McKesson Corporation · NYSE:MCK
McKesson — NLC Breakout Session (April 2012)
43 slides from McKesson's conference presentation, Apr 17, 2012
Slide 1: Quality Initiatives and the Concept of Complexity Compression
Quality Initiatives and the Concept of Complexity Compression Debra Hurd Hurd, RN RN, NS NS, NEA-BC NEA BC Patient Care Executive St. John’s Hospital, HealthEast Care System Educational Grant Providers Co-Sponsored by:
Slide 2: Agenda
Agenda Background on HealthEast Impactt off quality I lit initiatives: i iti ti complexity compression Quality initiatives at HealthEast Technology experience to mitigate complexity compression
Slide 3: HealthEast Care System, St. Paul, Minnesota
HealthEast Care System, St. Paul, Minnesota Woodwinds St. Joseph’s St. John’s Bethesda HealthEast Care System • 4 Hospitals • 12 Primary Care Clinics • More Mo e than 35 specialty specialt services se ices • Home Care & Hospice • Medical Transportation Hospital p Capacity p y Licensed Beds: 925 St.
Slide 4: Clinicians have so much to think about!
Clinicians have so much to think about! CMS Core Measures CPOE ANCC Magnet Recognition Program®
Slide 5: Complexity compression
Shared . . Leadership Complexity compression Strategies Transforming Clinical Guaiity and Care Delivery
Slide 6: Complexity compression
Complexity compression Definition: “…what nurses experience when expected to assume additional,, unplanned p responsibilities p while simultaneously conducting their multiple responsibilities in a condensed time frame.”* Complexity compression adds to the cognitive burden already on clinicians *
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Slide 9: The chaotic nature of nurse activities
The chaotic nature of nurse activities 98 hours of direct observation of 27 med-surg RNs Nurses N rses shift acti activities ities constantl constantly Nearly 77% of nurses activities lasted less than 30 seconds Approximately 5% of events lasted longer than two minutes . Source: “Transformin
Slide 10: The chaotic nature of nurse activities
The chaotic nature of nurse activities Few professionals are required to perform as many functions and tasks in as many locations often “on on the fly fly” Frequent switching results in nurses monitoring numerous “in-process” in process activities simultaneously There is little “flow” in nurse
Slide 11: Human factors and patient safety
Human factors and patient safety Cognitive factors that contribute to error – Stress & fatigue – Lack of familiarity with the task – Trying something new under pressure – Information overload – Workload and multi-tasking – Doing more with less resources – Favoring production over safety – Task sat
Slide 12: How often do you feel you are in information overload?
“How often do you feel you are in ‘information overload’?” 70 60 50 40 Non-Nursing 30 Nursing 20 10 0 Never Rarely Sometimes Of ten Almost Always (Survey of St St. Joseph’s Joseph s Hospital Staff – Fall 2007)
Slide 13: How often do you feel you have had adequate preparation to do something new?
“How often do you feel you have had adequate preparation to do something new?” 90 80 70 60 50 Non-nursing 40 Nursing 30 20 10 0 Never Rarely Sometimes Often Almost Always (Survey of St St. Joseph’s Joseph s Hospital Staff – Fall 2007)
Slide 14: How often do you encounter multiple, simultaneous changes at work?
“How often do you encounter multiple, simultaneous changes at work?” 70 60 50 40 Non-nursing 30 Nursing 20 10 0 Never Rarely Sometimes Often Almost Always (Survey of St. Joseph’s Hospital Staff – Fall 2007)
Slide 15: How often do you have difficulty prioritizing tasks?
“How often do you have difficulty prioritizing tasks?” 90 80 70 60 50 Non-nursing 40 Nursing 30 20 10 0 N Never R l Rarely S Sometimes i Of ten Al Almost Al Always (Survey of St St. Joseph’s Joseph s Hospital Staff – Fall 2007)
Slide 16: Incidence of multiple quality bundles per patient
Incidence of multiple quality bundles per patient New nursing research at HealthEast* Goal: to gain insight into the cognitive burden on nurses by discovering how many quality bundles are assigned to patients in both typical and extreme cases Background: literature review provided no related i
Slide 17: Multiple quality bundles per patient
Multiple quality bundles per patient Quality Bundle Occurrence Critical Care and Telemetry Combined Bundle occurrence across 114 Bundle telemetry and critical care patients (150 activated bundles) Central Line 20% Stroke 16% HF 14.6% VAP 14.6% SCIP 12.6% Pneumonia 8.6% Sepsis 8.6% AMI 6 6% 6.6%
Slide 18: Multiple quality bundles per patient
Multiple quality bundles per patient No. of Cumulative Cumulative bundles percentage p g of percentage p g critical and of critical telemetry patients patients only 0 21 9% 21.9% 14 9% 14.9% 1 or 0 62.2% 51.7% 2, 1 or 0 85.8% 81.6% 3 or less 96.3 95.4% 4 or less 100% 100% 38% of patients were on 2 o
Slide 19: Clinical transformation
Clinical transformation* Adoption of new processes to improve clinical workflow and patient outcomes Heightened attention to culture, people, processes, and technology to assure permanent change Information technology – an important vehicle for success *Source: “The Role of Nursing Leadership
Slide 20: Clinical transformation
Clinical transformation Before … After!
Slide 21: HealthEast
HealthEast Care System MISSION Rooted in Judeo Christian values, our mission is high quality, compassionate, cost effective health care for the communities we serve, 1853 1980s 2000 Fint hosgtalin Minn. Centers of enelence EMR mplomentatien Tranaparnigy Mrs colabotatee sternal henchmarting Nursng-na
Slide 22: Clinical Outcomes: Approach for Improvement
Clinical Outcomes: Approach for Improvement Process – HealthEast Quality Institute • Headed by Dr. Craig Svendsen, VP/CMQ Technology – HealthEast Informatics Department • Headed by Dr. Brian Patty, VP/CMIO Staff Engagement
Slide 23: Clinical Outcomes: HealthEast CMS Core Measure Scorecard
Clinical Outcomes: HealthEast CMS Core Measure Scorecard
Slide 24: HealthEast Nursing
Shared . Leadership HealthEast Nursing Strategies Nursing Strategic Direction FY2009-10 Clinical Advantage » Goals * Meet defined targets for the Nursing Sensitive measures Patient Experience Meet defined target for “would you recommend” - Patient Experience survey Employee Engagement Meet Nursing E
Slide 25: HealthEast Nursing
HealthEast Nursing HealthEast Nursing Dashboard - Nursing Sensitive Measures O Death among surgical inpatients with treatable serious complication — Failure to Rescue O Pressure Ulcer Prevalence Falls Prevalence Falls with Injury Restraint Prevalence Uninary Tract Infection (UTI) for ICU patients et
Slide 26: Ventilator-acquired pneumonia (VAP) in perspective
Ventilator-acquired pneumonia (VAP) in perspective 9.6 more days on ventilator 6 1 additional days in ICU 6.1 11.5 additional days in hospital Additional cost $40 $40,000 000 1-2 patients of every 10 with bacterial pneumonia will end up on ventilator 50% die Source: “Targeting Ventilator-Asso
Slide 27: Every Patient, Every Time
“Every Patient, Every Time” How do we deliver: ;100% of the care associated with a best practice to ; 100% of the p patients who need it ; 100% of the time
Slide 28: VAP prevention bundle
VAP prevention bundle Five measures in the “All or None” bundle 1. Head of bed elevated >30 degrees 2 VTE prophylaxis 2. h l i 3. Stress ulcer prophylaxis 4. Daily wean assessment 5. Daily sedation reduction
Slide 29: The VAP improvement journey begins
The VAP improvement journey begins Explore technology (August, 2009) M workflow Map kfl processes Engage a team to work on improvement
Slide 30: Quality monitoring technology
Quality monitoring technology VAP Monitor – New tool added to our decision support toolset – Allows for real-time visibility at the unit level of how every patient on the unit is p p performing g on the elements of that Core Measure – Has been shown to help increase order set usage – Has been shown
Slide 31: Quality Monitor pictures here
Quality Monitor pictures here
Slide 32: Process changes
Process changes Report room location M ltidi i li Multidisciplinary rounds d Leadership monitoring Point of care documentation
Slide 33: Improvements
Improvements VAP rate for 2010 was 0 at St. John’s! Improved adherence to VAP bundle components VAP Quality Monitors installed in two additional ICUs (February 2010) May 2010, all 3 ICUs were at 95% or > in each of the 5 bundle elements
Slide 34: St. John's VAP rates
St. John’s VAP rates St. John's John s VAP Rates Compliance with "All or None" 3.5 Bundle 3 100% 90% 2.5 80% 70% 2 60% 50% 40% 1.5 30% 20% 1 10% 0% 0.5 0 2008 2009 2010 St.John's trendline
Slide 35: Clinical Outcomes: VAP Bundle Scorecard
Clinical Outcomes: VAP Bundle Scorecard VAP Bundle Core Measure Sep-09 Jul-10 Measure: HOB >30 degrees St.Joseph's J41 86% 100% St. Joseph's J51 96% 100% 64% St.John's 100% Measure: VTE Prophalyxis Woodwinds St. Joseph's J41 63% 100% 100% 95% At the time of St. Joseph's J51 St.John's 97% 90% 100%
Slide 36: Clinical Outcomes: VAP Bundle Scorecard
Clinical Outcomes: VAP Bundle Scorecard Quality monitor project started in October 2009 at St. John’s, and February 2010 at St. Joseph’s First time ever in yellow or green for all or none bundle: January 2010 One to three units consistently in yellow or green since th t time that ti
Slide 37: Data
Data HealthEast All or None VAP Bundle 100% QM live at Johns QM live at Joes 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% FY 08 FY09 FY10 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 July 10 * Aug-10 YTD
Slide 38: Unanticipated benefits
Unanticipated benefits Team engagement T Team collaboration ll b ti Unit leadership Physician engagement Point of care documentation Improved scores in the Woodwinds ICU even without the quality monitor – Workflow and documentation process changes were done system-wide
Slide 39: Staff perspectives
Staff perspectives “The Quality Monitor has fostered teamwork “The colors are a good visual cue to for us. Collaboration between RT and nursing trigger opportunities to chart in a ggrew. We,, together, g , have this p person on a timely manner. manner” vent.” ICU Staff Nurse, St. John’s Cindy Geary,
Slide 40: Lessons learned
Lessons learned Nurse engagement Nurse champions Location of board (monitor) One “source of truth” for data
Slide 41: Summary
Summary SUCCESSES LEARNINGS Better patient outcomes Location of quality monitors Physician engagement needs to support workflow Transparency of outcomes Engage staff at inception/ Leadership involvement staff champions Staff engagement g g Determine the “source of Point of care doc
Slide 42: It's about high performance …
It’s about high performance …
Slide 43: Questions?
Questions? X Transforming Clinical Guaiity and Care Delivery