In 2002, a federal report ranked New Jersey 48th among U.S. states on two dozen process-of-care measures for Medicare fee-for-service patients. That statistic galvanized the New Jersey Hospital Association into action, and its Institute for Quality and Patient Safety was born that same year.
The institute is now a statewide force in uniting providers and engaging national experts in collectively and continuously working to improve health care quality. A multitude of interventions, educational programs and collaborations over the years have saved lives, reduced costs and often exceeded national benchmarks.
“For over a decade, we’ve been focused like a laser on this work,” says Elizabeth Ryan, president and CEO of the New Jersey association, which was given an honorable mention for the Dick Davidson Quality Milestone Award. “This recognition is the culmination of those efforts, and the institute has been critical to that recognition.”
Aline Holmes, R.N., senior vice president of clinical affairs, was instrumental in the institute’s formation and leads the NJHA’s quality improvement team, which comprises three public health specialists, experts in long-term care and mental health and four advanced practice nurses, one of whom is an infection preventionist. “We all learn from each other — we all bring our strengths to the work we do and openly share those strengths and our ideas every other week — and that allows us to try new things,” Holmes says.
One example of their efforts is an NJHA partnership with the South Jersey Behavioral Health Innovation Collaborative, which is working to improve treatment access for residents in the southern part of the state with mental illness and substance abuse disorders. “Mental and physical health are very interrelated,” Holmes says. “We’ve been working on that [connection] for a long time.”
Such dual-diagnosis patients often visit multiple hospital emergency departments several times a year — a costly and inefficient use of resources that doesn’t help ED throughput or those patients. Five South Jersey health systems have formed the collaborative, which is experimenting with such alternatives as behavioral-health patient observation units adjacent to the inpatient psychiatric unit, and embedding specialists in behavioral-health and substance-abuse disorders in the ED.
“Our nation needs innovative solutions [for this epidemic], and those needs in the local community were apparent to this group,” Ryan says. “The fact that five health systems that have traditionally been fierce competitors came together to share data and work on this issue is unprecedented.”
Another important focus for the institute has centered around sepsis outcomes improvement — a quest with personal meaning for Ryan. “Two and a half years ago, I let my appendix burst,” she says. “I was septic and hospitalized for 13 days. I had excellent care and consider myself lucky — but I came out of that experience saying, ‘This is something we need to work on.’” In its first 18 months, the New Jersey Sepsis Learning Action Collaborative engaged virtually all New Jersey hospitals in implementing severe-sepsis treatment and screening protocols, as well as achieving a 38 percent increase in compliance with a three-hour sepsis treatment bundle. Since 2015, those actions have saved close to 650 lives and reduced sepsis mortality by 11.6 percent. And, as with all of the institute’s efforts, collaboration and adaptability have been hallmarks of its work.
“You have to have a willingness to make changes and learn from your failures as well as your successes,” Holmes says. “We’ve been learning why some things work in some places and not in others. And that’s really the fun in doing this work — it’s always evolving, it’s always changing, and what we are learning helps everyone get where they want to go.”
The Dick Davidson Quality Milestone Award for Allied Association Leadership is presented annually by the American Hospital Association 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.