1. September 2008 Partnership for Health and Accountability The PHA: Where to Next? Vi Naylor Executive Vice President Georgia Hospital Association

2. September 2008 Partnership for Health and Accountability The PHA Roadmap to Success

3. September 2008 Partnership for Health and Accountability Once upon a time…. Georgia Hospital Association established the Partnership for Health and Accountability Purpose: To promote: Accountability, Best practices, Patient safety and To improve quality of care statewide Vision: "Stakeholders collaboratively use data to proactively improve quality, patient safety and health, and effectively communicate results across the publics served."

4. September 2008 Partnership for Health and Accountability Critical Success Factors Long standing good relationships among partners Built on existing programs Involved all from the beginning Full authority for committees Utilized provider-driven, non- punitive public/private effort that fostered learning Addressed public and provider needs Public recognition

5. September 2008 Partnership for Health and Accountability Addressed Public and Provider Needs Public Health Education and Public Reports User friendly and readable State of the Health of Georgia Hospital Specific Reports: Quality Insights Provider Accountability for Patient Safety: Sharing of Sensitive confidential data Shared learning opportunities: Toolkits Technical Assistance

6. September 2008 Partnership for Health and Accountability Positive Recognition

7. September 2008 Partnership for Health and Accountability The End Result? Award program with recognition from the Governor Public Website for consumer information Significant reduction in medication errors Improved in adherence to evidence- based guidelines Sentinel Event Reporting with related Safety Alerts Shared Learning

8. September 2008 Partnership for Health and Accountability Whew!

9. September 2008 Partnership for Health and Accountability Is the Party Over? The program is now institutionalized – Give us a break!

10. September 2008 Partnership for Health and Accountability Now What? GHA board agreed to fund on-going PHA initiatives We switched focus to the Community Side while maintaining Quality and Safety Initiatives Strategically sought grants

11. September 2008 Partnership for Health and Accountability Community Outreach Grant funding to develop a community based program in chronic care management Grant to develop a tobacco-free hospital campus toolkit Created Center for Rural Health Library initiative: “connected the dots” between the public and their local hospitals Diabetes and VTE Special Interest Groups

12. September 2008 Partnership for Health and Accountability Quality and Patient Safety Continued Event Reporting and Safety Alerts and Safe Medication Audio Conferences Expanded the Quality and Patient Safety Award program Created the Hospital Mentor Program Responded to environmental forces: –Transparency website –Teams for Infection Prevention Success (TIPS) Best Practices PowerHour Plus telnets held monthly Added resources/toolkits

13. September 2008 Partnership for Health and Accountability Clinical Measures AMIAMI 1 Control Issues AMI 5 Control Issues AMI 7 Control Issues PNEPNE 2 In Control PNE 3 Control Issues PNE 5 Control Issues HF HF 1 Control Issues HF 2 Control Issues HF 3 Control Issues 2002 Analysis 2007 Analysis AMIAMI 1 In Control AMI 5 In Control AMI 7 In Control PNEPNE 2 In Control PNE 3 In Control PNE 5 In Control HF HF 1 In Control HF 1 In Control HF 1 In Control

14. September 2008 Partnership for Health and Accountability Georgia Progress Lags National Progress

15. September 2008 Partnership for Health and Accountability Our Wake-up Call US Averages * National = 84.5% Top State = 92.9% Top 10th State = 88.1% Georgia Status Average = 81.4% * Georgia Rank = 46 Georgia Now = 87.1% Right care every time for targeted core measures: AMI, CHF, PN

16. September 2008 Partnership for Health and Accountability Moving Georgia to the Top Ten What Can Hospitals Do to Improve? Participate! Participate! Participate!

17. September 2008 Partnership for Health and Accountability Increased Participation = Better Results

18. September 2008 Partnership for Health and Accountability Original Guiding Principles Revisited Accountability to the public Physician is responsible for medical treatment decisions* Physician performance should be reviewed by physician peers* Proactive and voluntary Public and private stakeholders Continuous improvement rather than a punitive, “name, blame, shame”* Provides for trust Resources and buy-in to support a long term commitment – with QI staff Repository for confidential peer review protected information* User-friendly feedback reports, but not for CEOs, MDs and Trustees Promotes best practices Educational *Crucial!

19. September 2008 Partnership for Health and Accountability Return to Prior Success Build on existing programs Involve all from the beginning Full authority to committees Foster collaboration and shared learning/education Public recognition

20. September 2008 Partnership for Health and Accountability Moving to the Next Level Top Ten Program Step up Trustee Education Communicate Board’s action Increase physician and CEO engagement Invitational Conference: From Worst to First Create infrastructure to implement Conference recommendations Make Quality a standing Board agenda item. Increase public recognition

21. September 2008 Partnership for Health and Accountability Sample data for illustration purposes only

22. September 2008 Partnership for Health and Accountability Change in Reporting

23. September 2008 Partnership for Health and Accountability Hospitals meeting the Joint Commission 90th percentile in one or more Appropriate Care Measure Increasing Public Recognition JANE JANE Jane Doe Georgia Hospital Somewhere, GA Red Circle = AMI Yellow Circle = Heart Failure Green Circle = Pneumonia

24. September 2008 Partnership for Health and Accountability Quality Honor Roll

25. September 2008 Partnership for Health and Accountability Engaging Physicians and CEOs From Worse to First Conference Recurring Theme: Incentivize acceptance and promote implementation of evidence-based practice among the hospital board, CEO, medical and hospital staffs

26. September 2008 Partnership for Health and Accountability Right Care Model

27. September 2008 Partnership for Health and Accountability Top Ten Organizational Structure

28. September 2008 Partnership for Health and Accountability Purpose Work together in partnership with physicians, hospitals, trustees, and CEOs/Executive Leadership/Front line staff to determine and promote mutually endorsed reliable, systematic processes of care that support “right care every time.”

29. September 2008 Partnership for Health and Accountability Physician-Directed “Right Care Every Time” Use of evidence-based practice to support “right care, every time” Systematic reliable process of care such as Medical staff-approved order sets and nurse initiated protocols Strategies to recognize and promote physicians’ investment of time in developing processes for outstanding performance. Identify obstacles to providing “right care every time”

30. September 2008 Partnership for Health and Accountability Physician-Directed “Right Care Every Time” Strengthen physicians’ role as the captain of the ship as related to accountability for “right care every time” Identify system supports such as “redundancy” and “forcing” Provide physician specific real-time data Promote the use of performance data in re-credentialing; set targets

31. September 2008 Partnership for Health and Accountability Physician-Directed “Right Care Every Time” Integrate activities and recommendations in partnership with hospital trustee and executive leadership activities Promote local Top Ten infrastructure Strategies for active engagement of local “voluntary” physicians Provide regular CME to address Top 10 strategies through “Physician Power Hour”

32. September 2008 Partnership for Health and Accountability Trustees: Institutional Policies/Statements Assure visibility of the board’s ultimate responsibility for evidence-based practice Include adherence to evidence-based practice in contracts Reinforce physician accountability for evidence- based practice Institutional adoption of evidence-based practices Performance data for re-credentialing Recognition program related to evidence- based practice

33. September 2008 Partnership for Health and Accountability Executive Leadership Facilitate evidence-based practices Multi-disciplinary discussions to determine obstacles and identify supportive system functions to facilitate “right care every time” Employ forcing and redundancy strategies

34. September 2008 Partnership for Health and Accountability Executive Leadership Enhance ability for physician to participate in recommending reliable systematic processes of care Concurrent monitoring for real time assessment and completion of missing elements of “right care every time”. Physicians real-time feedback data

35. September 2008 Partnership for Health and Accountability The Future QUARTERGA GA NATIONAL TOP STATE RANKRATE RATE RATE_____ Q4 2010 1 95.5 90.2 95.5 Our Vision - 2010