Transcript Slide 1

Aligning Forces for Quality:
Taking the Next Steps
General Overview
Presentation
Stephanie Sobczak, MS, MBA
WHA Manager of Quality Improvement
May 1, 2009
The Beginning of AF4Q
The initial Robert Wood Johnson Foundation’s Aligning Forces
for Quality Initiative focused on three complementary
strategies to advance the quality of chronic care provided in
physicians’ offices, clinics, and other outpatient settings.
Helping health care providers measure and publicly
report their performance;
Helping health care providers improve their own ability
to deliver quality care; and
Helping patients and consumers understand their role
in recognizing high-quality care.
In 2007, the Robert Wood Johnson Foundation offered the
Wisconsin leaders the opportunity to extend the project
through April 30, 2011, expanding the focus to acute care.
Robt. Wood Johnson’s Changing Approach
•RWJ has made a strategic shift away from funding national
initiatives and narrowly defined studies to a focus on
collaboration between regions and local communities
•Wisconsin is just one of three communities (out of 14
nationwide) taking a statewide approach
•RWJ gives enormous flexibility to communities and values
creativity and innovation
•Wisconsin will leverage a “pull” strategy and focus on
working with healthcare organizations with a strong interest
in the key priorities of Aligning Forces for Quality
AF4Q National Areas of Focus
“How-to”
of quality
improvement
Language
matters
Robert
Wood
Johnson
Foundation
Addressing
equity
Nurses leading
the way
on quality
Increasing
consumer
engagement
Increasing
public
reporting
Improving Care Across the Continuum
“How-to” of quality improvement
Focus on better ways to coordinate quality improvement
services, and share lessons learned and best practices to
increase knowledge and deliver lasting change
Increasing consumer engagement
Help all stakeholders – consumers, patients, providers, health
plans, and employers – understand how better information can
improve the quality of care and help consumers take an active
role in their own care and make informed choices.
Improving Care Across the Continuum
Increasing public reporting
Support work that explores how to structure and provide
reporting systems that resonate with consumers and
providers while rewarding high-quality care.
 Transparency in the measurement process so both
doctors and patients can trust the data
 Consumer and provider input into the process to help
ensure information is meaningful to consumers and fair
to doctors
 Help providers improve their own ability to deliver care
 Help patients and consumers understand their vital role
in recognizing/demanding high-quality care
Improving Care Across the Continuum
Nurses leading the way
 Engage nursing staff, and other bedside care givers, to
improve the quality of patient care
 Improve the organization of work and use of information
technology to increase quality and efficiency
 Examine the physical design of hospitals to improve
patient satisfaction and quality of care
 Build leadership among nurses to create quality
improvement champions on the frontline and executive
levels of nursing
Improving Care Across the Continuum
Addressing equity
Implement specific efforts aimed at reducing, and
eventually eliminating, disparities in care especially those
from certain racial and ethnic backgrounds
Language matters
Ensure that people in all communities with limited English
proficiency have access to language services and
assistance in clinical encounters when visiting hospitals
and clinics
One aspect: AF4Q Hospital Collaborative
RWJ has chosen to work
directly with hospitals on
these initiatives
QI/Nursing
(IHI/AONE)
Hospitals in WI will
receive contact from RWJ
from time to time about
these opportunities
QI/Medicaid
Plans
(Center for
Health Care
Strategies)
QI/Language
(GWU)
Coalition
Leadership
Team
QI/Equity
QI/Ambulatory
(GWU)
(TBD)
RWJ Hospital Collaboratives Rollout
QI/Nursing Collaborative
Sponsored by AONE and IHI
These RWJ projects
November 2008 Solicitation
are conducted in
February 2009 Start
(Cohort 2 starts late 2009)
parallel with the
Wisconsin AF4Q QI/Language Collaborative
initiatives, but are
Sponsored by GWU
February 2009 Solicitation
not directly related,
June 2009 Start
and funds are
QI/Equity Collaborative
provided to
Sponsored by GWU
hospitals separately.
February 2009 Solicitation
June 2009 Start
To Review: The Big Picture
Partners in Aligning Forces for Quality
WCHQ Board of
Directors
Aligning Forces
for Quality
Leadership Team
WHA Council on
Medical &
Professional Affairs
Wisconsin
Organization of
Nurse Executives
WHA WIs Quality
Steering Committee –
CheckPoint
Wisconsin
WCHQ
Ambulatory Care
Specifications
Workgroup
Consumer
Workgroup
Rural Wisconsin
Health Cooperative
Quality Improvement
Roundtable
Wisconsin Health
Information
Organization
Wisconsin
Medical Society
Quality Forum
WHA’s Role in the Wisconsin AF4Q
The extended project includes three additional areas of focus
for the acute care setting:
1. Helping health care providers in hospitals and other
inpatient facilities improve the quality of care.
2. Focusing and strengthening the role of nurse leaders
and frontline nurses in quality improvement
initiatives.
3. Developing, implementing, and using performance
measures to better capture patient care experiences
and reduce racial and ethnic gaps in quality.
Where are we today?
Grant
Awarded
Strategic
Planning
Retreat
Held
Project
Mgr
Hired
Initiatives
Defined
Project
Detail
Planning
Advisory
Teams
Launched
WHA and WCHQ in partnership
Wisconsin AF4Q Leadership Team
Cindy Schlough
Dana Richardson
Judy Warmuth
Project Director
WCHQ
Project Sponsor
WHA
Project Sponsor
WHA
Stephanie Sobczak
Project Manager
WHA
(To be named)
Project Coordinator
General Timeline for AF4Q Initiatives
Phase 1
Now through April 30, 2009
(DEFINE Projects & Goals)
Phase 2
May 1, 2009 through April 30, 2010
(MEASURE Baselines, CONDUCT
Pilot(s) & ANALYZE Results)
Phase 3
May 1, 2010 through April 30, 2011
(IMPROVE & HOLD THE GAINS)
WHA’s focus on AF4Q Initiatives
Performance
Measurement &
Public Reporting
Year 1
Report H-CAHPS
data on Checkpoint.
• Identify nurse
sensitive measures
based on developed
and tested national
measures.
Year 2
•Add perinatal measures
to Checkpoint & evaluate
areas for improvement.
• Identify data collection
strategy for nursing
sensitive measures –
(including automation?)
• Begin internal data
collection for nursing
sensitive measures.
WHA’s focus on AF4Q Initiatives
QI Education &
Engagement of
Nurses and
other bedside
practitioners
Year 1
•Evaluate existing
&/or develop QI
products for
nurses, MDs and
other bedside
practitioners
 Gather baseline
data bout QI in
Wisconsin hospitals
Year 2
•Implement QI
products &
resources
•Promote use of
Quality Resource
Website
•Conduct QI
project to support
improvement in
HCAHPS results
•Disseminate best
practices.
WHA’s focus on AF4Q Initiatives
Quality
Improvement
for Nurse
Leaders
Year 1
•Identify Nurse
Leader QI needs,
resources and
products.
Year 2
•Implement Nurse
Leader resources.
•Educate nurse
leaders on strategies
that increase
accountability of
nurses to apply QI to
daily work.
•Disseminate best
practices.
Stephanie’s Role as Project Manager
• Conduct the project within the parameters of the AF4Q grant
budget and service agreement with WCHQ.
• Ensure progress is systematic and false starts are minimized.
• Document the project according to standard to methodologies
(PDSA, DMAIC).
• Be accountable for achieving project milestones and expected
results.
• Bring expertise to the development and implementation of
creative approaches to achieving the RWJ objectives.
• Ensure that outcomes are first, practical and useful to hospitals
and, secondly, might be transferrable to other healthcare
settings.
Early findings from QI Managers Survey
Q: What percentage of responding hospitals ascribe to these
improvement approaches?
Magnet Status Baldrige/WFA
ISO-9000
IHI
90%
A:
22%
1%
31%
Q: What proportion of responding QI Managers report that their
QI projects result in lasting change at least 80% of the time?
A: 30.2%
Average Success Rate = 67%
Q: What percent of responding hospitals have or are in process
of implementing a Shared Governance model for nurses?
A: 56%
Early Survey findings…
Q. What are the top 3 barriers listed by responding QI
Managers to getting the engagement of front line staff?
1. Too little time at work to participate on teams.
2. Compared to the rest of staff’s work, it isn’t a high priority.
3. Recommendations for new processes and procedures
are not followed.
“How do we participate?”
1. You can participate in the Advisory teams at any time:




Interested in implementing Nurse Sensitive Measures?
Interested in staff engagement in QI?
Interested in nursing leaders role in leading QI?
Interested in change based on patient feedback (HCAPHS)
2. We will need your feedback and participation on occasion
via our AF4Q “Sounding Board”:
 Focus Groups  Materials Review
 Phone Interviews
3. We will need your assistance to test and pilot the deliverables
 Small pilot groups within hospitals, or in groups of hospitals
4. We will ask for your assistance in the broad implementation
of the resources and deliverables, in spreading the change, and
being an active participant in statewide efforts.
What is going on now?
Advisory Teams are convening for the 3 main initiatives.
Initial commitment is 4 one hour meetings via phone
conference. After each phase of meetings next steps
are planned with a “Go” or “No Go” decision.
On-line Survey of QI Managers has been completed.
This establishes a baseline for quality activities in
Wisconsin. We collected information from 91
hospitals for a 66% statewide response rate.
Additional presentations on the Aligning Forces for Quality
grant will continue into May. Information on AF4Q will be
posted on wha.org/about/af4q
For more information or to get involved,
please contact:
Stephanie Sobczak
Manager, Quality Improvement
[email protected] or 608.268.1847
Aligning Forces for Quality is supported by the Robert
Wood Johnson Foundation, through a grant to the
Wisconsin Collaborative for Healthcare Quality. In
Wisconsin, Aligning forces for Quality is a joint project
by the Wisconsin Collaborative for Healthcare Quality,
Wisconsin Hospital Association, and other
organizations.