June/July 2004, In This Issue:
- Progress Report Issued and 2004 - 2005 - Priorities set for HPCI.
- LEAN Health Care - high HPCI priority.
- Three complimentary tracts of LEAN Enterprise in health care.
- Mercy Medical Center in Des Moines launches Mercy Six Sigma using Lean tools and methods.
- Applying LEAN in Iowa's health industry: creating win-win-win opportunities.
- Consensus on Patient Safety: National Quality Forum Consensus Report on 30 Safe Practices.
- The Leapfrog Group establishes a fourth Leap for hospital patient safety applies to all US hospitals including small and rural hospitals.
- Moving Towards Consumer Centered Health Care FACCT: Focus On Consumers.
- Centers for Medicare and Medicaid Services (CMS) announce significant increase in numbers of hospitals reporting "starter set" quality data.
- Building organizational support for change; recommendations from the Institute of Medicine.
HPCI issued a progress report on the first year of the new agenda developed from the statewide policy conference held at the Hy-Vee Conference Center, entitled "A New Vision for Health Care: Forging a Partnership for Business, Consumers and Health Care Providers".
Both a summary and a more detailed report is available through HPCI. In addition, priorities for 2004 - 2005 have been identified. They are:
Priority 1: Engage LEAN Enterprise in Iowa's health industry to drive out cost and improve quality.
Priority 2: Operationalize the customer focused expectation and measurement model using Quality/Cost/Delivery/Safety (QCDS) Metrics and other LEAN tools.
Priority 3: Improve accountability, patient safety, transparency of health care information and recognize/reward results.
- Leverage national solutions and resources: National Quality Forum, The Business Roundtable founded Leapfrog Group, Foundation for Accountability (FACCT), the National Consumer & Purchaser Disclosure Project, and eValue8 health plan/provider system evaluation tool.
- Co-sponsor the Iowa Health Buyers Alliance.
Priority 4: Conduct education, research, data collection and analysis on key health issues:
- Consumerism in health care.
- Public reporting of Iowa health care provider costs, quality and patient safety.
- Education and information for consumers, patients, health care providers and other stake holders.
- Prevention and chronic care improvement.
Applying LEAN in Iowa's health care industry is a high priority of HPCI. Dedicated LEAN Health Care staff has been committed to the new Hot Team and to otherwise work on priority efforts (see Priority #1 and #2 of the 2004 - 2005 HPCI Program Priorities - above).
Three complimentary tracks applying LEAN into Iowa's health care sector has been identified. They are:
- Health Care Services
- Health care professionals and organizations, i.e. hospitals, doctors, clinics, etc.
- Administration (Billing, Claims, Payment and Information Services)
- Clearinghouses, TPA/insurance companies, Pharmacy Benefit Managers (PBM), information vendors, etc.
- Internal only to 1, 2 or 3 and multi-stakeholders crossing all three groups
- Customers (Expectations, information/measures)
Congratulations to the Mercy Medical Center in Des Moines for launching its Mercy Six Sigma effort. The effort includes both LEAN and Six Sigma tools and methods. Mercy has made a serious commitment to continuously improve their processes focused on improving care and reducing costs. Dedicated staff have been identified and trained to lead this process improvement team. Twenty one (21) projects have been identified and work is underway. For more information, contact Dan Varnum at 515-643-5307.
The March issue of the Iowa Nurse Reporter published by the Iowa Nurses' Association contained an article entitled, "Applying LEAN in Iowa's Health Industry: Creating Win-Win-Win Opportunities." It was prepared by the Health Policy Corporation of Iowa at the request of the Iowa Nurses' Association. The article concludes that, "we are reaching out to nurses and other health care professionals in Iowa to develop a collaborative effort. This holds much promise for a win-win-win for patients/consumers, health care professionals, employers and other sponsors of health care coverage and plans."
The full article is available through HPCI.
The National Quality Forum (NQF) recently released its Consensus Report entitled "Safe Practices for Better Health Care". The report describes 30 safe practices that can have a major impact on the safety of patients in health care settings. Early indications are that hospital leaders are finding this report very useful as an audit or checklist for improving their organization's safe practices.
The NQF is a non-profit organization created to develop and implement a national strategy for quality measurement and reporting. It makes recommendations for improving health care quality through a rigorous national consensus process.
The good news is that this new consensus report includes the original three Leapfrog leaps. The Leapfrog Group, founded by The Business Roundtable, has added a fourth leap based upon this report. This Consensus Report is especially important in Iowa. A group representing all major Iowa stakeholders recommended to the HPCI measurement task force that it:
- Consider public/private coalition's efforts and strategies underway in other locations.
- Determine what quality measures are missing from those currently in play.
- Determine consensus defined measures of quality and make them widely available to the public.
- Provide information to the provider community to help them improve their practice and systems.
- Celebrate the high quality we have in Iowa (go from good to great).
This NQF report is of great assistance in meeting these recommendations.
Please refer to the NQF website for additional information: www.qualityforum.org
The Leapfrog Group for patient safety/rewarding higher standards was founded by The Business Roundtable. It is a prominent regional and national force working to initiate breakthrough improvements in the safety, quality and efficiency of health care for Americans. There are now nearly 100 Iowa employers and other organizations supporting the Leapfrog Group and the numbers are growing.
Based upon research by the Institute of Medicine which is part of the National Academy of Science and other highly regarded scientists and researchers, the Leapfrog Group originally established three leaps to improve quality and safety:
- computer physician order entry
- ICU physician staffing
- evidence based hospital referral
The National Quality Forum safe practices leap is the fourth leap which was recently added and put in place.
Leapfrog's initial three leaps applied primarily to urban hospitals. All hospitals are now invited to complete the survey for the NQF safe practices leap. They may also choose to complete the survey for the first three leaps. Results of submitted surveys will be posted on the Leapfrog Group website.
The Iowa Health Buyers Alliance, co-sponsored by HPCI, is requesting larger Iowa hospitals to complete the 2004 Leapfrog Group Hospital Survey. An "all hospital" town hall call has been scheduled to brief hospitals on the new 2004 hospital survey. The call will take place on Thursday, June 17th from noon to 1:00 p.m. Contact the HPCI office for more information.
The Foundation for Accountability (FACCT) undertook a series of research studies which resulted in several key findings:
- Consumers are deeply concerned about the quality of care they receive and are eager to receive information and be offered options for action.
- Consumers are generally cynical about the likelihood of stakeholder action to improve quality.
- Most consumers feel powerless to influence the health system themselves and do not feel they have any place to turn for help.
- Consumers think that quality is determined by the individual doctors they see.
- Consumers regard health plans as insurance companies, not managers of care.
- Few consumers understand the concept of a "system" of care, or the complex factors that may ultimately influence the quality of care they receive.
- Consumers from low income and minority experiences are more receptive to collective action as a means to influence the health care system.
- Most consumer and patient organizations have not yet responded to their members' needs for help in navigating and advocating within the health care system, but are interested in building that capacity.
- Few consumers believe that national policy discussions are directly relevant to the quality of care they receive.
- FACCT is a national organization improving health care for Americans by advocating for an accountable and accessible system where consumers are partners in their care and help shape the delivery of care.
FACCT's Goal: informed, motivated consumers who make better decisions and act as partners in improving health. For more information on FACCT go to www.facct.org
The majority of Iowa hospitals are expected to report at least one quality measure from a set of ten quality measures July 1st. This information will be available on the CMS website www.cms.hhs.gov/quality/hospital. The ten measures in three disease areas that make up the "starter set" are:
- Heart attack (Acute Myocardial Infarction)
- Was aspirin given to the patient upon arrival at the hospital?
- Was aspirin prescribed when the patient was discharged?
- Was a beta-blocker given to the patient upon arrival at the hospital?
- Was a beta-blocker prescribed when the patient was discharged?
- Was an ACE Inhibitor given to the patient with heart failure?
- Heart failure
- Did the patient get an assessment of his or her heart function?
- Was an ACE Inhibitor given to the patient?
- Was an antibiotic given to the patient in a timely way?
- Had a patient received a Pneumococcal vaccination?
- Was the patient's oxygen level assessed?
Hospitals that do not submit data to CMS will receive an update of market basket minus 0.4%. Hospitals will be eligible for the full market basket update if the data is received by July 1st.
The CMS quality initiative was launched nationally in 2002 as the Nursing Home Quality Initiative (NHQI) and expanded in 2003 with Home Health Quality Initiative (HHQI) and the Hospital Quality Initiative (HQI). These initiatives are a part of the comprehensive look at quality of care. CMS also supports the Leapfrog Group as a liaison participant and is a member of the National Quality Forum.
"Leaders of today's health care organizations face a daunting challenge redesigning the organization and delivery of care to meet the aims set forth in this report. They face pressures from employers, medical staff, as well as from local communities, including residents, business and service organizations, regulators and other agencies. It is difficult enough to balance the needs to this many constituencies under ordinary circumstances. It is especially difficult when one is trying to change routine processes and procedures to alter how people conduct their everyday work, individually and collectively."
This section of the report describes the general process of organizational development that offers a set of tools and techniques, drawing heavily from engineering concepts, as a starting point for identifying how organizations might redesign care.
Recommendations: Convene a series of workshops to identify, adapt and implement state of the art approaches to address the following challenges:
- Redesign of care processes based upon best practice. (Redesign aimed at increasing an organizations ability responding to changing demand may be accomplished through a variety of approaches, such as simplifying, standardizing, reducing waste, and implementing methods of continuous flow.)
- Use of information technology to improve access to clinical information and support clinical decision making.
- Knowledge and skills management.
- Development of effective teams.
- Coordination of care across patient conditions, services and settings over time.
- Incorporation of performance and outcome measures for improvement and accountability.
Source: Institute of Medicine, National Academy of Science - Crossing The Quality Chasm, A New Health System For The 21st Century.
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