1. Montana Rural Hospital Flexibility and Rural Healthcare Performance Improvement Network Orientation Program June 2010

2. Some common acronyms… Flex = Rural Hospital Flexibility Program PIN = Performance Improvement Network DPHHS = MT Dept of Public Health and Human Services MHREF = MT Health Research and Education Foundation, the not-for-profit arm of MHA MHA = MT Hospital Association

3. Some common acronyms… CAH = Critical Access Hospital QI = Quality Improvement PI = Performance Improvement CMS = Centers for Medicare and Medicaid Services

4. Montana’s Flex Program  MT Grantee = DPHHS Quality Assurance Division Jeff Buska, Administrator Kathy Lubke, Program Officer  DPHHS contracts with MHREF to administer Flex funded activities  DPHHS retains program evaluation and fiscal management responsibilities

5. Flex/PIN Staff Flex Director Carol Bischoff457-8016carol@mtha.orgcarol@mtha.org Rural Hospital Quality Coordinator Kathy Wilcox461-6186kathy@mtha.orgkathy@mtha.org

6.  St. John’s Lutheran Hospital  Clark Fork Valley Hospital  Mineral Community Hospital  Marias Medical Center  Liberty Medical Center  Pondera Medical Center  Teton Medical Center  Missouri River Med. Center  Big Sandy Med. Center  Powell Co. Medical Center Granite Co. Medical Center   Ruby Valley Hospital  Barrett Memorial Hospital  Mountainview Medical Center  Livingston Healthcare  Pioneer Medical Center  Stillwater Comm. Hospital  Beartooth Hosp. & Health Center  Rosebud Health Care Center  Dahl Memorial Healthcare Assoc.  Fallon Medical Complex  Prairie Community Hospital  Garfield Co. Health Center  McCone Co. Health Center  Roosevelt Med. Center  Poplar Comm. Hospital  Sheridan Memorial Hosp.  Frances Mahon Deac. Hospital  Phillips County Hospital  Wheatland Memorial Healthcare Montana Critical Access Hospital Program Status April 2010  Critical Access Hospitals Potential Critical Access Hospital  Broadwater Health Center  Madison Valley Hospital  St. Luke Comm. Hospital  Glendive Medical Ctr  Big Horn County Memorial Hospital  St. Joseph Hospital  Community Hospital of Anaconda Marcus Daly Memorial Hospital   North Valley Hospital  Northern Rockies Medical Center  Daniels Memorial Healthcare Center NE MT Health Services  Fort Belknap Service Unit  Crow/N. Cheyenne Indian Hospital  Roundup Memorial Healthcare  Sidney Health Center Blackfeet Comm. Hospital  Central Montana Medical Center  Holy Rosary Healthcare

7. Flex Grant Objectives 2009-2010 Continue collaboration with Mountain Pacific Quality Health-MT’s QIO Support key CAH staff on quality and performance improvement issues Maintain and enrich PIN data programs Provide networking and education opportunities for key CAH staff Sustainable leadership skills development program

8. Flex Grant Objectives 2009-2010 Advance development of health information technology systems in MT CAHs Support MT DPHHS EMS Trauma Systems to encourage trauma designation Partner with EMS and trauma stakeholders to support and assist rural EMS agencies Provide Community Health Services Program in conjunction with MT Office Rural Health

9. Flex QIO Collaboration Activities 2009-2010 Promote Hospital Compare data submission Support development of potential rural projects Medication Reconciliation project-Round 2 Networking, meetings, list serve

10. Flex Networking/Ed Activities 2009-2010 Joint QI Coordinators & DONs Regional Meetings Region 1Marcus Daly Memorial Hospital, Hamilton Region 2Marias Medical Center, Shelby Region 3Sidney Health Center, Sidney (north) Region 3Fallon Medical Center, Baker (south) Region 4Ruby Valley Hospital, Sheridan Region 5Livingston HealthCare, Livingston Oct 2010; dates to be announced

11. Flex Networking/Ed Activities 2009-2010 CAH Administrators Sept 22 & 23, MHA Fall Convention, Billings Directors of Nursing (DON) Forum March 16-18, 2011 QI Coordinators Showcase April 20-22, 2010 Fairmont Hot Springs

12. Flex Networking/Ed Activities 2009-2010 Champions for Quality 2010 “Embracing Challenges and Changes” July 16-18, 2010 Great Northern Hotel Helena Medical Education, CMEs Symphony Under the Stars and Family Fun! 100% say this conference is worth their time to attend!

13. Flex Networking/Ed Activities 2009-2010 Health Care Trustee Association of MT (HCTAM) - televideo education for trustees - 2 scholarships to attend Western Region Trustee Symposium - funding to support Trustee track at the MHA convention Coding Tele-video series CFO Networking: new ListServe

14. Sustainable Leadership 2009-2010 Leadership Institute Series underway LEAN Process Management

15. Flex HIT Support Activities 2009-2010 HIT Technical Assistance website Collaboration with MHA HIT Task Force

16. Flex EMS Support Activities 2009-2010 Build regional ATLS training caches Web-based trauma coordinator training Encourage CAH reporting to State Trauma Registry Support for Pre-hospital Trauma Life Support training Group purchasing for the Western EMS Network

17. Flex MORH Collaborative Activities 2009-2010 (MT Office of Rural Health) Community Health Services Development (CHSD) Year 4-Needs assessment and community health care planning; 6 sites: McCone County-Circle, St. John’s-Libby, Teton Medical-Choteau, St. Joe’s-Polson, Frances Mahon-Glasgow, Wheatland Memorial-Harlowton Lean Process Management in a CAH Sites selected: Clark Fork Valley-Plains, Liberty County- Chester, Pioneer-Big Timber, Roosevelt-Culbertson, Prairie Community-Terry, Fallon Medical-Baker

18. Significant Flex resources support the Montana Rural Healthcare Performance Improvement Network (PIN)

19. Performance Improvement Network Formed at request of CAH CEOs in 2001 All 47 MT CAHs are members Governance provided by PIN Advisory Board up to 10 members: CEOs, DONs, QI/PI Clinical oversight provided by the Clinical Improvement Panel (CIP)

20. Performance Improvement (PI) Program C-0191Agreements with qualified entities C-0195Agreements for Credentialing and Quality Assurance C-0271Clinical policies and procedures

21. Performance Improvement (PI) Program C-0330“Periodic Evaluation”, ie, the Annual CAH Program Evaluation C-0336“An effective QA program”: the expectation of measurable improvement C-0337All patient care and other services affecting patient health and safety are evaluated

22. Performance Improvement (PI) Program C-0338Includes nosocomial infections and medication therapy C-0339Includes quality and appropriateness of diagnosis and treatment (ie, “peer review”) C-0341Considers findings and recommendations from the QIO and takes corrective action C-0342Takes appropriate remedial action to address deficiencies found through the QA program (ie, CAH survey deficiencies)

23. Performance Improvement (PI) Program Provides support for in-house PI staff Opportunities for improving performance Clinical improvement studies, benchmarking Education, training and PI resources PIN Education Committee Regulatory information and support (CMS) Tag by tag review; last Wed each month, 2 pm

24. Performance Improvement (PI) Program Support for in-house staff, cont. Consultation onsite as requested – Networking opportunities sponsored meetings Engaging administration and medical staff Administrator meetings; Champions for Quality; clinical improvement panel and studies

25. Facility Staff Support Resources “Best Practice” tools, resources and education PIN ListServ pin@astro.lyris.netpin@astro.lyris.net Quarterly PIN newsletter PIN website www.mtpin.orgwww.mtpin.org Currently under construction- watch for big changes!

26. 9 years in the development 13 indicators initially; 26 currently 94% reporting rate in 1st quarter 2010 Continually refining metrics & peer groups PIN Benchmarking Project

27. Sample report 8 quarters 5 Peer Groups

28. Clinical Improvement Studies Program Clinical Improvement Studies (CIS) 2 studies underway at all times Clinical Improvement Panel (CIP) 8 PIN Physician volunteers 2 PIN mid-level volunteers CIS Development Committee (CIS-DC) DON and QI/PI Coordinator volunteers

29. CIS Program 2010 Patient Safety: Reduce Preventable Falls Pediatric Emergency Care: launched April 2010 Clinical Benchmarking Project Pressure Ulcers, HF, CAP, Stroke, Inter-facility Transfer measures Quality Awards: 2010 recipient criteria Applications due August 1, 2010 You MUST apply to receive an award!

30. PIN Lessons Learned Leadership commitment is essential Involve more than CEOs Clarifying program responsibility and accountabilities in the facility are essential (not just the coordinator) Frequent communication “What gets measured gets managed” Cultural transformation is a slow, deliberate, strategic process

31. QUESTIONS? Cultural transformation is a slow, deliberate, strategic process.