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Value Based Purchasing: Value Based Purchasing:                                                       St. David s Medical ...
SDMC HCAHPS “ODYSSEY”                                      2006 ENGAGED STUDER GROUP                                      ...
CLOSING THOUGHTS:                                                                       Questions or Comments? Higher perf...
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Value Based Purchasing: From Rule to Reality - One Hospital’s Journey - Susan Griffin, St. David's Medical Center

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Susan Griffin, St. David's Medical Center - Speaker at the marcus evans National Healthcare CNO Summit Spring 2012, held in Hollywood, FL, April 26-28, 2012, delivered her presentation on Value Based Purchasing: From Rule to Reality - One Hospital’s Journey

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Transcript of "Value Based Purchasing: From Rule to Reality - One Hospital’s Journey - Susan Griffin, St. David's Medical Center"

  1. 1. Value Based Purchasing: Value Based Purchasing: St. David s Medical Center (SDMC) located in Austin, Texas, is part of St.  St David’s Medical Center (SDMC) located in Austin Texas is part of St David’s HealthCare, one of the largest health systems in Texas. St. David’s  From Rule to Reality Medical Center includes a 351 bed acute care hospital and a dedicated 64  bed Rehabilitation hospital. St. David’s Medical Center is a Primary Stroke  One Hospital’s Journey Center and Certified Chest Pain Center.  Susan Griffin, RN, MSN, CENP Chief Nursing Officer St. David’s Medical Center Austin, Texas 1THE SDMC JOURNEY: SDMC CORE MEASURE COMPLIANCE SAMPLE TACTICS: From 2003 Deficit Reduction Act Detailed nurse leader and staff education on rule and how to accomplish  – Pay for reporting mindset – Core Measures compliance To Final Rule May 6, 2011 – Currently encompasses Innovated use of nursing status board in nursing EMR to flagging Core  • Year 1 Measure patients and issues 70% Core Measures 30% HCAHPS 30% HCAHPS Core Measure patient census report auto prints twice daily for charge nurse  Core Measure patient census report auto prints twice daily for charge nurse • Year 2 oversight 20% Core Measures 30% HCAHPS Flow charts created and posted in every OR on Beta Blocker and timely  antibiotic administration/selection 50% Other Mortality(AMI,HF,PN), Patient Safety Indicators, HAC’s • Years 3 – 8 Misses shared in unit huddles/staff meeting Readmissions included Witholds increasing to 6% Every staff member involved in miss meets with CEO/CNO 2 3SDMC BIGGEST IMPACT: CORE MEASURES Measure CMS Top Quarter 1 Quarter 2 Quarter 3 Quarter 4 Success tied to culture and accountability at every level 10% 2011 2011 2011 2011 “It’s the right thing to do for our patients” Acute Myocardial Evolved from a quality department owning culture to an everyone owning  100 100 100 100 100 Infarction culture (AMI) – CNO/CMO presence and actively involved in weekly Core Measure mtg / p y y g Heart Failure 99.64 98.7 99.02 99.02 99.57 with quality/nursing/CMO – Physicians engaged Pneumonia 98.84 99.68 99.3 98.29 100 • Hospitalists Surgical Care • Anesthesiologists Improvement 99.16 98.97 99.62 99.87 99.85 Program – Staff Engagement (SCIP) Goal: Reduce Misses to ZERO: – 38 misses in 2010 – 25 misses 2011 4 – 5 misses 1st quarter 2012 5 1
  2. 2. SDMC HCAHPS “ODYSSEY” 2006 ENGAGED STUDER GROUP HCAHPS QUARTER TO DATE SUMMARY HCAHPS Quarter to Date Summary Tools for Service Excellence HCAHPS Top Box Ntl Ntl Ntl – AIDET HCAHPS Summary Measures Avg 75th 95th Q1 11 Q2 11 Q3 11 Q4 11 CHG Communication with Nurses – Key words at key times 76% 80% 86% 79% 84% 79% 82% 3% Communication with Doctors 80% 84% 89% 86% 84% 82% 82% 0% – Managing Up  Responsiveness of Hospital Staff 64% 70% 81% 60% 69% 64% 68% 4% – Service Recovery Pain Management 69% 72% 78% 78% 77% 78% 76% -2% – Rounding Communication About Medicines 61% 65% 73% 65% 67% 67% 68% 1% – Bedside Reporting Discharge Information (% Yes) 82% 86% 89% 87% 89% 87% 91% 4% – Service Validation  Cleanliness of Hospital Environment 72% 76% 85% 72% 74% 70% 74% 4% • Leader Rounding – All Levels Quietness of Hospital Environment 58% 65% 77% 64% 66% 68% 69% 1% • Discharge Phone Calls Overall Rating of this Hospital 68% 73% 83% 76% 81% 79% 80% 1% • HCAHPS Willingness to Recommend this Hospital 70% 76% 86% 78% 85% 81% 81% 0% Grand Composite (Avg of 10 domains) 70% 74% 81% 74.5% 77.6% 75.5% 77.1% 1.6% Tools/tactics/accountability are good but to achieve an “always” culture requires  sustained cultural transformation 7 OUR I‐CARE VALUES, MISSION, VISION, GOALS AND BEHAVIORAL CULTURE EATS STRATEGY FOR LUNCH BUT STRATEGY +  STANDARDS : DEFINE THE CULTURE > DTC CULTURE =  WINNING COMBINATION Now, we must live the culture > LTC Investing Time in Culture Development Yields Tangible Benefits:“Unless we hold one another  – Our words and actions line up with our         I‐Care values and behavioral standards accountable for living our  culture, we will not sustain  We also must manage the culture > MTC • Focus – aligns organization p patient satisfaction  – We hold one another accountable for living  our culture in our actions  lt i ti excellence” and words • Motivation – builds loyalty and pride Our Expectation: Leaders and peers are  empowered to correct poor performance  quickly and on the spot if necessary • Connection – builds Team cohesion Susan Griffin Chief Nursing Officer St. David’s Medical Center • Spirit – shapes behavioral consistency 9 CULTURE SETTING TACTICS: What an excellent culture can yield in valued based  New Employee orientation and training on culture and  expectations purchasing New employees meet Executive Team and cultural  Example: 300 Bed Hospital expectations reinforced by CEO 1% withhold at risk $500,000 Potential Earn back $760,000 Leader Rounds Net Improved Earning $260,000 Employee Meetings Hire and exit employees around cultural expectations 10 11 2
  3. 3. CLOSING THOUGHTS: Questions or Comments? Higher performing hospitals will be rewarded Lower performing hospitals will be penalized Nursing’s role is central to all value based purchasing outcomes N i ’ l i l ll l b d h i A culture of excellence is imperative for sustaining excellent results CNO’s play a key role in driving cultural transformation 12 13 3

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