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Remaking Heathcare in Memphis

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July 2004 : Remaking Healthcare in Memphis: Improving Healthcare at at the local level requires enormous effort. In Memphis we initiated our working by forming Memphis Quality Initiative ...

July 2004 : Remaking Healthcare in Memphis: Improving Healthcare at at the local level requires enormous effort. In Memphis we initiated our working by forming Memphis Quality Initiative (www.memphisquality.org), a hospital collaborative, and Healthy Memphis Common Table, (www.healthymemphis.org), a community collaborative. This presentation shows the theoretical and philosophical thought behind this effort.

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Remaking Heathcare in Memphis Remaking Heathcare in Memphis Presentation Transcript

  • Remaking Healthcare in Memphis Manoj Jain MD MPH Baptist DeSoto Hospital- Chairperson Infection Control Memphis Quality Initiative – Coordinator of Physician Team Healthy Memphis Common Table – Coordinator of Council Partner QSource, Tennessee’s QIO- Medical Director
  • Remaking Healthcare at…
    • Hospital Level
    • Desoto ICU and Crucial Care
    • City-wide Hospital Level
    • Memphis Quality Initiative
    • City-wide Community Level
    • Healthy Memphis Common Table
    • State Level
    • Quality Improvement Groups
    • National Quality Initiatives
    • Institute for Healthcare Improvement
    • Institute of Medicine
  • Hospital Level Initiative DESOTO ICU and FLOOR
  • 4 Elements of Change
      • Multidisciplinary teams – MD led
        • Physician buy-in
      • Flow Meetings
        • Administrative support
      • Bundles
        • Evidence based medicine
      • Culture of change
        • Horizontal Decision Making
  • Bundles
      • Completeness –100% EBM
      • Consistency – 100% patients
      • Coordination
      • Concurrency
      • Cost Savings – Over $750,000
    Evidence based medicine from BENCH to BED in days not decades VAP, Central line and UTI Bundles in place
  • Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)
  • VAP Rate in ICU 67.56% Decrease FY 02-FY04YTD
  • Nosocomial Infection Rates FY 2001-FY 2004 YTD
  • Statistical Significance
  • BMH-DeSoto HSMR (Health System Mortality Ratio)
  • ICU Cost Per Workload Unit (Patient Day) 13.5% Decrease
  • ICU ALOS Per Episode
  • Average Cost Per ICU Episode 15.6% Decrease 8.6% Decrease
    • To design a seamless flow model that will drive clinical practice, optimize resources, and improve identified critical outcome indicators
    Aim of Crucial Care Initiative
  • Crucial Care Model 12/09/2003 C RUCIAL C ARE ED ICU Step Down Acute Care Quality Mgt. Access OR PACU FTC Core Measure Cohort Mobile Registration Flow Specialists MET Asthma Clinic Chest Pain Center Infection Control Protocol Patients
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  • City wide Initiative Memphis Quality Initiative
  •  
  •  
  • Quality Quality Quality Quality Quality Quality
  • Quality Quality
  • Quality Quality Quality
  • Memphis Quality Initiative (MQI)
    • Mission Statement: To improve care by sharing quality initiatives among medical and administrative professionals
  • Community Professional Standard
    • M A QI - Administrators
    • M P QI - Physicians
    • M N QI - Nurses
    • M PH QI - Pharmacists
    • M CQO QI – Quality Directors
    • M IT QI – Information Technologists
  • MQI M A QI M P QI M N QI M QID QI M PH QI M IT QI
  • MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative M PH QI M IT QI
  • MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative M PH QI M IT QI
  • MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative M PH QI M IT QI
  • MQI M A QI M P QI M N QI M CQO QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MQIDQI Memphis Chief Quality Officers Quality Initiative MPRQI Memphis Pharmacists Quality Initiative M PH QI M IT QI
  • MQI M A QI M P QI M N QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative MNQI Memphis Nursing Quality Initiative M PH QI M IT QI M CQO QI MQIDQI Memphis Chief Quality Officers Quality Initiative
  • MQI M A QI M P QI M N QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative MNQI Memphis Nursing Quality Initiative M PH QI MITQI Memphis Information Technologists Quality Initiative M IT QI What a ride!!!! M CQO QI MQIDQI Memphis Chief Quality Officers Quality Initiative
  • City wide Community Initiative Healthy Memphis Common Table
  • 1 st Initiative: Reversing the trends in obesity & diabetes in Shelby County! Healthy Memphis Common Table
  • Bottom 6% in exercise Average BMI is 27.3 (25+ is overweight) Below average for healthy eating 2002 SELF magazine: Memphis is “ The Unhealthiest City in the Nation” *2003: Minor improvement reported but long way to go! 168/200
  • “ America's Unhealthiest City for Men” Men’s Health magazine, 2003 In 2003
  • Diabetes Care for TennCare Enrollees
    • Wide variations exist in HbA1c screening rates:
    • average annual rates ranged
    • from 26.3 - 80.2%.
    Bailey et al, 2000 data
  • Charitable Associations & Grant Makers Diabetes Assoc. JDF, Heart Kidney Public Education Schools, Fitness Centers, Churches, Clubs, Restaurants
    • Specialty Care
    • endocrinology
    • wound care
    • nephrology
    • cardiology
    • eye care
    • dialysis
    • psychiatry
    Memphis on the Move & consumer leaders, fund raisers (volunteers); Mem-Fit campaign
    • Primary Care Givers
    • Int. Med.
    • OBs
    • F.M.
    • GPs
    • Pediatricians
    • NPs, Pas
    • School RNs
    Payer’s MD directors Patient educators Outreach efforts Employers & MBGH HR benefit managers Employee relations Small businesses CEO Government S.C. Health Dept. & Loop State health clinics State Diabetes Programs Education (fitness, wellness, exercise nutrition) Good nutrition Regular exercise Diabetes special care Hospital & End stage organ disease care 3 ° Organ tx, pancreas islet tranplants & obesity surgery MEDIA WREG WMC WHBQ, WPTY Commercial Bsns. Journal Best Times UMC DATA GROUP UMC Diabetes Project Manager UMC staff
    • Hospitals
    • Wellness ed
    • Patient ed
    • Administrators
    • Marketing
    • Nurse execs
    • MD officials
    Researchers & scientists UT Preventive Medicine, QSource, CRC, private, data resources. Regular primary 1 ° care & checkups Timely, quality, affordable specialty care 2 °
    • Food Sources
    • Restaurants
    • Grocers
    • Employers
    • Cafeterias
    • Clubs
    • Churches
    The Mid-South
  • Building a Common Table
    • 1. April 2000: Non-profit incorporated to encourage “people working together” to “improve health care systems”
    • January 2001: Non-profit becomes 501(c)(3)
    • Winter 2002: Dr. Bob Waller calls for a “Common Table”
    • Spring 2003: Healthy Memphis Common Table formed
    • Fall 2003: Merger of Common Table with 501(c)(3)
    • Nov. 2003: Norfleet Forum -Common Table public launch
      • Nearly 400 attend
      • Don Berwick et. al. focus on diabetes and obesity
      • Leaders pledge support for Common Table
    • Jan. 2004: IOM Crossing Quality Chasm Meeting
      • Community health collaboratives championed
  • Working Group Process
    • Feb. 2004: Community Partner Planning Meeting
      • Over 40 community & healthcare leaders attend
    • Mar. 2004: Working Group Convener Training/Organization
    • April 3, 2004: 1st Community Partner Meeting; 120 attend
      • Workgroups review data, set goals and organize for action
    • April 26, 2004: Community Partner Working Group Meeting
      • over 75 attend
    • April - June 2004: Workgroup Action Teams develop Action Plans
    • June 12, 2004 : Working Group Coordination Session
    • July 2004: Meet the Press at 2nd Quarterly Community Partners Meeting
  • Charitable Associations Grant Makers Diabetes Assoc. JDF, Heart Kidney Public Education Schools, Fitness Centers, Churches, Clubs, Restaurants Specialists endocrinology wound care nephrology psych heart eye Primary Care Int. Med. OBs F.M. GPs Pediatricians NPs, Pas School RNs Payer’s MD directors Patient educators Outreach efforts Employers & MBGH HR benefit managers Employee relations Businesses CEO Public Health Reg. Health Council, Health Dept. Loop, MED, Mental Health Ctrs. UT Ext. Service UMC DATA GROUP UMC Diabetes Project Manager UMC staff Researchers & scientists UT Preventive Medicine, QSource, CRC, Continuum of health for ALL citizens in ALL locations Food Sources Restaurants Grocers Employers Cafeterias Clubs Churches
    • Hospitals
    • Memphis Quality Initiative
    • Administrators
    • Physicians
    • Nurses
    • Pharmacists
    • I.S./data
    MEDIA Comm. Appeal M e m – F I t WREG WMC WPTY Etc. Tennessee on the Move Memphis on the Move fund raisers (volunteers)
  • Mission The Healthy Memphis Common Table is a 501(c)(3) non-profit organization whose mission is to support and encourage people working together to improve the health of everyone in our community.
  • Our “ BAG ” (Big Audacious Goal) By 2008, we will REVERSE the growth of Diabetes and Obesity in Shelby County. Not SLOW the trend, or STOP it. REVERSE THE TREND . The graphs head DOWNWARD !
  • “ BAG ” Benchmarks for the Greater Memphis Area 2002
  • “ BAG ” Benchmarks for the Greater Memphis Area 2002
  • “ BAG ” Benchmarks for the Greater Memphis Area 2002
  • Key Activities
    • 1. Action-Oriented Working Group Facilitation
    • 2. Quarterly Community Partner Meetings
    • 3. Annual Community Partner Summit
    • 4. HMCT Community Partner Email Newsletter
    • 5. www. healthymemphis.org website
    • 6. www. peopleshealth.org website
  • Working Group Goals
    • Community Awareness/Education:
      • Everyone in Memphis knows how to prevent diabetes through healthy living
    • Screening:
      • Everyone in Memphis has a BMI checked
      • Everyone knows their BMI
    • Diabetes Management:
      • Everyone with diabetes gets recommended care
    • Business Case:
      • Every business, payer and person finds a way to pay for prevention and real value in healthcare
  • Healthy Memphis Common Table
    • Executive Committee
    • (4 officers, 1 other member & Executive Director)
    • Meets weekly or as needed
    • Delegates responsibility for some governance functions, business and operational issues
    • Board of Directors
    • (11 members)
    • Meets monthly; includes the Executive Committee.
    • Makes polices for the organization.
    • Has ultimate responsibility for corporate governance, including all operational and development issues
    Executive director & staff
    • Membership of the Common Table
    • Actively participates in Working Groups and Action Teams
    • Source of candidates for Council, Board and Committees
    • Provides resources for the Common Table (donations-financial & in-kind, volunteers, membership fees)
    • Meets at least quarterly
    • When requested, reviews proposed policies and initiatives.
    • Leadership of the Common Table
    • Helps set agenda
    • Evaluates and proposes future initiatives
    • Oversees quarterly meetings
    Community Partners Community Partners Council
  • For board members: Sharepoint "Team Site"                                      For board members: Sharepoint "Team Site" Slide for home page of website                                                                                                                                                                                                                                                                                                                                                                                                                                          
  •  
  • Vision: In Conclusion
    • We, the Community Partners of the Healthy Memphis Common Table, envision a healthy community built upon the fundamental H ealth CARE principles of:
        • H ealth: We seek to reorganize our health system to promote health as its primary goal.
        • C hoice: We choose the best value in health care providers and treatments.
        • A ccess: We provide care according to need for all people.
        • R esponsibility: We take responsibility for our health and are accountable for our health care resources.
        • E ducation: We continually learn and share how to best improve our health and the health system.
  • Charitable Associations Grant Makers Diabetes Assoc. JDF, Heart Kidney Public Education Schools, Fitness Centers, Churches, Clubs, Restaurants Specialists endocrinology wound care nephrology psych heart eye Primary Care Int. Med. OBs F.M. GPs Pediatricians NPs, Pas School RNs Payer’s MD directors Patient educators Outreach efforts Employers & MBGH HR benefit managers Employee relations Businesses CEO Public Health Reg. Health Council, Health Dept. Loop, MED, Mental Health Ctrs. UT Ext. Service UMC DATA GROUP UMC Diabetes Project Manager UMC staff Researchers & scientists UT Preventive Medicine, QSource, CRC, Continuum of health for ALL citizens in ALL locations Food Sources Restaurants Grocers Employers Cafeterias Clubs Churches
    • Hospitals
    • Memphis Quality Initiative
    • Administrators
    • Physicians
    • Nurses
    • Pharmacists
    • I.S./data
    MEDIA Comm. Appeal M e m – F I t WREG WMC WPTY Etc. Tennessee on the Move Memphis on the Move fund raisers (volunteers)
  • Community Partners
    • Government
    • City of Memphis, Center for Neighborhoods
    • Memphis & Shelby County Health Dept.
    • Methodist Healthcare, Government Relations
    • Shelby Co. Government
    • Shelby County Schools
    • Tennessee Dept. of Health
    • Tennessee Bureau of TennCare
  • Hospitals Baptist Memorial Health Care Baptist Memorial Health Care, Diabetes Services Baptist Women's Hospital Methodist Healthcare Methodist Healthcare, Cafeteria Methodist LeBonheur Methodist LeBonheur, Coordinated School Health St. Francis Hospital The MED The MED, Community Health Education Other Providers Christ Community Health Services Church Health Center Delta Medical Center Hope & Healing Center Memphis & Shelby County Health Dept., Health Loop Clinics Memphis Health Center Midtown Mental Health Center Pediatric Lifestyle Clinic The Endocrine Clinic, PC Univ. of TN, College of Nursing, Center for Health Evaluation & Lifestyle Promotion UT Medical Group UT Medical Group, Child Health UT Medical Group, Endocrinology UT Medical Group, Pediatric Endocrinology UT Medical Group, Pediatrics
  • Payers & Quality Improvement Organizations Medical Outcomes Management Memphis Managed Care Corp. (TLC) OmniCare Health Plan Qsource, Center for Healthcare Quality Colleges & Universities Southern College of Optometry Southwest TN Community College, Hotel Management Program Univ. of Memphis Univ. of Memphis, Center for Healthcare Economics Univ. of Memphis, Dept. of Anthropology Univ. of Memphis, Dept. of Health & Sport Sciences UT: Children's Foundation Research Center UT: Dept. of Medicine UT: Dept. of Pediatrics UT: Dept. of Preventive Medicine UT: College of Nursing UT: Dept. of Telemedicine UT: Extension Service, Nutrition UT: Institute for Women's Health UT: Reference Library
  • Fitness Centers & Youth Groups Camp Body Rock / Inside Out Gym DeSoto Athletic Club Elite Personal Fitness Girls Inc. of Memphis YMCA Faith-Based Organizations African American Pastors Association Calvary Episcopal Church Memphis Healthy Churches Metropolitan Inter-Faith Association (MIFA) Shelby County Inter-Faith   Coalitions, Medical Advocacy & Support Groups American Diabetes Association Angels Support Group Bluff City Medical Society Memphis Minority Health & Community Development Coalition Women's Foundation of Memphis Pediatric Wellness Roundtable Tennessee on the Move Individuals, Businesses, & Business-oriented Groups Access MD / Isys Technology Commercial Appeal (newspaper) Creative Foodworks Individual (Creative Director / Marketing) Individual (Writer) International Paper LHS, Inc. (Charitable Foundation) Memphis Business Group on Health Memphis Light, Gas & Water (Utilities) Methodist Healthcare, Web Services Novo Nordisk Pharmaceuticals Pfizer Inc. UT Medical Group, Human Resources Dept. Univ. of TN Pharmacy Walgreens WREG-TV
  •  
  • State Level TENNESSEE
  • Year 2000 Baseline Performance Variability Among the 16 Largest TN Hospitals
  • Knoxville Model
    • Meeting of Senior Administrators January
    • Meeting of Medical Directors
    • Topic for Improvement – ICU care – VAP
    • Business Group – HC21 is leading the effort
  • Nashville Initiative
    • Meeting of Medical Directors
    • Meeting of Senior Administrators
    • October 28 with Brent James
    • Facilitated by Tennessee Hospital Association and QSource
  • Tri-Cities and Chattanooga Initiative
    • Meeting of Medical Directors
    • Meeting of Senior Administrators
    • Planning a meeting in 2-4 months
  • National Initiative Institute of Healthcare Participant Institute of Medicine Participant
  • Aims For Improvement
    • Safe
    • Effective
    • Patient-centered
    • Timely
    • Efficient
    • Equitable
  • Phase III: Priority Areas for National Action: Transforming Health Care Quality
    • Committee on
    • Identifying Priority Areas for Health Care Quality
    • To order: www.nap.edu
  • Collaboration with IHI
    • Major hospitals part of IMPACT
    • 50-60 physicians attend annual IHI Conference
    • Major presentations by Hospitals/QIO/
    • Baptist Memphis Quality Officer co-chair for Dec. 2004 conference.
  • Principle of Nonviolence
    • Don’s challenge to us is analogous to the principles of non-violence
    • No needless deaths
    • No needless pain
    • No helplessness
    • No unwanted waiting
    • No waste
    • Jesus – in his kind, humble way “Do not Kill” - No needless death
    No needless death
    • Hippocrates – oath to doctors – First do no harm
    No Needless pain
    • Buddha – no suffering - No needless pain
    No Needless pain
    • Gandhi – “It is not the British who have made us subordinates but we ourselves allowed them to dominate us” - No helplessness
    No Helplessness
    • Martin Luther King – I have a dream and we must change now – No waiting
    No Unwanted Waiting
    • Mother Teresa – Every life is precious – We must have no waste
    No Waste