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Nationwide Children’s Sheilah Harrison September 2011. Quality Improvement in Health Care. Presentation Overview. My Journey Nationwide Children’s Hospital (NCH) Background Quality Goals Quality Improvement Services Heart Center Quality Improvement Coordinator Key Measures - PowerPoint PPT Presentation
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The Heart Center
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Quality Improvement in Health CareNationwide Children’sSheilah HarrisonSeptember 2011
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The Heart Center
Presentation OverviewMy JourneyNationwide Children’s Hospital (NCH)
• Background• Quality Goals• Quality Improvement Services
Heart Center • Quality Improvement Coordinator• Key Measures
Quality Improvement ToolsMy Observations on Health CarePersonal Goals to Achieve Success
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The Heart Center
My JourneyCredentials
• B.S. Industrial & System Engineering (BS I.S.E.)• Project Management Professional (PMP)
Industry Exposure• Internship at OSU Medical Center• Supervisor in Retail Warehousing• Supply Chain Engineer in Telecommunications• Medical Device Manufacturing• “Offshoring” Financial Processes• Chemical Supply Chain Project Management• Medicaid Project Management in Government• Health Care Quality Improvement
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The Heart Center
Nationwide Children’s Hospital~1000 Medical Staff7200+ Employees124 Specialties on Main Campus28 Outpatient Care Centers18,472 Discharges18,873 Surgeries914,456 Outpatient Visits
The Heart Center
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NCH Quality GoalsEliminate
Preventable Harm*• Event Reporting
System• Non-Punitive
Huddles• Preventable
Harm Indices• Focus on
Numerator
HOSPITAL ACQUIRED INFECTIONS
Medication Errors
Non-ICU Cardiac Arrests
Surgical Site Infections
PRESSURE INJURIES
Serious Safety Events
Falls
* A condition/event has the potential of being placed upon the Hospital’s Preventable Harm Index (Index”) when the condition/event occurs as the result of a variation from a “best,” and/or “expected” practice. Such variation of practice does not necessarily equate to a standard of care definition.
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The Heart Center
NCH Quality Improvement Services (QIS)
Organization consists of:• Service Line Coordinators• Clinical Quality• Decision Support• Accreditation• Patient Satisfaction and
Grievances
The Heart Center
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Quality Improvement Tools
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The Heart Center
Quality Improvement CoordinatorHeart CenterMonitor and Report on Patient Safety
Measures• Manage 10 Blue Chip Goals• Support 40 Others
Facilitate Interventions for Improvements to Patient Care
Assist Heart Center with migration to standard for measuring quality
Introduce quality tools and terms• Control Charts• Aim statements / Key Driver Diagrams• Baseline data
The Heart Center
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NCH Quality Strategic Goal“Do Not Harm Me”
• Central Line Associated Blood Stream Infections • Adverse Drug Events• Prevention of Pressure Ulcers > Stage II
THE HEART CENTER STRATEGIC QUALITY GOALSImprove Chronic Care of High Risk
CHD Infants
• Optimizing Nutritional Needs for Patients with Congenital Heart Disease
Create Seamless Hand-offs
• OR to Cardiothoracic
ICU• Cardiothoracic ICU to
Step-Down Unit• Non-Invasive
Cardiology Lab to Inpatient Units
Reduce Mortality and Morbidity in
CHD Patients
• Blood Conservation in the OR
• Anticoagulation Protocol for Post Stage II Hybrid Patients
Key Quality MeasuresThe Heart Center
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The Heart Center
My Observations of Health CareOrganizational charts• Hard to obtain• Have numerous dotted lines
Absence of clinical project management Accountability is distributed Physician support is familiar
requirementComprehensive patient charts but
challenges with trend analysis
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The Heart Center
Personal Goals to Achieve SuccessLargest endeavor is to seek trust from staff
• Need to create allies that have focus on quality• Need to admit my skill deficiencies• Need not turn away opportunities to help others
Creating strong relationships with physiciansEnsure ideas and tasks have ownersEducate staff with Project Management toolsAddress Change ManagementIdentify areas where data collection can be
automatedModel new processes with strawmen
The Heart Center
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Example Communication
Dr. Smith: So, I have some questions about the Anti-Coagulation protocol for post-Comprehensive Stage II patients. I hardly understand the subject matter, but I want to spur conversation among you, Dr. Jones, and any others, so we can further improve our Aim/Driver Diagram. I think Dr. Jones talked with you about one or more of these questions, but I haven’t heard the conclusion. 1. Should we specify when it is important to monitor fractionated Xa vs unfractionated Xa?2. Should we add TEG evaluation as a key parameter in this document?3. What information does the D-Dimer count provide, particularly if we do add TEG evaluations? Thanks!
Sheilah Harrison, PMP Quality Improvement Coordinator | Heart Center | Nationwide Children’s HospitalTel: [email protected]
The Heart Center
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QUESTIONS?Quality Improvement in Health Care
