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Health systems form 'Safest Hospital Alliance'
All member hospitals will follow the same template
Three health care systems — Wellmont Health System, based in Kingsport, TN; Novant Health, based in Winston-Salem, NC; and Adventist Health System, based in Winter Park, FL — have come together to seek a solution to improving patient safety. Their collaborative, called the Safest Hospital Alliance, was founded by Richard Salluzzo, MD, president and CEO of Wellmont. Together, the systems say they serve about 1.5% of all the hospital patients in the United States.
The alliance, led by each system's chief medical officer, will create metrics, benchmarks, and templates, and identify best practices in an effort to define how a truly "safe" hospital should function and provide treatment to its patients. Over a two-year period it will focus on one to three core hospital-wide processes, seeking to close the gap between current performance and "perfection" by 80% percent. The group's preliminary estimates indicate that implementing the safest hospital template could reduce health care costs by 20% to 30%. The alliance has been given a head start by Wellmont Holston Valley Medical Center in Kingsport, TN, which has been implementing a preliminary template for about six months.
The alliance proposes to implement 172 safety measures at participating hospitals, each of which has about three to five critical steps that, if followed, should eliminate the error. For instance, in order to reduce the number of falls in hospitals, the plan requires nurses to assess each patient's risk of falling upon entry to the hospital; if they have a high risk, the nurse orders a bed alarm, checks on the patient hourly, places a sign on the door, and puts a star on the patient's chart.
No perfect model
What was the impetus behind the alliance? "There were two things," says Anthony Oliva, DO, chief medical officer of Wellmont. "One was that when we looked at trying to go after safety, the basic premise we worked under was that there is really not anything out there to model what we need to do; there's really no template out there to get to a level of reliability."
The second driver, he says, involved metrics. "If you go to the Agency for Healthcare Research and Quality [AHRQ] they will very clearly tell you their metrics are based on empiric performance — on 27 indicators; that's the benchmark," says Oliva. "If that's the case, it's not a very good benchmark because what you really have are average 'bad' performances. Now, we could do this as a single hospital, but would the data be reliable and statistically significant? If we do it with a couple of other systems and get the volume of denominators up to a certain point, we might be able to create something statistically significant and drive numbers to a new level and keep them there."
The final question, then, would be whether the template is transferable. "In other words, can we get enough statistical value out of our numbers to say we can move to a new place?" Oliva poses. "These should be the numbers to look for — pushing to four, five, or six sigma levels in certain areas."
What made the alliance attractive to Novant? "We had a relationship with them through our CEO," says Stephen Wallenhaupt, MD, executive vice president and chief medical officer. "They had chatted and visited, and Rich [Saluzzo] said he'd like us to work together on something they were doing involved with patient safety."
The source of the model
How did Wellmont determine the basic model for the initiative? "We've been working with a group called Value Capture, which was developed and put together by [former Treasury Secretary] Paul O'Neill," says Oliva. "He had previously been with Alcoa and adopted the Toyota production system model. They were driving employee injuries to zero."
When O'Neill left government, says Oliva, "He decided he wanted to move from industry to health care. So the challenge became, how do you use the Toyota system to drive moving health care organizations toward zero defects on a real-time problem-solving basis?"
In addition, as Wallenhaupt notes, "A lot of people are working diligently across the country, and there are quite a few external organizations that have developed lists of safety measures they consider important. Tony Oliva asked for a comprehensive health safety plan, and they have collated all the safety measures from groups like the National Quality Forum, the Institute for Healthcare Improvement [IHI], The Joint Commission, and AHRQ [the Agency for Healthcare Research and Quality] in an organized manner that made sense."
Rolling the model out
For about 18 months now, says Oliva, Wellmont has been working on creating the "safest unit" at Holston Valley. "Now, we are ready to roll it out and drive our rapid cycle improvement model hospital-wide," he asserts.
In terms of the other alliance members, he says, a "big education mode" was to be implemented beginning in July. "It will have three pieces," he explains. "First, we will create some structure. We have reached out to NQF and adopted their 30 safe practices as best practices; we are using AHRQ's 27 patient safety indicators as key metrics. We are implementing all the IHI initiatives, and working with The Joint Commission to make sure to implement the National Patient Safety Goals."
At this point, the other systems have started to begin to set what Oliva calls "their base core," getting metrics in place. "In other words, they will begin the same process we have gone through," he explains.
"We are now in the phase of analyzing the [combined] list of measures to be sure the definitions are consistent, and in most cases we have processes under way to improve them," says Wallenhaupt. They are also working on a "scorecard" — a template for evaluating performance — "to make sure we are all on the same page," he adds.
Wallenhaupt says he already has brought a team to Holston. "Our first pilot group sat side by side with them to see how they do it," he says.
In order for the 56 facilities to share experiences going forward, Oliva says Wellmont has installed software to capture all the data gathered by the alliance. "We will have a joint committee led mostly by the CMOs and chief quality people," he notes. "We will also be trying to centralize a lot of the data collection process here, so we can put out the same dashboards, and so everyone will get the same data."
Third, he says, they are developing an advisory board of industry leaders "to help give us direction on where we should be going."
How will they measure success? "In a couple of ways," says Oliva. "We will look at whether we have made true improvements in real metrics. In other words, what are the real outcome indicators, rather than process indicators."
One of the key questions, he says, is whether the alliance can truly get some outcome measures. "AHRQ, and perhaps some others, are starting to look at the number of failures per process," he notes. "We want to see if we can get to a reliability level; can we get to one to two errors per 100,000 times? People need to start thinking about zero."
Oliva says there are key things hospitals do every day that they must do perfectly, or they will create bad outcomes. "It's like the wheels coming down on an airplane before it lands; that has become a very highly reliable thing," he explains. "What we need is to be performing on a very high reliability level in areas like door-to-balloon time for chest pain and MI. Initial processes like getting an EKG done and alerting the lab have to work perfectly every time to function at a most reliable level. If a patient comes in with chest pain and gets an EKG in five minutes, there is no failure."
As the alliance progresses, says Oliva, he'd like to bring in other systems — perhaps by the end of this year. His long-term goals are anything but modest. "Hopefully, at some point down the road we'd like to create a template where The Joint Commission could say, 'Here's an accreditation piece on patient safety,'" he shares. "Can we do that? That's the question."
[For more information, contact:
Anthony Oliva, DO, Chief Medical Officer, Wellmont Health System, Kingsport, TN. Phone: (423) 224-5615.
Stephen Wallenhaupt, MD, Executive Vice President and Chief Medical Officer, Adventist Health System, 111 North Orlando Ave., Winter Park, FL 32789. Phone: (407) 647-4400. Fax: (407) 975-1469.]