Putting the Pieces Together - Making Sense of all that's ... Putting the Pieces Together ~~~~~ Making

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  • 4/20/2017

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    Nikki Medalen, MS, BSN, APHN-BCJean Roland, RN, BSN, CPHQ

    Putting the Pieces Together ~~~~~

    Making Sense of All That’s Available

    Objectives

    Share highlights of January and February ND HRET HIIN hospital site-visits

     Identify priorities, resources and strategies to facilitate the HIIN 20/12 reduction goal

    Share Map of Actors tool, focusing on readmissions work.

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    New Hospitals!

    New Hospitals

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    Diverse HIIN Team  Unity Medical Center - Grafton

     St. Andrew’s Health Center - Bottineau

     Sanford-Mayville

     Presentation Medical Center - Rolla

     First Care Health Center – Park River

     CHI Mercy Hospital – Valley City

     Tioga Medical Center

     Sakakawea Medical Center - Hazen

     Trinity - Kenmare Community Hospital

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    Huddles Shift Change Huddles:

     Carrington Health Center

     CHI-Valley City

     CHI St. Joseph’s -Dickinson

     First Care Health Center – Park River

     Sanford Hillsboro

     Heart of America - Rugby

     Northwood Deaconess

    Safety Huddles: CHI Mercy – Valley City Post Fall Huddles: Northwood Deaconess

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    Huddles Multi-Disciplinary Huddles:

    Heart of America – Rugby  Sanford Hillsboro

    Huddle Boards: Carrington Health Center CHI-Valley City CHI-Devils Lake CHI-Dickinson

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    White Boards

     Sakakawea Medical Center – Hazen

     CHI Mercy Hospital – Valley City

     Sanford Mayville  Mountrail County

    Medical Center - Stanley

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    Rounding Bedside Rounding:

    Heart of America Medical Center - Rugby

    Linton Hospital Hourly Rounding:

    Sakakawea Medical Center - Hazen Presentation Medical Center - Rolla

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    Patient and Family Advisory Councils Sanford Mayville CHI-Valley City CHI-Devils Lake First Care Health Center – Park River Sanford Hillsboro St. Andrew’s Medical Center - Bottineau

    Carrington Health Center Northwood Deaconess Sakakawea Medical Center - Hazen

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    Prioritizing Readmissions  Ashley Medical Center

     Carrington Health Center

     Cavalier County Medical Center - Langdon

     CHI – Devils Lake

     Cooperstown Medical Center

     First Care Health Center – Park River

     Wishek Community Hospital

     Linton Hospital

     Mountrail Medical Center - Stanley

     Heart of America Medical Center - Rugby

     Towner County Medical Center - Cando

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    Readmissions Provider Champion: Implementing BOOST readmissions strategies – Towner County Medical Center Discharge Planning Checklist: CHI-Dickinson, Heart of America Case Manager Post Discharge: Carrington Health Center, Cooperstown Medical Center, McKenzie County Medical Center, First Care Health Center-Park River

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    Utilizing Change Packages in Swingbed Population Community Memorial Hospital-Turtle Lake Garrison Community Hospital Jacobson Memorial Hospital-Elgin Kenmare Community Hospital Mountrail County Medical Center-Stanley Nelson County Medical Center-McVille Northwood Deaconess Health Center

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    Leadership Engagement

    Executive Leadership Engagement

    Patient Serving on Hospital Board Pembina County Memorial Hospital, CHI- Valley City, First Care Health Center, Sakakawea Medical Center, St. Andrew’s Health Center

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    Innovation Heart of America Medical Center!

     Telemedicine: Diabetes, Nutrition, Pacemaker clinic, Infectious disease, Mental Health Services

    Expansion based on Community Assessment: Chemotherapy administration, Cancer Support Group

    Utilization of Paramedics: Home Visiting, ER

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    Acknowledging Barriers…

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     Falls fatigue  Sepsis protocols  Need for follow-up post discharge  Communication and teambuilding training  Home visiting – payment (or lack thereof)  Hiring freeze  Teach-back training  EHR challenges

    Acknowledging Barriers… Presentation of data in a more meaningful way Provider training on readmissions How do we coach up? (community culture

    issues) How to build safety into facility design (built

    environment) Resistance to bedside rounding/huddles Policies and processes – can we collaborate? Hand hygiene…how do we keep this fresh?

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     Adverse Drug Events (ADEs)  Catheter Associated Urinary

    Tract Infections (CAUTI)  C. difficile Infections (CDI)  Central Line-Associated

    Blood Stream Infections (CLABSI)

     Injuries from Falls and Immobility

     Pressure Ulcers (PrU)

     Sepsis

     Surgical Site Infections (SSI)

     Venous Thromboembolisms (VTE)

     Ventilator Associated Events (VAE)

     MRSA bacteremia events

     Hospital Patient Safety Culture

     Readmissions (12% reduction)

    20/12 Reduction

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    Fellowship Enrollment Patient and Family Engagement

     Kathy Skager – Sanford Hillsboro  Megan Thompson – First Care Health Center  Jamie Nienhuis – Cavalier County Memorial

    Hospital  April Johnson – Cooperstown Medical Center Cohort 2  Kathy Knudson – Sanford-Mayville  Charlene Hanson – Southwest Health Care -

    Bowman 20

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    Fellowship Enrollment Quality Improvement – Foundations

     Amanda Jordan – Sanford Mayville

     Beth Hetletved – Community Memorial Hospital

     Denise Beaver Eslinger – Cooperstown Medical Center

     Diana Neva – Cooperstown Medical Center

     Kathy Skager – Sanford Hillsboro

     Lisa Luft – Mountrail County Medical Center

     Marie Loven – Presentation Medical Center

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    Fellowship Enrollment Quality Improvement – Accelerated

     Jessica Linderman – Carrington Medical Center

    Ann Nelson – Tioga Medical Center Coleen Bomber – Northwood Deaconess

    Health Center

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    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

    Map of Actors Mapping actors: Used to develop and implement a relational strategy to build collective leadership capacity and enlist stakeholders’ commitments to a shared purpose

    Values Interests Resources Power

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    Map of Actors

    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

    INTERESTS INTERESTS

    ASSETS ASSETS

    1. What change do we want?  (What is our interest?)

    2. Who has the assets to  create that change?  

    3. What do they want?  

    4. What assets do we  have that they want?  

    YOUR AIMS C

    C = Commitment

    YOUR   MAP OF  ACTORS

    Power Analysis

    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

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    Map of Actors

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    What is the difference between a constituent and a stakeholder?

    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

     To recognize people as our greatest asset!  To understand our system through our stakeholder’s values, interests,

    assets & relationships

     To develop a strategy for building & engaging a core team

     To build power ‘with’ – instead of doing ‘to’ or ‘for’

     To see constituents and stakeholders as partners in health

     To illuminate momentum builders & roadblocks

     To promote reciprocity & mutual respect between stakeholders with power differences

     To generate collective power to co-produce health

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    Map of Actors: Why?

    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

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    The right people

    A compelling

    purpose

    An enabling structure

    Effective Team

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    Power isn’t something you have…it’s a relationship with others.

    This strategy is based on turning the ASSETS we

    have into the POWER we need to get the CHANGE

    we want!

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    Map of Actors

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    Map of Actors: Candidates

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    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

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    Map of Actors

    ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016

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    Coaching Can you be more specific in certain places by

    naming people by name, not just organizations? Are there other influential stakeho