Synergy generates faster results and better outcomes. That's how Bruce Rueben, president of the Florida Hospital Association, describes the statewide momentum focused on clinical performance improvement.

Armed with the data and desire to strengthen collaboration and engagement, the association's board sought to develop programs targeting such major issues as surgical complications and readmissions — and through these initiatives, Florida hospitals succeeded in saving lives, improving care and reducing costs.

"More than 150 Florida hospitals participated in at least one of our collaboratives," Rueben says. "Hospitals are working together to share our successes and failures, tap the knowledge of experts, draw upon the latest evidence-based practices, and build a community of trust, communication and collaboration."

For proven results, which foster a culture of patient safety, the FHA has earned the 2013 Dick Davidson Quality Milestone Award for Allied Association Leadership.

The Florida Surgical Care Initiative, created in partnership with the American College of Surgeons, made enormous progress. From March 2011 to April 2012, surgical complications declined 10.5 percent, saving more than $1.7 million. Meanwhile, surgical-site infections dropped 37.7 percent, pulmonary embolism decreased 35.2 percent and the risk of pneumonia receded 8.7 percent.

During a two-year pilot, participating hospitals collected information on their patients' conditions prior to their operations, and how they fared 30 days afterward. Tracking outcomes for that time period was important because half of all surgical complications occur after patients leave the hospital, says Martha DeCastro, R.N., the hospital association's vice president of nursing.

"The hospitals reviewed patient charts — not billing data that other quality programs use — and followed up directly with patients," she explains. "Making calls required an investment in staff, but the payoff was richer information about postsurgical complications than could have been gleaned from claims or administrative data."

FHA's initial readmissions collaborative focused on high-impact areas, such as congestive heart failure, acute myocardial infarction, pneumonia, coronary artery bypass graft and hip replacement.

To achieve notable decreases in readmissions, Florida hospitals shared information — even with competitors in the same area. That was necessary because data revealed that, at times, patients may be readmitted to another nearby hospital rather than to the one that originally treated them.

From 2008 to 2010, readmissions fell 11.2 percent statewide, but the hospitals participating in the collaborative fared even better, with their readmissions dropping 15 percent and saving at least $25 million.

"Our hospitals made gains by improving patient handoffs, making sure patients understood their medications at the time of discharge and, in some cases, conducted home visits," says Kim Streit, vice president of health care research and information.

Today, these efforts move forward through the association's Hospital Engagement Network and the No Place Like Home readmissions initiative. The association participates in the HEN project spearheaded by the American Hospital Association's Health Research & Educational Trust. In June, the network hosted a statewide meeting to convene hospitals and continuing care providers.

"While Florida hospitals have made tremendous progress, our work is not done," Rueben says. "We aim to continue working to provide the very best clinical care possible."


Bold steps and steady commitment

Zero preventable harm is the ultimate goal.

That's the philosophy behind eliminating health care-acquired infections — one of several successful initiatives the Tennessee Hospital Association has undertaken in a transforming health care landscape. Other endeavors focus on reducing early elective deliveries before 39 weeks and improving surgical outcomes.

For its commendable achievements as a facilitator and collaborator, the THA has won the 2013 Dick Davidson Quality Milestone Award for Allied Association Leadership.

This road to recognition was paved with a $1 million grant from the BlueCross BlueShield of Tennessee Health Foundation. In July 2007, the hospital association used the grant to help launch the Tennessee Center for Patient Safety to support hospitals in implementing evidence-based practices.

The 126 hospitals participating in the center's programs serve more than 90 percent of all admitted patients in the state. Thanks to its initial success, the BlueCross BlueShield foundation awarded a $2,991,660 grant in August 2010 to help fund the center through 2015.

The "initiatives not only save lives but demonstrate that investing in quality pays," Craig Becker, the association's president and CEO, wrote in the application for the Davidson Award. "The reductions in health care-associated infections and surgical complications are estimated to have saved a total of $18 million in health care costs from 2008 to 2011."

In December 2009, the association's board adopted a strategic aim of zero preventable harm. That set aggressive, but attainable, incremental goals to curb health care-acquired infections. Specific reductions address central-line infections, hospital-onset MRSA and surgical care improvement.

The board asked hospitals to openly share monthly data for all safety center initiatives. In turn, hospitals receive a state scorecard and specific information about their performances.

Valued long-term partnerships matter. For more than five years, the association has aligned closely with the Tennessee Department of Health, the Tennessee Initiative for Perinatal Quality Care and Qsource, a Memphis-based nonprofit, health care quality improvement and information technology consultancy. Along with the March of Dimes, they are collaborating to reduce early elective deliveries in a public awareness campaign, "Healthy Tennessee Babies are Worth the Wait."

Meanwhile, in 2012, the Tennessee Surgical Quality Collaborative — a partnership between THA and the state chapter of the American College of Surgeons — was expanded to 21 hospitals, as a result of a $3,984,700 grant from the BlueCross BlueShield of Tennessee Health Foundation.

"Physicians are very much data-driven," Becker says. "The fact that this was created for and by surgeons made a difference. They trusted it a lot more."

Last year, the state also grappled with an unexpected priority during an outbreak of fungal meningitis. The TCPS worked night and day with the state health department, the Centers for Disease Control and Prevention and the Food and Drug Administration, ensuring that hospitals and their staff had the latest and most accurate information to care for patients.

Taking bold steps is important, but so is a steady commitment to convening diverse groups and maintaining solid leadership support from hospital executives, says Chris Clarke, R.N., senior vice president of the Tennessee Hospital Association.

"We refer to it as a journey, not a sprint," she says.


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.