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Healthcare providers collaborate for safety
SPS in Ohio wins kudos
A patient safety initiative in Ohio has led to health care savings of nearly $13 million, reduced patient days spent in the hospital by 900, and resulted in nearly 3,600 fewer adverse drug events and infections in children. It's also garnered praise from US Secretary of Health and Human Services Kathleen Sebelius, who recently went to Ohio to recognize the work of the Solutions for Patient Safety (SPS) project.
Launched in January 2009, SPS is a partnership involving 25 participating hospitals from Central Ohio, who came together at the behest of the Ohio Business Roundtable, which had been working for years to find ways to help its members control healthcare costs.
One of the roundtable members, Cardinal Health, a group purchasing organization, decided to put some money behind the idea, and two years ago, with $1.5 million, they took on four projects at 17 hospitals and the Ohio Children's Hospital Association. The latter was already working collaboratively with stand-alone facilities as well as pediatric facilities housed within other hospitals.
The four projects were to reduce surgical-site infections and medication errors in children's facilities, and to attack MRSA and other hospital-acquired infections in the other hospitals.
According to Jessie Cannon, project director for SPS at the roundtable, getting the hospitals together was easy compared to some of the other hurdles. For instance, they talked to hospital leadership, and they talked to clinical providers. Getting the messages to flow between the two groups was an issue.
Another hurdle they overcame was dealing with how various facilities with different amounts of resources would contribute to the efforts. Some were large hospitals or systems that had cash and time to spare. Others were small community hospitals that did not. "We had to be sensitive to the fact that they were in different places financially. We had to frame it carefully from the start."
Dianne Radigan, the community relations director at Cardinal Health, says they wanted to see what they could accomplish in under two years. "We asked them what they needed in terms of professional development, tracking, whatever. They built the infrastructure to share information and started on the path. Our only caveat was that leadership had to be involved. If they were, we felt that whatever changes ended up being made would stick. We wanted it to become embedded."
She says the work was "very thoughtful" and that the members worked as a team to "move the needle forward."
"That was really interesting for me, to see how they encouraged each other. These are hospitals in a competing area with overlapping territories, but they did not compete. They shared everything and kept the perspective focused on the patients," she says.
The results have been impressive. In 18 months, the hospitals saved $12.8 million and more than 900 hospital days. They figure they saved 14 lives. The latest report from the group, released in January, reports an 11% reduction in MRSA isolates, a 42% reduction in MRSA bloodstream infections, and a 37% reduction in central line-associated blood stream infections (CLABSI). Their work together led them to hire student nurses to do observational work at all the participating hospitals. They determined that hand hygiene was the most important factor in MRSA infection, and in a three-month period, they witnessed a 20% increase in hand-hygiene compliance. To reduce CLABSI, they found that the length of time the hub was scrubbed was instrumental, with the 15-second ideal met only 20% of the time. Provider education was implemented to improve that.
The group was energized enough that the children's groups are going to attempt to "end all harm and eliminate adverse events within five years," says Radigan. Cardinal Health is impressed enough with the initial work that it is kicking in an addition million dollars for that effort. "They have the baseline information and are looking in various areas to see where they are and where they want to go," she says. "What they hope to change in quantifiable terms is harm. But what they are really working on is culture change."
That they all sat down, shared information, and "no one died from it," is something that does not really shock Mina Ubbing, MBA, FACHE, CEO of Fairfield Medical Center in Lancaster and board chair of the Ohio Hospital Association. But there are some for whom the fact that it went off without a hitch is amazing. "We put the patient and his or her well-being in the best place: at the forefront," she says.
It was the larger systems that took more convincing. Smaller hospitals like hers are "thrilled to get to participate" in big projects like this one. Usually, a community hospital in a smaller town does not have that kind of opportunity, and they are happy to sit together and work toward a common goal, Ubbing says. "No one brings us to the table, because what do we know. So we were happy. But for others, it was a new way of working. It is funny, because when there is a disaster, people come together, and this isn't that different."
Prospects for the future
One reason she thinks it worked was that they sent the clinicians in to talk to each other, not the guys in suits who carry calculators and sit at desks covered with law books. "When it is a level away from the business people, it works."
The results were probably less surprising than the success of the collaborative effort. Ubbing says that she had an idea of the baseline and no real sense of what was possible. But she knew that with the emphasis on patient safety, there would be success. "The clinicians did most of the heavy lifting."
By 2020, the group hopes for a 20% reduction in all harm and will continue to work together to achieve that and other goals.
Putting on her hospital association hat, Ubbing says she thinks that as the industry moves to a "blame free" culture, there will be more sharing. Reform is driving organizations to seek out best practices. Sometimes, learning from what others have done and succeeded at or more pointedly, what they have tried that hasn't worked can bring the most impressive results. "You do not celebrate the mistakes, but you can learn vital lessons from them. The heart needs to be around the patients, not your market share. You have to collaborate."
Perhaps Ubbing is most gratified at one other benefit of their work and the good press it has engendered: Several other hospitals have called from other regions asking how to go about setting up their own cooperatives.
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