Meritus Health, Hagerstown MD
Many hospitals and healthcare systems yearn for a “Board-Driven Quality Program.” Meritus Health, an independent hospital in western Maryland, actually made it happen, and they are realizing the significant benefits of their considered effort.
It all began with a Board Strategy Retreat that included all Board members, senior hospital management and senior medical leadership. Given a choice among “Board Driven,” “Physician Driven,” and “Management Driven” the 80+ people in attendance opted almost unanimously for “Board Driven.”
Their first significant action – while at the Retreat – was to set a standard VERY high: elevate Quality-related metrics (eg Core Measures, Hospital Acquired Conditions, Harm, Readmissions, Falls with Injury, The Patient Experience (HCAHPS), and the like) from “below to about average” in the State of Maryland to “Top Decile.”
In order to achieve this significant improvement, the Board understood they needed a Strategy for Quality Management that outlined the key priorities and focus areas, organizational responsibilities and accountabilities, policy/process/procedure changes, infrastructure (especially information technology), and improvements to organizational culture (both for the hospital as well as for the medical staff). This Strategy, in keeping with the original tenets of the goal-setting process at the Retreat, was developed in a collaborative session that included Board members, physicians, and hospital leaders.
Improving The Patient Experience is the overarching focus area in the journey to Top Decile, supported by three so-called Strategic Vectors:
- Clinical Excellence: Meritus Health will be a provider of excellent care across the continuum with the patient and the family at the center.
- Patient Safety: Zero preventable patient harm.
- Population Health: Meritus Health will relentlessly improve and promote the health and wellness of every person in our service region.
Those who created the strategy understood that in order to achieve the visions for the Strategic Vectors there would be required improvements to six significant “Foundational Enablers:” Physician Engagement, Technology, Just Culture, Continuous Improvement, Data Powered & Transparent, Workforce Alignment & Development.
The Board Quality & Patient Safety Committee meets monthly to review/approve management and physician plans for improvement, and, of course, review progress against specific goals, objectives and milestones.
Specific improvements during the first six months of focused effort include the following:
- Core Measure Fall-outs (or, Opportunities for Improvement) reduced from ~50 per month to less than 5 per month
- Harm Index reduced from 6-7 per month to 1-0 per month (yes, Zero is possible!)
- Hospital Acquired Condition ranking improved from worst in the State to #7 (Top Quartile).
A Board-Driven Quality Program
University of Maryland Medical System, Baltimore, MD
After five years of increasingly positive results from initiatives to improve the overall quality of care, the University of Maryland Medical System (UMMS), a 12-hospital organization that includes the University of Maryland Medical Center, concluded that performance was beginning to "plateau." Maverick was engaged to help take the organization to the "next level," which the Board of Trustees deemed to be: "Among the Top Decile" healthcare providers in the country.
Our proprietary "five markers assessment" (Strategy, Process, Infrastructure, Organization, Culture) identified specific areas of opportunity and a comprehensive multi-year initiative was organized, funded and launched.
First year accomplishments included creating client-populated Strategic Work Groups ("SWiGs") in five focus areas:
- Strategy: to create a System-wide Quality Management Strategy and guide member hospitals on Tactical Plans
- Core Measure Excellence: to improve performance using a three-part program (Awareness, Education and Intervention) and sustain performance by "hardwiring" best practices
- Maryland Hospital Acquired Conditions: to develop an action plan to minimize Potentially Preventable Complications (PPCs) and achieve measurably better clinical and financial performance.
- Quality Management Information System (QMIS): to create a tactical plan for implementation of a Quality Management Information System and a Risk Management system
- Organization: to develop an organization structure for Quality Management (System and hospitals) and to simplify governance and management structures.
Composite quality management scores have improved continuously and steadily from approximately 90% to nearly 98% -- well within the targeted performance and within range of achieving "Top Decile."
Based on the success of first year results and on the Quality Management Strategic and Tactical Plans, second year activity emphasizes design and implementation of approaches to: reduce hospital acquired conditions, reduce readmissions, reduce falls with injury, maintain Core Measure Excellence, and expand System-wide capabilities for the practice of Evidence Based Care.
Achieving Top Decile
For many years Jefferson Health and Thomas Jefferson University operated as related but separate organizations and had separate governance and leadership structures. In 2013 the organization embarked on a wholesale restructuring that included combining the organizations . We were engaged by the new CEO of the combined entity to help develop the strategic plans to operationalize the combination and propel it to new heights. As part of our work we helped senior leadership develop their “Blueprint for Strategic Action” that resulted in significantly improved educational and financial performance. Accomplishments included:
1. Facilitated Staff, Physician and Executive Leadership work groups to develop Strategies related to:
- “One Jefferson” integration of University, Hospital and Physician Enterprise
- Patient and Family Satisfaction
- Seamless Clinical Enterprise
- High-Impact Science
- Programs of Global Distinction
- Forward thinking Education
2. Defined “Foundational Enablers” required to achieve strategic goals
3. Defined new tactical initiatives and consolidated with existing ongoing projects
4. Defined Blueprint for Strategic Action implementation organization and management process
Jefferson, Philadelphia, PA
Alegent Health, Omaha, NE
Developed comprehensive Quality Management Strategy as part of Alegent Health's overall strategy: "The Quality Revolution"
Developed Quality Management organization, including:
- Chief Medical Officer
- Chief Quality Officer
- Key leadership positions in Process Improvement, Evidence Based Care, Safety, Informatics
- Improved Core Measure performance from 82% to 99%+
- Created Accelerated Quality Improvement process and "Innovation Laboratories" to improve:
- Nursing Care / direct patient care time at the bedside
- Nurse / Physician communication
- Care Planning process
- Medication management / reconciliation
- Surgical care workflow