1. HRET Improvement Leader Fellowship WHA Guidance Call Travis Dollak and Thomas Kaster WHA Quality Coordinators 1

2. Webinar Agenda Future Fellowship Events How to Catch Up if you Missed Chicago Overall WHA-ILF Guidance and Strategy HRET and CMS Harm Across the Board Description Harm Across the Board template demo and rewards Upcoming deadlines and events 2

3. Future HRET Fellowship Events San Diego – July 24 and 25 – As soon as we know Chicago, September 30 and October 1 3

4. How to Catch Up if you Missed Chicago To be receive a funded slot for the San Diego ILF we are asking you to complete the IHI Open School Wave 1 Modules – You will need to register on HRET’s / IHI site Click Here to Enroll – http://app.ihi.org/lms/home.aspx?CatalogGUID=5b5c79b8-f019-442c-a199- de2041cdfbf5 http://app.ihi.org/lms/home.aspx?CatalogGUID=5b5c79b8-f019-442c-a199- de2041cdfbf5 4

5. Overall WHA-ILF Guidance and Strategy HRET-IHI Open School Valued at over $7000 The more you give the more you get – Not required to do anything WHA wants to capitalize on your achievements – Webinars, Q&A’s and Storyboards HRET and WHA provide you a audience to share your great work at a National and Federal level 5

6. Harm Across the Board Template WIFM Giving you an essential resource for driving improvement in your hospital Demonstrating throughout the country the great work we do here in WI Building awareness at the federal level of how essential and valuable this work is 6

7. Harm Across the Board Template Description Provides a framework that changes the discussion from numbers and rates into how people are literally harmed in facilities Brings the reality that people are harmed to the forefront Helps people change the way they think about common errors ---no harm is acceptable Template will be sent via email and on the WHA Quality Center 7

8. Improving Harm Across the Board Title Slide (1 of 15)

9. TEMPLATE GUIDE Treat harms as events that can be summed Focus on harms (outcomes) rather then preventive measures (process) Special conditions can be considered a harm (e.g., EED, Readmits, …) Produce an overall harm trend for the hospital (**Delete this slide when content of presentation is complete) (2 of 15)

10. 2012 Breakthrough in Reducing HARM: 250 to 50 harms/1,000 discharges 10 (3 of 15) WHA has created a template for all 4 graphs in this template

11. Cut “harm across the board” in half: 60 patients per quarter to under 30 11 (4 of 15) WHA has created a template for all 4 graphs in this template

12. 2012 Breakthrough in Readmission: From 20% of discharges to 10% of discharges 12 (5 of 15) WHA has created a template for all 4 graphs in this template

13. 2012 Breakthrough in Reducing Readmissions: From 20 per quarter to 10 per quarter 13 (6 of 15) WHA has created a template for all 4 graphs in this template

14. Pearls Please list the drivers of safety that produced these results. Include one about patient and family engagement, if relevant (7 of 15) The Most Important Slide

15. (8 of 15) Defining Moment(s) In Our Journey Name and date one or two defining moments. Moments that caused the organization to commit to extraordinary safety. Moments that resulted in a big breakthrough in the organization’s ability to deliver safety. 15

16. Strategies to Drive Results What challenges did you encounter that you were able to overcome to achieve the results you are presenting here? What were the strategies you used to overcome them? (9 of 15)

17. Risk Profile by Areas of Risk HACsEstimated annual number of patients at risk in each areaNumber ADE# of inpatients: CAUTI# pts in IP units with catheter in place: CLABSI# pts in IP units with central lines: Falls# of discharges: Ob AE# of women with deliveries: Pr Ulcer# of discharges: SSI# of applicable surgical pts: VAP# of patients on a ventilator: VTE# of inpatients: EED# of women with elective deliveries TOTALRisk opportunities for harm across the board Readmit# of inpatients at risk of readmit: (10 of 15)

18. EXAMPLE HACsEstimated annual number of patients at risk in each area ADE4587 of inpatients: CAUTI1268 pts in IP units with catheter in place: CLABSI668 pts in IP units with central lines: Falls4587 of discharges: Ob AE747 of women with deliveries: Pr Ulcer4587 of discharges: SSI5502 of applicable surgical pts: VAP183 of patients on a ventilator: VTE4587 of inpatients: EED283 of women with elective deliveries Readmit4587 of inpatients at risk of readmit: TOTAL 31,586 Risk opportunities for harm across the board

19. Improving Harms by HAC Scale: number of hospital-acquired conditions (HACs) at each level – IDEAL: level represents what we see as best possible – At Target: level represents meeting improvement target – Progress: level not yet at target – Opportunity: level represents an improvement opportunity (**Delete this slide when content of presentation is complete) (11 of 15)

20. Improving HAC Rates (12 of 15) Use the baseline data that is available to you WHA can also help with Target Rates HACs Baseline [time period] Target 40% Reduction OR Current [time period] Improvement Status (scale) ADE <7% Insulin, <5% INR, 100% Med Rec CAUTI.48 per 1000 catheter days CLABSI.48 per 1000 central line days Falls 2.15 per 1000 days OR.5 (with injury) per 1000 days Ob AE.1208 per 100 births Pr Ulcer 3.21 per 1000 discharges SSI.504 per 100 VAP.66 per 1000 ventilator days VTE.556 per 1000 discharges EED <2% Readmit 20% reduction WHA can help fill this page if you send your draft slides

21. HACsBaseline [time period] TargetCurrent [time period] Improvement Status (scale) ADE0.008 ( 2011) 40% ↓ 0.0050.007 (Jan-Dec 2012) Progress CAUTI0.0008 ( 2011) 40% ↓ 0.00050 (Jan-Nov 2012) Ideal CLABSI0 ( 2011) Sustain0 (Jan-Dec 2012) Ideal Falls w Injury 0 (Jan-Dec 2011) Sustain0 (Jan-Sep 2012) Ideal Ob AE0.012 ( Dec 2011) 40% ↓ 0.00720.0011 (Jan-Sep 2012) Ideal EED0 (Dec 2011) Sustain0 (Jan-Nov 2012) Ideal Pr Ulcer0 (Oct-Dec 2011) Sustain0.0002 (Jan-Sep 2012) Ideal SSI0.003 (2011) Sustain0.003 (Jan-Sep 2012) Ideal VAP0.0 (2011) Sustain0 (Jan-Sep 2012) Ideal VTE0.0002 (2011) 40% ↓ 0.00110 (Jan-Dec 2012) Ideal Readmit0.066 ( 2011) Sustain0.068 ( Jan-Sep 2012) Ideal EXAMPLE

22. Our Hospital Risk Profile & Result Annual Volume (Discharges) Total risk: annual harm opportunities Risks per patients (Total Opportunities)/Discharges) Number of PfP Harm Areas Applicable (0 – 11) Number of PfP Harm Areas Applicable & Adopted Number of PfP Areas at Improvement Target Number of PfP Areas at IDEAL (13 of 15)

23. EXAMPLE Annual Volume (Discharges)4587 Total risk: annual harm opportunities31,586 Risks per patients (Total Opportunities)/Discharges) 6.9 Number of PfP Harm Areas Applicable (0 – 11)11 Number of PfP Harm Areas Applicable & Adopted 11 Number of PfP Areas at Improvement Target1 Number of PfP Areas at IDEAL10

24. Future Actions to Reduce Harm What other actions will you take to reduce harm in the future? (14 of 15)

25. Photo of Hospital CEO & Safety Team (15 of 15)

26. Future Details Draft Templates Due to WHA by April 29 th Weekly HATB Development and Coaching Calls Please send to WHA Final Templates Due June 3 rd – Top 3 from Wisconsin to be on storyboards in San Diego (93 total) – Top 3 in San Diego to receive certificates and discuss progress with Don Berwick 26