1. 2014 Silver Award Recipient American Hospital Association (AHA)/Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN) 2.0 Hospital Kick-off Tuesday, September 29 & Thursday, October 1, 2015 1:00-3:00 PM CT 1

2. 2014 Silver Award Recipient WELCOME AND INTRODUCTIONS Maulik Joshi, Associate Executive Vice President, AHA Clinical Leadership and Health Improvement; President, HRET Jessica (Blake) McNab, Director, HRET 1:00-1:10 PM 2

3. 2014 Silver Award Recipient First Things First Congratulations! We are excited to have the HEN 2.0 contract We are looking forward to working with you, your state hospital associations, your patients and their families 3

4. 2014 Silver Award Recipient Agenda for Today 1:00-1:10 PMWelcome from the AHA/HRET Team Open and provide housekeeping information. Welcome and overview of the project along with initial thoughts on keys to success in this project. Jessica McNab Director, Clinical Quality Maulik Joshi President 1:10-1:15 PMWelcome from CMS Welcome hospitals to the HEN 2.0 project. Shelly Coyle Nurse Consultant, DHHS, CMS 1:15-1:20 PMKeys to HEN 2.0 Success – Additional Areas of Focus Review additional key strategies for success. Ken Anderson Chief Operating Officer 1:20-1:30 PMProject Scope and Goals Provide background on the HEN project and the goals for 2015-2016 and benefits to participation. Charisse Coulombe Vice President, Clinical Quality 1:30-1:50 PMEducation Opportunities Outline national education offerings at the national level, including meetings, the fellowship and topic-specific webinars. Jessica McNab 1:50-2:05 PMData Expectations and Support Introduce data expectations and the support that will be provided by HRET to meet the project aims, including the Comprehensive Data System. Mariana Lesher Director, Data 2:05-2:15 PMTechnical Assistance and Targeted Offerings Summarize opportunities for hospital participants to receive targeted support, including office hours, technical assistance and affinity groups. Sarah Bender & Marissa Kumabe Program Managers 2:15-2:30 PMWhat’s Next for You Provide details on how to engage, including the Needs Assessment and HEN 2.0 website. Natalie Erb & Angela Michalek Program Managers 2:30-2:40 PMAction Items Discuss any next steps and how we will support you in accomplishing them. Charisse Coulombe Vice President, Clinical Quality 2:40-3:00 PMQ & A and Closing Questions for the HRET teamAll

5. 2014 Silver Award Recipient Bold Aims 12-month SPRINT to reduce all-cause preventable inpatient harm by 40% and readmissions by 20% 1.Be in action to support your patients and their families by committing to this project 2.Work to reduce harm across the board 3.Learn together by sharing your hospital stories – successes and opportunities 4.Data is the foundation of all improvement at the unit level, hospital level, state and national level 5

6. 2014 Silver Award Recipient WELCOME FROM CMS Shelly Coyle, Nurse Consultant and AHA/HRET’s COR, DHHS, CMS 1:10-1:15 PM 6

7. 2014 Silver Award Recipient KEYS TO HEN 2.0 SUCCESS 7 Ken Anderson, Chief Operating Officer, HRET 1:15-1:20 PM

8. 2014 Silver Award Recipient PROJECT SCOPE AND GOALS 8 Charisse Coulombe, Vice President, HRET 1:20-1:30 PM

9. 2014 Silver Award Recipient HENs: What are they? Hospital Engagement Networks 2.0 Improvement collaborative Best-practice incubator Community of peers Learning cohort Quality improvement (QI) Clinical content Similar to the original HEN project from 2011-2014 regarding focus and bold aims Different regarding standardized measures and accelerated timeframes

10. 2014 Silver Award Recipient PfP HENs for HEN 2.0 1.AHA/HRET 2.Ascension Health 3.Carolinas HealthCare System 4.Dignity Health 5.Healthcare Assoc. of NY State 6.Health Research Education Trust of NJ 7.Hosp. & Healthsystem Assoc. of PA 8.IA Healthcare Collaborative 9.LifePoint Health 10. MI Health and Hosp. Assoc. Health Found. 11. MN Hosp. Assoc. 12. OH Children’s Hosp. Solutions for Pt. Safety 13. OH Hospital Assoc. 14. Premier Inc. 15. TN Hospital Assoc. 16. VHA-UHC Alliance NewCo Inc. 17. WA State Hosp. Assoc. 10

11. 2014 Silver Award Recipient The AHA/HRET HEN Structure Patients & Families Hospital Team State Hospital Association (SHA) Team AHA/HRET HEN Team

12. 2014 Silver Award Recipient Core Topics – Aim is 40% reduction 12 1.Adverse Drug Events (ADE) 2.Catheter-associated Urinary Tract Infections (CAUTI) 3.Central line-associated Blood Stream Infections (CLABSI) 4.Early Elective Deliveries and Obstetrical (OB) Harm 5.Injuries from Falls and Immobility 6.Pressure Ulcers (PrU) 7.Surgical Site Infections (SSI) 8.Venous Thromboembolisms (VTE) 9.Ventilator Associated Events (VAE) 10.Readmissions (20% reduction)

13. 2014 Silver Award Recipient All Other Forms of Harm 13 1.Airway Safety 2.Clostridium difficile (C. diff) 3.Culture of Safety 4.Failure to Rescue 5.Iatrogenic Delirium 6.Radiation Exposure 7.Sepsis

14. 2014 Silver Award Recipient Special Topics of Focus Patient and Family Engagement (PFE) Health Care Disparities (HCD) 14

15. 2014 Silver Award Recipient AHA/HRET HEN Team 15

16. 2014 Silver Award Recipient Our Partners 16 1.State hospital associations (SHAs): Hospital support 2.Cynosure Health: Clinical education 3.Institute for Healthcare (IHI): Quality improvement education 4.University of Michigan (U of M): CAUTI education 5.Operations and Logistics 6.Communications, Graphic Design and 508 Compliance 7.Continuing education

17. 2014 Silver Award Recipient The Timeline 12/1/2014 - HEN 2.0 Pre-Solicitation Released 12/8/2014 - HEN 1.0 Ends2/11/2015 - HEN 2.0 RFP Released 3/27/2015 – AHA/HRET HEN 2.0 Proposal Submitted 7/21/2015 – SHA Convening & Questions from CMS Received 7/31/2015 – AHA/HRET HEN 2.0 Revised Proposal Submitted 9/24/2015 – CMS Executes Contract with AHA/HRET HEN 2.0 17 9/23/2016 – Project End

18. 2014 Silver Award Recipient What We Know Project Period – 12 months Aim – Reduce all-cause preventable harm by 40%; readmissions by 20% Required Measures for Core Topics – 17 outcome measures 18

19. 2014 Silver Award Recipient AHA/HRET HEN 2.0 Overall Plan We have not had an opportunity to discuss these details with CMS – These plans are subject to change pending CMS feedback – We wanted to share the preliminary details to help you understand the support we plan to provide As soon as we can, we will provide you and your SHA with additional details for project components, such as finalized adverse drug event (ADE) measures, etc. 19 Stay tuned!

20. 2014 Silver Award Recipient Our Commitment To leverage HEN 1.0 successes and learnings To communicate early and often via our main communication tool - the HRET HEN 2.0 website To support you and your state hospital association in the best way possible to achieve the project goals To move as quickly as we can to achieve the 40 / 20 percent reduction in harm! 20

21. 2014 Silver Award Recipient EDUCATION OPPORTUNITIES 21 Jessica (Blake) McNab, Director, HRET 1:30-1:50 PM

22. 2014 Silver Award Recipient Visit Our New Website!

23. 2014 Silver Award Recipient Where to Find Your SHA Details 23

24. 2014 Silver Award Recipient Overview of Our HEN 2.0 Plan Biweekly 90-minute Topic-specific Webinars Two Annual National Scientific In-person Meetings Monthly Data Webinars Bimonthly Rural/CAH Affinity Group Webinars Foundational HEN Action Leader Fellowship Experienced HEN Action Leader Fellowship SHA-led Meetings Site Visits Hospital-level Improvement 24

25. 2014 Silver Award Recipient Topic and Data Webinars Topic webinars – We have designed shorter, mid-day webinars to help you incorporate education into your (busy!) schedules and to keep your focus in the unit Approximately twice a week No more than 90 minutes long – Topics will be prioritized based on our direction from CMS and project data, including a needs assessment (which will be explained in more detail) Data webinars – Will cover how you can use project data to inform quality improvement, including baseline statistics – Approximately once a month 25

26. 2014 Silver Award Recipient Fellowship Foundational HEN Action Leader Fellowship: Track offered for new HEN participants or those new to quality improvement Experienced HEN Action Leader Fellowship: Track offered to experienced HEN participants or those who have been focused on quality improvement and patient safety for more than five years Details for each include: – Monthly webinars building on learnings throughout the project – Action Learning Projects (ALPs) that will highlight individual or hospital progress toward HEN project goals – Opportunity to meet and network with other Fellows at in- person national scientific meetings – Sharing of ALPs on website upon completion – Certificate of completion upon project submission 26 Registration details will be communicated soon!

27. 2014 Silver Award Recipient Hospital Onboarding Checklist

28. 2014 Silver Award Recipient Education This Month  September 29, 1-3 PM CT – Hospital Kickoff Webinar  October 1, 1-3 PM CT – Hospital Kickoff Webinar (repeat)  October 6, 11-12:30 PM CT – Hospital Data Intro Webinar  October 8, 11-12:30 PM CT – Hospital Data Intro Webinar (repeat)  October 13 & 15, 11-12:30 PM CT – Tentative Readmissions and CAUTI Webinars  October 20 – Tentative Fellowship Kickoff 28 √ √

29. 2014 Silver Award Recipient Chat Us! What are you most excited about in HEN 2.0? 29

30. 2014 Silver Award Recipient DATA DETAILS 30 Mariana Lesher, Director, HRET 1:50-2:05 PM

31. 2014 Silver Award Recipient Measurement Philosophy Simple, straightforward, explainable Capitalize on existing data where possible Use standardized measures Be responsive to unique needs 31

32. 2014 Silver Award Recipient HEN 2.0 Data Components 32 ComponentFrequency / date due Needs assessmentOnce, upon enrollment, by Nov 16 Baseline outcome and process measures data Once, upon enrollment (timeframe TBD) Monitoring outcome and process measures data Monthly, by last day of month following close of month (except readmissions) Start date TBD Operational items Monthly, by last day of month following close of month

33. 2014 Silver Award Recipient Needs Assessment – by Nov 16 Basic hospital information HEN topic prioritization and measurement practices Quality improvement efforts Patient and family engagement practices Leadership and governance activities Disparities data collection efforts Cultural competency practices HEN contacts 33

34. 2014 Silver Award Recipient Program Evaluation Measures Focus Area CMS Required Evaluation Measure(s) CAUTI  NHSN 1 Reporting Facilities: CAUTI Standardized Infection Ratio (SIR) (NQF 0138) o Intensive Care Unit (ICU) Units, excluding Neonatal Intensive Care Units (NICU) o ICU + Other units All Facilities: CAUTI Rates (CAUTIs /1,000 catheter days, CAUTIs / 10,000 pt days) o ICU Units, excluding NICU o ICU + Other inpatient units  All Facilities: Urinary-catheter utilization ratio (catheter days / 10,000 pt days) CLABSI  NHSN 1 Reporting Facilities: CLABSI SIR - (NQF 0139) o ICU Units, including NICU o ICU + Other units  All Facilities: CLABSI Rates (CLABSIs / 1,000 central line days, CLABSIs / 10,000 pt days) o ICU Units, including NICU o ICU + Other inpatient units  All Facilities: Central-line utilization ratio (central line days / patient days) [1] [1] Hospitals reporting CAUTI, CLABSI, SSI and VAE data may confer rights to their data to the AHA/HRET or another group to meet the measurement requirements for this topic. All other hospitals are expected to follow the NHSN definitions of the measures and will submit numerators and denominators. Rates will be calculated based on numerators and denominators.

35. 2014 Silver Award Recipient Program Evaluation Measures, cont’d Focus Area CMS Required Evaluation Measure(s) Falls  Falls with injury (NQF 0202) Obstetrical (OB) adverse events  Early elective deliveries (EED) (PC-01, NQF 0469)  Vaginal deliveries with instrument (Agency for Healthcare Research & Quality [AHRQ] PSI 18)  Vaginal deliveries without instrument (AHRQ PSI 19) Pressure ulcers (PrU)  PrU rate, Stages 3+ (AHRQ PSI-03)  PrU prevalence (hospital-acquired), Stage 2+ (NQF 0201) Surgical site infections (SSI)  NHSN 1 Reporting Facilities: SSI SIR (NQF 0753) o Colon surgeries o Abdominal hysterectomy o Total hip replacements o Total knee replacements All Facilities: SSI Rates (# infections / # surgeries) o Colon surgeries o Abdominal hysterectomy o Total hip replacements o Total knee replacements [1] [1] Hospitals reporting CAUTI, CLABSI, SSI and VAE data may confer rights to their data to the AHA/HRET or another group to meet the measurement requirements for this topic. All other hospitals are expected to follow the NHSN definitions of the measures and will submit numerators and denominators. Rates will be calculated based on numerators and denominators.

36. 2014 Silver Award Recipient Program Evaluation Measures, cont’d 36 VAE  Ventilator-Associated Condition (VAC)  Infection-Related Ventilator-Associated Complication (IVAC) VTE  Post-Operative pulmonary embolism (PE) or deep vein thrombosis (DVT) rate (AHRQ PSI-12) Adverse drug events (ADE)  ADEs per 1,000 patient days  ADEs due to opioids  Excessive anticoagulation with warfarin  Hypoglycemia in patients receiving insulin Readmissions  All cause 30-day readmissions Other outcome and process measures may be added, as well as other topic measures.

37. 2014 Silver Award Recipient Setting Up for Success Education Encyclopedia of Measures Data Intro Webinars Monthly Data Webinars Technical Support HRETdatasupport@ aha.org Office Hours CDS Platform Enhancements Data validationReports Other Resources Improvement Calculator Harm Across the Board 37

38. 2014 Silver Award Recipient Comprehensive Data System (CDS) Secure, web-based data collection and reporting system for HRET projects Will support all hospital-level data submission and reporting for HEN 2.0 Expanded and enhanced features since HEN 1.0 38

39. 2014 Silver Award Recipient Immediate Next Steps for Data 1.Review resources from your SHA / website – Encyclopedia of measures – Needs assessment – CDS Quick Start Guide 2.Join a Data Intro Webinar next week – Tues Oct. 6 and Thurs Oct. 8, 11-12:30 PM CT 3.Return your signed commitment letter for access to CDS 4.Start collecting and submitting data! 39

40. 2014 Silver Award Recipient TECHNICAL ASSISTANCE AND TARGETED OFFERINGS 40 Sarah Bender, Program Manager, HRET Marissa Kumabe, Program Manager, HRET 2:05-2:15 PM

41. 2014 Silver Award Recipient Technical Assistance Don’t worry! We’re here to help! 41 AHA/HRET offers two types of technical assistance: Shared inboxes Office hours

42. 2014 Silver Award Recipient AHA/HRET Shared Inboxes HEN Inbox (HEN@aha.org):HEN@aha.org – Available for any technical or national project support needs. Emails to be reviewed and responded to within two business days. HRET Data Support Inbox (HRETdatasupport@aha.org):HRETdatasupport@aha.org – Available for data-specific questions about the project, including CDS, which will be responded to within two business days. 42

43. 2014 Silver Award Recipient AHA/HRET Office Hours Data: – Twice monthly opportunities to speak with the HRET data team for troubleshooting around data in CDS, reports and any measure specification questions. Quality improvement: – Twice monthly opportunities to speak to quality improvement advisors for troubleshooting around your facility projects and how to overcome barriers. 43

44. 2014 Silver Award Recipient Targeted Offerings Rural and Critical Access Hospitals (CAH) – Affinity group webinars Offerings every other month to address issues that are unique to rural and CAH hospitals – Customized materials: Rural/CAH Data Collection Tool Rural/CAH LISTSERV® Others, as needed or identified… 44

45. 2014 Silver Award Recipient Your SHAs And obviously, your SHA contacts will be wonderful resources to you as you go through the project! 45

46. 2014 Silver Award Recipient WHAT’S NEXT FOR YOU 46 Angela Michalek, Program Manager, HRET Natalie Erb, Program Manager, HRET 2:05-2:15 PM

47. 2014 Silver Award Recipient LISTSERV® Update The HEN 1.0 LISTSERVs® will sunset this week, and the HEN 2.0 LISTSERVs® will launch Hospital participants will need to sign up through the website (no one will be automatically subscribed)the website Committed hospitals will be subscribed 47

48. 2014 Silver Award Recipient LISTSERVs® Subscriber-based email group Each email group covers a different topic or group of topics Ideal for: – Peer-shared learnings – Asking questions about barriers – Sharing data-collection opportunities – Clarifications about measures or inclusion/exclusion criteria 48

49. 2014 Silver Award Recipient Site Visits Your SHA will contact you to set up a mutually agreeable date and time for them to visit and review the project, data and your organization’s goals During site visits: – Complete a site-visit action plan with the SHA After site visits: – Your SHA will submit the site-visit action plan into our CDS, where you will be able to view it and track progress We will be using this information to help us report on the quality and quantity of site visits, a crucial part of our HEN 2.0 strategy 49

50. 2014 Silver Award Recipient Commitment Letter Will be filled in for you Summary of you and your team's commitment to achieve the HEN 2.0 project goals Summary of CMS required measures for quick reference

51. 2014 Silver Award Recipient Commitment Letter Summary of CMS required measures for quick reference

52. 2014 Silver Award Recipient Commitment Letter Summary of optional topics HRET commitments to you and your team SHA will have their contact information included so you can have their information as a quick reference You and your team to complete and sign and return to your listed SHA

53. 2014 Silver Award Recipient Commitment Letter Details Contact your SHA for a copy of your state’s commitment letter Due date is at the discretion of your SHA Commits to: 1) working on all applicable topics; 2) submitting data on all applicable topics (and required measures); and 3) collaboration and sharing Summarizes CMS requirements Collects CEO and HEN lead signature and contact information

54. 2014 Silver Award Recipient Next Steps  Assemble your team.  Recruit an executive champion, physician champions, a project lead, data support and multidisciplinary support from across your organization.  Access resources on www.hret-hen.org.www.hret-hen.org  Search for resources by topic or type of resource  Access SHA information  Register for events.  Watch the Upcoming Events page for webinars that are relevant to you.Upcoming Events  Celebrate!  You are committing to an extraordinary national initiative to improve care. 54

55. 2014 Silver Award Recipient ACTION ITEMS 55 Charisse Coulombe, Vice President, HRET 2:30-2:40 PM

56. 2014 Silver Award Recipient Re-cap of Action Items  Assemble your team and celebrate!  Join a hospital kick-off webinar, data kick-off webinar and other upcoming events as they are scheduled  Get on HRET-HEN website  Review project and data resources  Submit your Letter of Commitment to your SHA  Complete your Needs Assessment in CDS  Schedule your first SHA site visit  Submit baseline and monitoring data into CDS 56 √ √

57. 2014 Silver Award Recipient What and Who General ?s: HEN@aha.orgHEN@aha.org Data ?s: HRETdatasupport@aha.orgHRETdatasupport@aha.org Clinical ?s: Topic LISTSERVs® And, of course – Your SHA

58. 2014 Silver Award Recipient Questions? 58