1. Disclaimer information here… Click to edit Master title style WHA’s Learning Series: QI 100 for Health Care Clinicians Unit 1: Why Quality Matters 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, the Wisconsin Hospital Association, and other organizations.

2. Disclaimer information here… Click to edit Master title styleQI 100 Rules of Engagement 2 1.This powerpoint must be in “Slide Show” mode in order for all links to be active (see the Slide Show menu at the top of your screen). 2.You must complete this unit in one sitting. You will not be able to exit and re-enter from where you left off. 3.This unit has three exercises and a five question quiz at the end. You must complete the quiz to get credit for Unit 1. You will be asked to enter your name. 4.CEU’s will be awarded after you have taken all five units and completed the Capstone Quiz – a link to this quiz is given in Unit 5. 5.The content provided in this unit is for educational purposes only and is not to be interpreted as an endorsement by WHA or any of it’s member or partner organizations. 6.This learning series is supported by the Aligning Forces for Quality grant. 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, the Wisconsin Hospital Association, and other organizations. 7.If you have questions or problems please e-mail: ssobczak@wha.orgssobczak@wha.org Please read carefully:

3. Disclaimer information here… Click to edit Master title styleQI 100 Unit Progression 3 Why Quality Matters Unit 1 Participating in Improvement Unit 2 Holding the Gains Unit 3 Health Care Change Systems Unit 4 Capstone & Credit Unit 5

4. Disclaimer information here… Click to edit Master title styleIntroduction to Unit 1 You are about to participate in the QI 100 Unit 1 Why Quality Matters After completing this unit, you will be able to: Describe the 3 major influences on health care quality improvement and the health care system. Describe how QI efforts improve health care for patients and families as well as health care clinicians. Describe why public reporting is becoming more important for hospitals and clinics. Describe your connection to the health care QI efforts. 4

5. Disclaimer information here… Click to edit Master title styleGetting Credit for Unit 1 When you see a light bulb icon, you can access a brief exercise to reinforce the concept. Simply click on the light bulb. When you see a screen icon, you should access a quiz to test your knowledge. Simply click on the question mark. When you are done with an exercise simply close the page by clicking the or at the top of the page. In order to receive continuing education credit, you need to complete the Unit 1 quiz. 5 X

6. Disclaimer information here… Click to edit Master title styleHealth care as a system The American health care delivery system is comprised of working relationships between many different entities: 6 Clinic Hospital Specialty Clinic Rehab Facility Home Care Agency Laboratory Medical Equipment Insurers Regulators Pharmacy Public Health

7. Disclaimer information here… Click to edit Master title style Complex systems are hard to change According to a 2009 report by the Agency for Health Care Reporting and Quality (AHRQ) the current rate of improvement in health care is about 2-3 % per year. At this rate, improving upon pressure ulcer prevalence or BSI, for example, could take 10 – 15 years. Therefore, it is vital for every health care professional to assist in the effort to improve the rate of change for our patients and families. 7

8. Disclaimer information here… Click to edit Master title styleSix aims of health care quality The Institute of Medicine released and important report in 2001, Crossing the Quality Chasm: A New Health System for the 21 st Century. This report concluded that the U.S. health care system is in need of fundamental change and recommended a framework and strategies for achieving substantial improvements in the quality of health care. The Quality Chasm's framework consisted of six aims for improving health care: making healthcare more safe more timely more effective more efficient more patient-centeredmore equitable This important book has been very influential in making health care quality improvement a priority across all health care delivery entities. 8

9. Disclaimer information here… Click to edit Master title styleRedesigning Health Care The Institute of Medicine report also made 10 recommendations for how to achieve the six aims of health care quality: – Care based on continuous healing relationships. – Customization based on patient needs and values. – The patient as the source of control. – Shared knowledge and the free-flow of information. – Evidence-based decision-making. – Safety as a system property. – The need for transparency. – Anticipation of needs. – Continuous decrease in waste. – Cooperation among clinicians. 9 Question for consideration: How do your organization’s improvement efforts align with these recommendations? Can you see a connection?

10. Disclaimer information here… Click to edit Master title styleApplying the Six Aims Exercise 1: Try this exercise to reinforce the six quality aims Just click on the light bulb  Match the clinical scenario with each of the 6 aims of health care quality. 10 X When you are done, simply close out by clicking the or at the top.

11. Disclaimer information here… Click to edit Master title styleWhat drives improvement? There are two main sources of influence that drive improvement in hospitals and clinics. Some of these are external drivers, such as regulations and reporting requirements. Others are internal drivers such as improvements after an adverse event, or to improve customer satisfaction. 11

12. Disclaimer information here… Click to edit Master title styleMeasurement Drivers There are many ways that measures are determined: Disclaimer information here…12 National Measurement Standards Key Indicators (CMS) Nursing Sensitive Measures Jt Commission Core Measures Required Reporting Measures Sentinel EventsInfection RatesDisease Facility Measures HCAHPS ER – Lab Turnaround Rate of BSIFalls Rates

13. Disclaimer information here… Click to edit Master title styleMeasurement and Public Reporting Not long ago clinical performance data was kept within the walls of our hospitals and clinics. Healthcare facilities had no idea if they were achieving very good outcomes or not. Therefore, the reasons to improve often resulted from examining an issue after the fact. Current emphasis is on prevention, so comparing performance and benchmarking great performers has become vital. 13

14. Disclaimer information here… Click to edit Master title stylePublic Reporting & Transparency 14 Enhance consumer choice by helping to identify high quality providers Assist employers in designing benefits that incorporate quality measures Promote research-based care to the public Raise the quality of care provided through competition and selection of providers Control growth of administrative resources, and Minimize conflicting or misleading quality information by providing a trusted source of information. Public Reporting of hospital and clinic data is well-established in Wisconsin. There are many reasons for publicly reporting health care performance data: In addition, studies have shown that health care facilities that participate in public reporting do more to actively improve their results than hospitals that do not publicly report.

15. Disclaimer information here… Click to edit Master title stylePublic Reporting in Wisconsin There are several outlets for public reporting of health care data. Three of these are listed below. Exercise 2: Click on a lightbulb to see the measures & look up your organization’s performance on a cardiac measure. Hospital Compare  WHA’s Checkpoint  Wisconsin Collaborative for Healthcare Quality  15 When you are done, simply close out by clicking the or at the top. X

16. Disclaimer information here… Click to edit Master title styleThe importance of public reporting Consumers. Consumers could use this information from the time they choose a health plan to the point of selecting a health care provider for a specific service. Providers. Health care providers would benefit from more transparent price and quality information and for identifying the most efficient and effective referrals. Employers/Purchasers. Employers may want information to use in selecting from various health plans or self-insured options. Policymakers. To monitor changes in the overall system, pinpoint areas that warrant closer investigation, and encourage the reporting groups to evaluate their own performance. 16 In 2007, The Commonwealth Fund, released a report on the stakeholders in public reporting of health care data. Here is how these groups might use publicly reported health care data:

17. Disclaimer information here… Click to edit Master title styleYour help is needed in this effort It is estimated that at least 10% of any organization must actively participate in or advocate for an initiative in order for the effort to be adopted and sustained.* If your facility is typical, you may have just a few folks dedicated to improvement efforts. QI efforts normally rely on teams of staff people to provide the expertise needed to design useful change. If improvement is viewed as the work of only a few people, you can see how the pace of improvement would be affected. *The Tipping Point, by Malcolm Gladwell 17 Imagine your hospital or clinic…How many people work there? How many are actively involved in improvement efforts?

18. Disclaimer information here… Click to edit Master title styleQI Efforts help patients & families Quality Improvement serves an important function in improving or mistake-proofing processes that could endanger the safety or lives of patients. Improvement efforts can also better leverage the communication methods and tools to ensure every family member and patient clearly understands the follow-up care plan. Improvement processes are also key to making a difference in patient satisfaction scores (HCAHPS).0 18

19. Disclaimer information here… Click to edit Master title styleQI Efforts improve job satisfaction Many studies have examined what makes an employee satisfied in their job. Money usually isn’t at the top of the list. Here are some factors that do influence job satisfaction: – Ability to make a difference in the lives of others – Opportunity to learn and apply new skills – Collaborating with others to solve problems – Opportunities to improve clinical practice – Involvement in decisions about patient care Are many of these important to you? 19

20. Disclaimer information here… Click to edit Master title styleWhat’s in it for you? QI efforts provide learning and career progression opportunities: You learn new skills or sharpen those you may have (such as leading a group). You meet and work with those from other departments and functions, understanding what they do. You gain experience with health care as a system, beyond your role as an individual contributor. You contribute to an important effort, locally and nationally. 20

21. Disclaimer information here… Click to edit Master title styleUnit 1 Summary Quiz 21 Congratulations! You have completed Unit 1: Why Quality Matters You can now test what you have learned by taking a short assessment: Just click on the screen icon  **You must take the assessment to get full credit for Unit 1 X When you are done, simply close out by clicking the or at the top.

22. Disclaimer information here… Click to edit Master title styleUnit 1 Resources 22 Articles: Public Reporting and Transparency, The Commonwealth Fund. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Feb/Public- Reporting-and-Transparency.aspx http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Feb/Public- Reporting-and-Transparency.aspx A study of job satisfaction of nursing and allied health graduates from a mid-Atlantic university. Journal of Allied Health, Spring 2003 by Lyons, Kevin J, Lapin, Jennifer, Young, Barbara Books: Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy Press; www.nap.edu. http://www.nap.edu/books/0309072808/html/www.nap.eduhttp://www.nap.edu/books/0309072808/html/ Gladwell, Malcom. The Tipping Point, Websites: www.wicheckpoint.org, www.whaqualitycenter.org, www.asq.org, www.wchq.org,www.wicheckpoint.orgwww.whaqualitycenter.orgwww.asq.orgwww.wchq.org