1. ………………..…………………………………………………………………………………………………………………………………….. Quality Improvement in Health Care Nationwide Children’s Sheilah Harrison September 2011

2. ………………..………………………………………………………………………………………………………………………………….. Presentation Overview My Journey Nationwide Children’s Hospital (NCH) Background Quality Goals Quality Improvement Services Heart Center Quality Improvement Coordinator Key Measures Quality Improvement Tools My Observations on Health Care Personal Goals to Achieve Success

3. ………………..………………………………………………………………………………………………………………………………….. My Journey Credentials 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

4. ………………..………………………………………………………………………………………………………………………………….. Nationwide Children’s Hospital ~1000 Medical Staff 7200+ Employees 124 Specialties on Main Campus 28 Outpatient Care Centers 18,472 Discharges 18,873 Surgeries 914,456 Outpatient Visits

5. ………………..………………………………………………………………………………………………………………………………….. NCH Quality Goals Eliminate Preventable Harm* Event Reporting System Non-Punitive Huddles Preventable Harm Indices Focus on Numerator * 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.

6. ………………..………………………………………………………………………………………………………………………………….. NCH Quality Improvement Services (QIS) Organization consists of: Service Line Coordinators Clinical Quality Decision Support Accreditation Patient Satisfaction and Grievances

7. ………………..………………………………………………………………………………………………………………………………….. 7 Quality Improvement Tools

8. ………………..………………………………………………………………………………………………………………………………….. Quality Improvement Coordinator Heart Center Monitor 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

9. ………………..………………………………………………………………………………………………………………………………….. 9 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 GOALS Improve 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 Measures The Heart Center

10. ………………..………………………………………………………………………………………………………………………………….. My Observations of Health Care Organizational charts Hard to obtain Have numerous dotted lines Absence of clinical project management Accountability is distributed Physician support is familiar requirement Comprehensive patient charts but challenges with trend analysis

11. ………………..………………………………………………………………………………………………………………………………….. Personal Goals to Achieve Success Largest 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 physicians Ensure ideas and tasks have owners Educate staff with Project Management tools Address Change Management Identify areas where data collection can be automated Model new processes with strawmen

12. ………………..………………………………………………………………………………………………………………………………….. 12 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 Hospital Tel: 614-722-3198 sheilah.harrison@nationwidechildrens.org sheilah.harrison@nationwidechildrens.org

13. ………………..………………………………………………………………………………………………………………………………….. 13 QUESTIONS? Quality Improvement in Health Care