ABOUT THE AWARD
The Dick Davidson Quality Milestone Award for Allied Association Leadership is presented annually to a state, regional or metropolitan hospital association, which, through its programs and activities, demonstrates exceptional organizational leadership and innovation in quality improvement and has made significant contributions to the measurable improvement of quality within its geographic area.
Recognizing significant contributions to quality improvement, the American Hospital Association presented the 2014 Dick Davidson Quality Milestone Award for Allied Association Leadership to the Connecticut Hospital Association and the Wisconsin Hospital Association during the annual Health Forum–AHA Leadership Summit in San Diego in July.
The winners “exemplify the key role now played by hospital associations across the country in convening and supporting their members in the critical work of quality and safety collaboratives,” says Rich Umbdenstock, AHA president and chief executive officer.
The award is intended to symbolize AHA President Emeritus Dick Davidson’s strong commitment to hospital associations’ role in spearheading quality improvement. Davidson is the former AHA president and president of the Maryland Hospital Association.
Winner | Connecticut Hospital Association
By altering hospital culture and revving up safety and quality endeavors, Connecticut hospitals have made major strides in reducing catheter-associated urinary tract infections, central line-associated bloodstream infections and surgical-site infections. The state’s bloodstream infection rate has dropped to half the national benchmark rate in the past few years.
In 2010, the Connecticut Hospital Association launched the first statewide high-reliability health care collaborative in the nation, modeling its plan after those used by high-risk industries such as nuclear power and aviation.
“We adopted this science in pursuit of the elimination of harm,” says Jennifer Jackson, president and chief executive.
As with the other complex industries, the association members focused on changing culture and implementing proven strategies to dramatically improve safety.
Hospitals “can put processes and behaviors in place that reduce the risk of error by 80 percent over two to three years,” says Mary Cooper, M.D., vice president and chief quality officer.
The programs gain traction and long-term sustainability by engaging physician champions at unprecedented levels. Physicians are among those who participate in high-reliability boot camps organized by the hospital association.
In its award application, the association notes that “in all, an estimated 3,000 leaders have been trained in high reliability at CHA; hundreds of trainers have been certified and have gone on to train thousands of staff members at participating hospitals.”
During the first year of the plan’s implementation, the association targeted hospitals. Then it began broadening the scope of its collaborative by expanding to medical and nursing schools, VA hospitals, long-term and post-acute care facilities and other organizations.
Front-line staff from member hospitals convened to design a statewide set of behaviors for all employees, and their ideas were endorsed at leadership meetings. The acronym CHAMP summarizes these behaviors: communicate clearly, hand off effectively, attention to detail, mentor each other, and practice and accept a questioning attitude.
Hospitals then pledged “to train everyone from the CEO to the front-line service worker.” Participating organizations report that staff often express their gratitude for the openness to discuss errors, mistakes and harm in a nonpunitive environment with the goal of preventing future incidents.
Other innovations have included a concerted effort to increase diversity in hospital leadership and enhance cultural competence in the delivery of care, consistent with the Institute of Medicine’s quality goal of care that is patient-centered and equitable.
The association also started a voluntary radiation dose-management initiative to standardize protocols, measure doses and decrease radiation per patient.
“Creating a culture of safety has been a great way to break down competitive barriers,” says Susan Davis, R.N, the association’s immediate past board chair who has since become president and CEO of Sacred Heart Health System in Pensacola, Fla. This enables hospitals “to learn from each other and make a difference for our patients.”
Winner | Wisconsin Hospital Association
The Wisconsin Hospital Association has achieved statewide clinical improvement milestones worthy of recognition by building strategic partnerships that advance quality care.
WHA leads a collaborative of 108 hospitals. The 80 hospitals aiming to decrease early elective deliveries — babies born for nonmedical reasons or at the mother’s request before 39 weeks — achieved a 78 percent reduction. Altogether, they avoided more than $210,000 in health care costs.
Working with WHA, Wisconsin hospitals also decreased readmissions by 22 percent, surpassing the government’s goal of a 20 percent reduction. More than 3,500 patients were not readmitted, which averted $34 million in health care spending.
“We are fortunate to have health care leaders — both lay leaders and physician leaders — who have been profoundly proactive in quality improvement,” WHA President and CEO Steve Brenton says, elaborating on the association’s successful engagement of hospitals in all areas, from rural to urban.
Nine years ago, Wisconsin became the first state to begin voluntarily reporting quality results on a Web-based, hospital-specific basis at www.CheckPoint.org. Research conducted in the state showed that transparency correlates with improvement. Hospitals can access an online data repository to compare their results with a state benchmark.
“We want to be ahead of the curve,” Brenton says. “And we think it has served us well — both to stave off bad legislation and mandates, as well as to accelerate improvement activities within our member hospitals.”
As hospitals strive to make positive changes, they also recognize that forming new partnerships within their communities is vital. WHA facilitates work groups and coalitions with long-term care and home health providers, and with agencies on aging to address readmissions. Representatives from all areas of the care continuum meet monthly to discuss the challenges of care transitions.
Hiring employees at the association level who have experience in the health care quality field eliminated a lot of trial and error. “That really helped us get moving faster,” says Kelly Court, WHA’s chief quality officer.
Monthly webinars, regular mentoring and site visits also make a difference. For instance, one series of webinars tackled each type of health care-acquired infection.
“If the hospital is struggling, then we will have coaching calls,” Court says. The site visits serve a proactive purpose to ensure that hospitals are accessing WHA’s resources, to congratulate them on their successes, and to help solve problems in specific areas.
Hospital quality departments often are spread thinly. As a result, “the efficient adoption of best practices can only occur when a large number of front-line staff serve as the passionate drivers of change,” the association stated in its application for the Davidson award.
Training quality leaders is also paramount. Many nurses are hired or promoted from within to fill a quality director vacancy, but are not given the proper guidance to excel in this role. To prevent turnover in this position, the association partnered with the Rural Wisconsin Health Cooperative to create a two-year track of on-the-job education for novice quality directors. To learn more about WHA’s quality improvement activities, visit www.WHA.org.