1. Northwest Medical Center
Kick Starting Change With MBQIP/FLEX

2. Northwest Medical Center
25 Bed Critical Access Hospital
Serving 4 Communities
Acute And Swing Bed Services
Dynamic Outpatient Department
Home Health Agency
4 Physician Clinics
Numerous School And Community Partnerships
Busy Emergency Department
Proudly Affiliated With Mosaic Life Care

3. Partners in Change…….
Through our partnership with the MBQIP/FLEX program we have been able to track our progress on core quality indicators and compare ourselves to our peers in an effective way. It is nice to be able to compare apples to apples instead of apples to oranges.
Participation in the program has provided invaluable opportunities for networking and real world education that we have been able to put into clinical practice.
Our participation has also, afforded us the ability to put some needed equipment, software, and educational tools in place at our facility that would have been cost prohibitive without grant resources that are available through MBQIP/FLEX participation.

4. Improvement On A Dime Quality Challenges At A CAH
Every time a CAH identifies an issue; they have to juggle resources.
Typically, improvement teams are not going to receive more FTE’s or an influx of money when a problem is identified.
It is a good thing that small rural hospitals are accustomed to innovating and creating to make things happen and to get results.
We knew what value-based purchasing was before it was cool!
Let’s discuss some of the things that NMC has done to solve challenges that we identified through feedback reports , education and mentorship from the MBQIP/FLEX program.

5. Recognizing Problems Drilling Down On The Data
MBQIP OQR rd Quarter
MBQIP OQR
2016 1st Quarter
Median time from ED arrival to provider contact.
13 minutes
49 minutes
2014 HCAHPS
Result
Quietness
53% always
Responsiveness
67% always

6. HCAHPS Improvement
Through our feedback reports we identified a problem with our scores on quietness and responsiveness.
Our improvement team decided to prioritize responsiveness.
If our patient’s feel like we are not meeting their needs in an expedient manner, it could affect their thoughts about our facility, as a whole.
The patient’s we serve need to know that we care and are here for them.
Attentiveness is everyone’s job!

7. Things That Make You Say HMMM…
How do you get buy-in?
How do we spread the concern and the mission hospital wide?
How do we communicate “call lights are everyone’s responsibility”.
What scripting will we provide for non-clinical caregivers?
Will there be an incentive initially?

8. Ingenuity Is Our Middle Name
The team used staff meetings to communicate the problem and the goal. Rounding with purpose began.
Call Light Commandos were born.
Fountain drink cards were handed out for 30 days.
Scripting was provided for non-clinical caregivers.

9. Culture is the Cure
Most important, our CEO held town hall meetings at our local theater for all NMC caregivers.
He talked about our organization, our issues, the vision for our culture, our mission and how we could get there.
Caregivers were encouraged to share and question.
Without C suite support and a culture for change; improvement does not happen!!

10. Moving On…. The next issue was our quietness rating.
Patient’s who do not rest, do not recover!
An improvement team was tasked with improving our environment.
Information was and continues to be pushed out through huddles, staff meetings and the weekly Eye On Nursing newsletter.

11. It Takes Teamwork
Culture, innovation, and organizational teamwork led to success.
Tools to help identify noise levels were put in place.
Maintenance waits until later in the day to vacuum.
Laundry is gathered after breakfast is served.
Lights are dimmed at 10pm and “Quiet Time”
goes into place.
NMC is meeting goals and improving
patient care and satisfaction with these processes.

12. Emergency…..Call 911, EDTC And Provider Contact Times Need Help
While we were focused on the previous issues we were able to identify some new concerns along the way, through our MBQIP feedback reports.
NMC’s median arrival to provider contact times had tripled in the ED in a short period of time.
NMC’s transfer communication was demonstrating a lack of nurse documentation/notes in the packet.

13. Solving For X
What is causing the increased wait time to be seen by a provider in the ED? Inquiring minds wanted to know…..the C-suite
The team decided that the best way to gather information is to talk to those involved and complete a root cause analysis.
Here is what we discovered:
The ED nurses wanted to adhere to real time, bedside documentation.
The ED physicians stated that they were responding within 5 minutes of being called in most cases.
We had new ED physicians with our new partnership and they were learning the EMR documentation.
Our ED nurses and physicians were engaged and wanted to
find a solution.

14. Engagement In Action
Physicians and nurses came together and discussed the findings. They found that nurses were finishing their initial assessments and charting before notifying the physician, unless the patient was emergent.
In trying to complete real time bedside documentation the nurses were increasing the time to provider median time.
Patients were telling their stories twice which is exhausting when you are ill.
Solutions:
Continuity has been established with consistent ED physicians and nurses.
All intakes are now completed in unison.
OUTCOME- Arrival to provider times are decreasing.

15. EDTC Improvement Innovations
After discovering the lack of nurse communication accompanying transfers out of ED from both data entry in the EDTC system and feedback, we rolled up our sleeves.
A Transfer Audit Record was created to assure completion of all elements.
NMC’s Technology Services team revamped the discharge packet in the ED EMR to assure thorough and complete communication with the receiving facility.
Nurse’s and ED physician’s collaborate on completion and communication.
A double check is completed of each record to proactively recognize potential issues and rectify or provide coaching, as appropriate.

16. Results Review
NMC has made significant improvement in all the areas discussed with the interventions shared.
HCAHPS scores have improved steadily. We recently were over the 90% mark in both areas (quietness and responsiveness) with our new vendor report.
Last quarter we had increased nurse communication to 91% on our EDTC report.
Our arrival to provider time is improving significantly in the ED, as well.

17. We appreciate you a whole LOTTO!
Celebrate Success!
We talk about problems, we need to talk about our success!
We appreciate you a whole LOTTO!

18. Partnering for success
The benefit of our partnership with MBQIP/FLEX has been a invaluable educational and quality tool for Northwest Medical Center.
I will leave you with the phrase that they preach, “Network, Share, and Steal Shamelessly!”

19. Contact Information
Lori Bishop, RN Northwest Medical Center 705 N. College Street Albany, Mo ext. 1208