailoring solutions to the needs of individual hospitals are instrumental to a successful quality improvement effort.”

To learn more, go to: www.mnhospitals.org/patient-safety. 

Honorable Mention: The Hospital & Healthsystem Association of Pennsylvania

Pennsylvania 'achieves more together' for quality and patient safety improvements

Sharing best practices. Collaborating with providers and stakeholders. Reflecting on what ultimately is best for patients and their health care experiences and outcomes. These are ways that the Hospital & Healthsystem Association of Pennsylvania (HAP) and its member hospitals have driven positive change for quality and patient safety in the Keystone State.

HAP’s Pennsylvania Hospital Engagement Network (PA-HEN) — through a three-year (2012–2014) Centers for Medicare & Medicaid Services’ Partnerships for Patients initiative — led a collaborative of 137 general acute care, long-term acute care, rehabilitation and behavioral health hospitals. All had a common goal: to improve quality and patient safety in Pennsylvania. This motivated group, along with more than 90 local, regional, state and federal partners, adopted the phrase “achieving more together” and worked as a team to reduce all-cause harm and preventable readmissions.

HAP’s PA-HEN and hospitals’ efforts resulted in a staggering 37 percent reduction in all-cause harm and a critical 26 percent reduction in 30-day all-cause readmissions. These important reductions also resulted in the prevention of 136,319 harm events and an estimated cost-avoidance of $694 million in Pennsylvania.

“The results of Pennsylvania hospitals’ quality improvement work is nothing short of remarkable,” says HAP President and CEO Andy Carter. “These positive strides toward better quality and safer patient care have a great deal to do with hospitals’ collaborative and team-based approaches to creating meaningful improvements.”

Carter emphasizes that, “through the concerted quality efforts, hospitals in the commonwealth have been encouraged to discuss opportunities for, and obstacles to, improvement. From this, an important forum for sharing ideas and best practices has been created in Pennsylvania, and has been recognized nationally.”

The PA-HEN work involved specific immersion projects, including the prevention of central-line infections, surgical-site infections, adverse drug events, adverse obstetrical events, patient falls, pressure ulcers and preventable readmissions.

Specifically related to the work on adverse drug events, the PA-HEN focused on improved use of the three main drugs linked to higher incidents of these events: opioids, anticoagulants, and insulin. Hospitals used best practices to safely prescribe, dispense and administer these drugs, as well as monitor patients’ responses after taking them.

When addressing pressure ulcers, the PA-HEN developed a Skin Care Safety Advisor program comprising skin care experts who conducted on-site hospital visits to analyze existing efforts and develop customized action plans for improvement. This specific project also addressed the importance of involving the patient and his/her family by designating skin care champions in each hospital at the unit level. These champions provide education and training, and then work with patients and their family members to keep the patients’ skin healthy.

HAP has found that to improve quality, health care outcomes and the overall patient experience, consumers need to be educated and engaged in their care and aftercare. The association established the first statewide Patient and Family Engagement Advisory Council comprising caregivers, patients and their families, and community members. HAP also has found value in recruiting individuals who reflect the patient voice to its board of directors.

“Small or modest improvements in quality can happen without much engagement from top leaders, but major strides forward typically only happen when boards and CEOs roll up their sleeves and make it a major priority,” Carter says.

Hospitals are determined to educate and train health care workers about health literacy. In fact, HAP has partnered with the Pennsylvania Library Association to better engage consumers in this effort. In addition, many Pennsylvania hospitals have adopted the teach-back method, in which patients and families repeat discharge care information back to the provider to ensure understanding. This creates effective two-way communication and a consumer base that is more knowledgeable about health care.

“Incorporating patient and family engagement and the consumer mindset into HAP’s and its members’ day-to-day operations, as well as the PA-HEN projects, has helped to accelerate improvement efforts, and engage health care consumers and all levels of hospital staff,” says HAP’s Michael Consuelos, M.D., senior vice president, clinical integration.

The association is looking to the future of health care in Pennsylvania.

“HAP and Pennsylvania hospitals are bringing the right people together to share what works and what doesn’t, and we do not plan to slow down these efforts for quality improvement anytime soon,” Consuelos says. “The momentum that has been building during the past three years now is propelling us into the future, and we envision this work will result in even greater achievements for our patients.”