Nurse-Sensitive Measures and Value-Based Purchasing

1 12/9/2013. Nurse-Sensitive Measures and Value-Based Purchasing Maureen White, RN SVP, Chief nurse Executive Kerri Scanlon, RN Deputy Chief nurse Executive Elena Memoracion, RN Director, Patient Care Services December 10th, 2013. Disclosures Presenters have no actual or potential conflicts of interest in relation to this program/presentation. 2. 1. 12/9/2013. Session Objectives Understand how to utilize structures and processes to enhance patient experience, safety, and quality while bending the cost curve. Identify ways to implement cost-effective, evidence- based practices to achieve excellent outcomes in Nurse-Sensitive indicators.

2 3. 4. 2. 12/9/2013. The Changing Landscape 5. Percentage of Expenses Covered by Payer 160%. 141%. 140%. 120%. 100%. 86%. 78%. 80%. 60%. 40%. 20%. 0%. Commercial/Other Medicare Medicaid 6. 3. 12/9/2013. Medicare, over time, will become the new normal rate for reimbursement 7. The Challenge: Bending the Cost Curve Expenses Revenue GAP . Dollars Affordable Care Act /. Accountable Care Organization Time 8. 4. 12/9/2013. Our System-Wide Approach to Bending the Cost Curve 1) Collaborative involve all stakeholders out of the gate 2) Evidence- based /best practices 3) Toolkits 4) Process checks 5) Outcomes validation 6) Refinement of the process 9.

3 North Shore-LIJ Health System Some people aren't used to an environment where excellence is expected.. - Steve Jobs Achieving excellence is the result of high performance throughout the organization . - Tom Peters 10. 5. 12/9/2013. North Shore-LIJ Health System Compelling vision to achieve measurable safety-quality improvements in Nurse-Sensitive indicators: Reduction and Prevention: Falls Hospital-Acquired Pressure ulcers Central Line-Associated Bloodstream Infection Catheter-Associated Urinary Tract Infection Annual Goal: 25% reduction (stretch goal of 50% reduction).

4 11. Road Map for Excellence Creates the vision for Transformational the future Leaders Listen, challenge, influence and affirm Engaged/empowered Structural workforce Empowerment Innovative Autonomy Professional Professional Model of Practice Care Clinical Quality 12. 6. 12/9/2013. How We Engage Employees Traditional Today's Design Design Top Down Top Down Leadership Strategic Plan Directing Guiding Controlling Decision-making Leadership Leading Vision Change Initiation Decision-making Employees Problem Solving Change Initiation Cross-functional teams Empowerment Bottom Up 13.

5 Collaborative Care Model HONORING THE. EXCELLENCE CARING COLLABORATION PROFESSIONALISM LEADERSHIP SAFETY. HUMAN SPIRIT. Health Care Team PATIENTS. COME. FIRST. Health Care Team Practice Environment Care Delivery Model (Structure) (Process). Outcomes Patient Experience Financial Performance Quality 14. Copyright 2012 North Shore -Long Island Jewish Health System Inc. 7. 12/9/2013. Collaborative Care Council Structure One-On-One Unit/dept Collaborative Care Council Work Team Hospital PICG System PICG. Board of Trustees 15.

6 Collaborative Care Council Agenda Patient Experience Quality and Safety Operational Healthy Work Performance Environment 16. 8. 12/9/2013. The Quality Paradigm Structure Process Outcome Exceptional Patient Outcomes Outcome data is at the heart of Nursing Quality Process providing healthcare. Outcomes Process is only as good as its design and ability to be consistently followed and Nursing Quality Process improved upon Nursing Quality Structure Nursing Quality Structure Essential for creating a quality program that is meaningful and comprehensive in the basic elements that are tracked for quality.

7 17. Structure for Nursing Quality Improvement Set standards System Level nurse and goals Executive Council Operationalize Hospital Nursing Standards and Leadership Hospital Quality Initiatives Hospital Nursing Quality Hospital CCC Unit Level Quality RN Quality Champion 18. 9. 12/9/2013. Role of RN Quality Champion A Quality Champion is one who dedicate to supporting, marketing and driving through an innovation (Grenhalgh, 2004). Driving force behind the implementation of wide range of initiatives Critical players in supporting performance improvement 19.

8 Creating A Culture of Improving Safety Just Culture - Offer no-blame, non-punitive response to adverse events - Promotes a learning culture while assigning accountability for behavioral choices Encourage Reporting of Events Utilize Data To Improve Care Empower and Engage Employees - Collaborative Care Council 20. 10. 12/9/2013. Establishing Standards of Care for Quality Improvement System System P & P Institute for Nursing Research Task Force (Falls, HAPU, CLABSI, CAUTI). System NEC. Hospital Nursing Leadership Nursing Quality 21.

9 Having the Right People: Pathway to Nursing Excellence Professional /Quality Programs Clinical Ladder RN Specialty Certification BSN Degree RNs 22. 11. 12/9/2013. Nurse-Sensitive Indicators and Revenue Improvement Increased Reducing the capacity for number with HACs more and associated LOS. admissions Revenue Avoidance of Improved Improvement CMS non- bond rating Through Cost reimbursement Avoidance Hospital's financial Reduced strategy, credit rating litigation and and ability to raise settlement capital for future projects may be costs improved 23.

10 Fall Prevention Evidence- based Practice North Shore-LIJ Health System Fall Prevention Task Force Fall Reduction Integration of Partnership for Program TeamSTEPPS Patients Use of Bed or Chair Medication Hourly Rounding Alarms Modification Observation Tracking Fall Free and Point-of- Lessons Learned Days Care Education 24. 12. 12/9/2013. North Shore-LIJ Health System Total Falls System Falls Program Implemented May 2011. 3,000. 2,500. 2,544 (27%). 2,000. 2,130. 1,500. 1859. 1,000. 500. 0. 2011. 2012. 2013 (Annualized).