Susan ReinhardThank you for joining us for today’s webinar on Hospital Safety as a Priority: An Opportunity for Nurses to Lead, presented by the Leapfrog Group.I’m Susan Reinhard, Senior Vice President & Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America.Before we go further, I wanted to mention that we are recording today’s webinar, so if you miss a section or would like to pass it on to a colleague, you can find the recording by going to .I also want to let you know, in advance, that we intend to leave some time for questions from those on the phone after the presentation. So if you have a question, write it down or hold on to it and you will have an opportunity to ask it after the presentation.
Susan ReinhardOn today’s webinar, our presenters will…Provide an overview of the work of the Leapfrog Group and their role in the public reporting of hospital safety scores.Discuss Magnet status and public reporting of scores means for hospitals and consumers.Explain Leapfrog’s role in ensuring a prepared nursing workforce and how that directly influences hospital safety and the Magnet designation. ….and we hope that what you hear today will motivate you to treat hospital safety as a priority in health care.As a board member of the Leapfrog group, I am proud of the work Leapfrog does and thrilled to have them here today to present this webinar. The Leapfrog Group has also been part of our Nursing Coalition at CCNA since 2010 and have been working with us to actualize the recommendations of the FON report.
Susan Reinhard Leah is President & CEO of The Leapfrog Group, a national organization based in Washington, DC, representing employer purchasers of health care calling for improvements in the safety of the nation’s hospitals. She is an influential voice for major change in healthcare. For each of the past three years she was named on Modern Healthcare’s list of the 100 Most Influential People in Healthcare, and one of 20 people making healthcare better in Health Leaders Magazine. She is a Forbes.com contributor. Ms. Binder sits on numerous national boards and committees, including the Institute of Medicine Collaboration on Patient Engagement, the National Priorities Partnership Board, and the Advisory Board of the Institute for Interactive Patient Care. She is a frequent speaker on hospital safety and quality, and the importance of payment reform and transparency.Before joining Leapfrog in the spring of 2008, Ms. Binder spent 8 years as vice president at an award-winning rural hospital network in Farmington, Maine, Franklin Community Health Network, and before that she was a senior policy advisor for the Office of Mayor Rudolph Giuliani in New York City. She started her career at the National League for Nursing, where she handled policy and communications for over 6 years.
Susan ReinhardOur second presenter is Marsha Manning. Marsha is Manager, Health Care Plans for General Motors. In this capacity, she is responsible strategy, plan design, administration and oversight for medical and prescription drug benefits for approximately 220,000 covered lives throughout the United States. In addition, the health care plans staff supports delivery system efforts that emphasize performance transparency, optimal use of health care information technology, evidence-based medicine, and patient safety. Manning has more than 30 years of varied experience in health care and human resources, including experience in clinical nursing practice, administration, data analytics, public policy, community initiatives and leadership. She is a member of the board of directors of the Greater Detroit Area Health Council (GDAHC) and The Leapfrog Group. She currently serves as a member of the Steering Committee of the SE Michigan e-Prescribing Initiative, is a member of the Executive Board of the Southeast Michigan Beacon Community, and chairs the Automotive Industry Action Group Health Care Value Task Force. In addition, she serves as the Regional Roll Out Lead for Leapfrog in Michigan, encouraging hospitals to publicly report data on hospital quality, safety and efficiency.So, Leah, I will turn this over to you…
Leah BinderWe have a problem in our country with patient safety. We first recognized the problem in the year 2000 when the Institute of Medicine came out with a study called To Err Is Human, which suggested that upwards of 100,000 Americans were dying unnecessarily of injuries, accidents, and infections in American hospitals. Unfortunately 12 years later all of the studies that have been done to see if we made progress suggest little or no improvement in safety.
Leah BinderThis is the Phoenix Stadium. It holds 60,000 people. This is three pictures of it, so you are looking at approximately 180,000 people. That is approximately the number of people who die every year of injuries, accidents, and infections in American hospitals. Some studies say it’s more. Some deaths are more preventable than others. But this is too many people, and this is too little progress.
Leah BinderThe 180,000 figure comes from a study by the Office of the Inspector General, which in 2010 did a physician chart review of over 800 randomly selected Medicare beneficiaries who were admitted to a hospital. This is the gold standard for observing errors. The results were dismal. A Medicare patient has a one in four chance of experiencing injury or harm or death when admitted to a hospital. Would any of you get on an airplane if you thought you had a one in four chance of being harmed in the flight? One in six people admitted to hospital suffer adverse events. In the course of this presentation today 20 people will die of an injury accident or error in a hospital.
Leah BinderThe Leapfrog Group was founded in 2000 by large employers reacting to the shock of that original IOM report. They were interested in using their leverage as purchasers of health benefits to drive real change. They sought giant “leaps” forward in safety and quality in hospitals, hence the name Leapfrog. They wanted to do so by allowing employees to shop for health care and hospital services the way they shopped for the kinds of products and services. It is perhaps not surprising that automakers were among Leapfrog’s most active founders and remain active today. They are accustomed to competing in a highly transparent marketplace and seek the same market for their health benefits. The Leapfrog Hospital Survey was created in 2000 to collect data from hospitals voluntarily on how they're doing an infection, injuries, errors, and accidents. Leapfrog also now looks at mortality rates from common procedures, and important quality indicators like rates of early elective deliveries. So we have now reported the Leapfrog Hospital Survey for over 10 years and we've learned some things about American hospitals.
Leah BinderLeapfrog is used across the country for public reporting by hundreds of employers. Most seek to engage consumers to support them in making decisions about hospitals based on their safety and quality. Leapfrog also serves as a good platform for candid and direct communication between purchasers and hospitals. These conversations can happen within communities and don’t have to be filtered through health plans. This opens up new opportunities for collaboration and change. Finally, the most important way employers can use Leapfrog is to drive markets for safety and quality—and thus drive a market for nursing priorities. Hospital leaders know well that too often when they perform with excellence markets do not necessarily respond. Leapfrog is about creating a market responsive to quality and safety.
Leah BinderTransparency alone won’t drive markets unless it’s real transparency. Here’s Leapfrog’s checklist for the elements of transparency that are required for consumers to actually use information in their decisiomaking. First, public reporting should show variation among competing products or services. Consumers want to know the best possible performance nationally, and how products contrast with each other. The second element is relevancy. Consumers want to know how products and services compare to each other on the elements that matter most to them. You do not publish a comparison of the type of plastic used to construct automobile hoods because consumers don't care. They want to know how safe the car is or its fuel efficiency. Finally, the third element of transparency that drives a market is that the information is presented in an unbiased and independent format. Consumers don’t think ads are transparent. So let's see how to Leapfrog checklist applies in markets outside of healthcare.
Leah BinderHere's a famous example of transparency that drives markets: the JD power.com website. JD Power interviews consumers to ask them what they think of various cars and then rates the cars on measures that consumers care about. Here's a screenshot example. If you are not familiar with this you certainly know some of the other auto comparison guides available like Motor Trend and Consumer Reports. Cars are compared along a variety of measures and it's quick and easy for consumers to instantly navigate and see how cars compare and contrast with each other.
Leah BinderHere's a more modern form of a transparency. This comes from Amazon.com. Leah was searching for Tupperware and found a 50-piece set that looked good. There were hundreds of consumer reviews, and Amazon sorts the reviews into the most helpful favorable review and the most helpful critical review so that favorable reviews. She agreed that the containers look quite sturdy, but she also agrees there aren’t enough large sizes. One reviewer suggested a different set available at Target, so Leah went and bought that one. So Amazon gave a consumer enough information to lose the sale. That is a new level of transparency demanded by the internet. And we have all come to expect it when we shop online.
Leah BinderSo let's think about these two examples from JD Power and Associates and Amazon.com. Applying Leapfrog’s checklist we certainly see lots of variation demonstrated in each example. We also saw that they offered information relevant to consumers. JD Power is designed to be relevant to consumers, or the company would be out of business. In the case of Amazon consumers themselves write the reviews on the product characteristics they find most important, which is as relevant as you get. Finally, are these tools ubiased? In the case of JD Power their business model relies on consumers trusting their independence. In the case of Amazon, they go out of their way to mitigate against their own sales bias by showing consumers enough information to reject the product.
Leah BinderLet’s look at how healthcare does on Leapfrog’s transparency checklist Here’s Hospital Compare, a famous website produced by CMS that does exactly what its name implies by publicly comparing hospitals on various measures. Leapfrog takes some pride in the fact that we help to advocate for the creation of Hospital Compare. However it’s no substitute for Leapfrog reporting and I’ll show you why. Here's a screenshot from Hospital Compare looking at the issue of pneumonia in hospitals. You can only search three hospitals a time--here's what we searched. Let’s look at that first comparison measure: “Pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics.” I don’t know many people, especially outside of healthcare, who would choose a hospital based on how they did on this particular measure. Most consumers do not care. But even if they did, here's the other problem: in the vast majority of cases the hospital does just fine. 97 to 100% of the time in this case. In fact, for most of the process measures like this in Hospital Compare most of the hospitals perform well most of the time. This is not going to help consumers discern among different hospitals.
Leah BinderThere are some measures on Hospital Compare that consumers do in fact care deeply about. Death rates for certain procedures and conditions are a good example, and here’s a screen shot of some of those. But here’s the problem: In almost all cases the hospital is no different than the national rate. So all hospitals are rated average. In fact, almost all hospitals are rated average almost all the time, with more than 90% rated average for these measures. Again, this is not helpful for consumers deciding among hospitals.
Leah BinderSo let's look at our checklist as it relates to Hospital Compare. It does not show the variation among hospitals. A few of the measures are relevant to consumers but most are not. Finally, is Hospital Compare unbiased? It’s hard to imagine how CMS could be unaffected by politics, and politics is why Hospital Compare is not going to be a good tool to drive markets.
Leah BinderSo let's look at what the Leapfrog Group reports from its survey. Here's a screenshot from Leapfrog. It's a good selection of information on issues like whether the hospital is successful in preventing medication errors, safe staffing for intensive care, precautions in place to prevent harm. Leapfrog’s governance is by purchasers outside of the healthcare industry—which means it’s built into the organizational DNA that it will report measures of interest Leapfrog also reports the data as we see it, and we see variation. You can see the variation among hospitals expressed as cellphone bars on the various measures.
Leah BinderSo let's apply the Leapfrog checklist to the Leapfrog public. Yes, Leapfrog shows variation. Leapfrog shows measures relevant to consumers. And Leapfrog is independent and unbiased in its organizational DNA.
Leah BinderAfter 10 years of public reporting to Leapfrog however we have to admit progress is too slow. We haven’t been able to get enough my enough traction, and although 1200 hospitals voluntarily report, thousands of hospital decline to report. So we have not made the progress we need to make. And that’s a lot of people still dying every year. So the Leapfrog Board Made the decision to try something new in transparency to drive markets.So now I will turn this over to Marsha…
Marsha ManningIn my role at GM, I am responsible for the health care benefits for 220K GM employees, retirees and family members. Thinking about the data that Leah just discussed, this translates into one GM covered member dying every other day from a preventable medical error. Put in those terms, it engages and motivates my leadership to support transparency and quality improvement in general and Leapfrog specifically.So what is the next step in addressing this silent crisis?: The Hospital Safety Score. Leah discussed transparency that shows variation, is relevant and is unbiased. The Hospital Safety score meets this criteria and focuses on a very discrete aspect of Hospital Care: How well do hospitals do at keeping patients safe from harm and error? The Hospital Safety Score’s letter grade scoring system allows consumers to quickly assess the safety of their local hospital, and will help them choose the best hospital to seek care. As consumers’ use of the Hospital Safety Score increases, we hope more hospitals will be compelled to participated in meaningful public reporting.
Marsha ManningWhat purchasers want is for their members to be able to easily identify hospitals where they can receive the safest care.The Hospital Safety Score approach was loosely modeled on the approach used to assess the achievement of food safety standards of restaurants in NYC. Some of you may be familiar with the fact that restaurants in NYC must display their sanitation score- A, B, C, in the window of their establishment for all of their potential customers to see. The score is based on inspections of the restaurant that score their attainment of food safety standards. So ask yourself- no matter how appealing the menu is, no matter how lovely the dining room appears- do you want to eat in a restaurant that has a big fat ‘C’ displayed in the window? Not likely.We want consumers to have the same opportunity to assess how likely it is that they may suffer harm in a hospital setting by using the Hospital Safety Score. This is a screen shot from hospitalsafetyscore.org that displays the safety scores of hospitals in the DC area. Where do you want to receive your care???
Marsha ManningScores are developed for 2,600 acute care hospitals using publicly available data from CMS and the annual Leapfrog Hospital Survey. Certain hospitals are excluded from the scoring process, such as specialty hospitals and those who do not report to CMS. The methodology utilized to score the hospitals has been thoughtfully developed by a Blue Ribbon Expert Panel.
Marsha ManningThis Expert Panel is comprised of many of the top experts in the country on the topic of patient safety. They have enthusiastically provided guidance in developing the methodology that creates one numerical score for each hospital. Leapfrog calculates the finals scores and sets the letter grades. I am sure that many of you are familiar with the work of many of these panelists.
Marsha ManningThe first Hospital Safety Scores were published this past June. As you can see, the release of the scores generated significant media attention, as well as traffic to the hospitalsafetyscore.org website. This is a strong indication that consumers do care about patient safety and are willing to consider this data.
Marsha ManningWhat we want is for consumers to use the Safety Score as one tool in the process of selecting a hospital. There are of course other sources of data, and Leah has shared some of the strengths and weaknesses of available data. The promise of introducing this data is that it will initiate a dialogue- we want patients to talk to their physicians and their nurses about safety, to pose the hard questions to hospital administrators to insure they are focused on safety, and to become better educated consumers so they can take steps to help stay safe in the hospital.
Marsha ManningSo what is ahead for the Safety Score? Hospitals have had some time to address some of their gap areas and improve their performance. The scores will be re-released next month, and Leapfrog anticipates twice yearly updates going forward. We hope that you will all see a big media splash for the next release of the Safety Score- there is a significant effort underway to push this information to consumers through major media outlets this fall.An app for smart phone users will be launched with this release so that consumers can easily identify the safest hospitals. Our enthusiastic Expert panel will continue to evolve the methodology and will work with leapfrog to identify ways to include more hospitals that today are not included in the scoring.
Marsha ManningSo now I want to talk about how critical Nursing is to patient safety. This webinar is timely, as earlier this month, The University of Pennsylvania released a study that confirms the following: if you want to assess a hospital’s quality of care, just ask the nurses.The researchers emphasized what all of you already know: nurses tend to have accurate perceptions of quality of care in the hospital where they work because they are on the front lines and are most familiar with the daily experiences of their patients. In recognition of a growing body of studies highlighting the key role nurses’ play in patient safety, Leapfrog began publicly reporting on hospitals that have demonstrated nursing excellence on the annual hospital survey. Hospitals participating in the Leapfrog Hospital Survey that indicate they have current Magnet® status designation, as determined by the American Nurses Credentialing Center (ANCC) will automatically earn full credit for the Nursing Workforce measure. This section of the survey is used to score hospitals on their commitment to staffing their hospitals with highly trained nurses and putting those nurses in leadership positions which allow them to have substantial input into patient safety issues. When Leapfrog announced the inclusion of the Nursing Workforce measure in the annual survey, Susan Reinhard, who is on the phone with us, stated that: “Representing purchasers of healthcare, Leapfrog offers an important business perspective to the importance of strong nursing. High quality health care requires high quality nurse-delivered care.” And I want to assure you that the purchaser members of Leapfrog recognize this strong link.The nursing workforce measure is also included in the Safety score, and it heavily weighted due to the recognition of the impact of the nursing workforce on patient safety.
Marsha ManningThis slide provides some examples of the standards upon which a hospital is assessed as it relates to the Nursing Workforce. Attainment of these standards demonstrates a hospital’s understanding of and commitment to the value of strong nursing leadership and data analysis related to staffing and outcomes.
Marsha ManningIn addition to the Nursing Workforce measure, nursing is key to many of the process measures that are included in the Hospital Safety Score. You can look at this list and recognize the connection with nursing responsibilities. Strong performance on these measures is in part the result of strong nursing leadership and engagement.
Marsha ManningThe same is true for the key outcome measures on the Safety Score. Again- the link between nursing leadership and engagement and these outcomes measures is tangible.
Marsha ManningAreas to highlight:Magnet Status by name of the hospital- this is the only such designation on the public Leapfrog reporting, indicating the importance of this statusSafe practices includes Nursing Workforce
Marsha ManningImproving the safety of hospital care will take the commitment and expertise of not only those who work within the hospital, but also those of us who work outside of the hospital environment. One of the founding principles of Leapfrog is that purchasers of health care can drive the value of the health care delivery system by demanding transparency of performance and then purchasing health care based on this performance. Continuing to drive value purchasing is key to driving change- the expectation needs to be clear that purchasers want their members to get safe care. In my role at GM, I have to think about the 220K members who receive their health care coverage through GM, and also to think about that one GM member who dies every other day in a US hospital due to a preventable error. Large purchasers, particularly those of us in the manufacturing sector, can also share our own experiences in process improvement and culture change to support change in health care. GM has supported hundreds of lean workshops in the health care delivery system over time. We know that process improvement and culture change can have a huge impact. In the area of safety, there was a time when GM had one of the worst plant safety records in the industry. At a certain point, GM leadership decided that safety must become a priority in our manufacturing environment. And the result is that GM now has one of the best plant safety records in the industry. It takes leadership, engagement and true culture change for this to occur. I am a nurse myself and I feel encouraged at the idea that there are thousands of nurses across the country providing care to all of those GM members- working to keep them safe from harm, demanding that their hospitals do better, being part of the solution.Meanwhile, those of us outside the hospital walls work toward the same end by driving transparency and demanding improvement. It is great to have this team in place!
Susan ReinhardThank you Leah and Marsha….I would now like to open the lines for Q&A Prompt the operator.Ask a question While waiting to hear from audience:
Sue Hassmiller Again I want to thank Leah and Marsha for their As I mentioned earlier, you can view and share the recording of this webinar and many others by going to www.championnursing.org/events. That concludes today’s webinar. Check us out on the web, follow us on twitter, or join us on Facebook!
Hospital Safety as a Priority: An Opportunity for Nurses to Lead Presented by: The Leapfrog Group
Hospital Safety as a Priority: An Opportunity for Nurses to Lead Presented by: The Leapfrog GroupOctober 31, 2012
Susan Reinhard, PhD, RN, FAANSenior Vice President & Director,AARP Public Policy Institute;Chief Strategist, Center to ChampionNursing in America 2
Patricia A. Polansky, RN, MSDirector of Policy and CommunicationsCenter to Champion Nursing in Americawww.campaignforaction.org/webinars 3
1. Provide an overview of the work of the Leapfrog Group and their role in the public reporting of hospital safety scores.2. Discuss Magnet status and public reporting of scores means for hospitals and consumers.3. Explain Leapfrog’s role in ensuring a prepared nursing workforce and how that directly influences hospital safety and the Magnet designation.4. Motivate you to treat hospital safety as a priority in health care. 4
Leah BinderPresident and CEO,The Leapfrog Group
Marsha Manning, RN, BSN, MLIRManager, Health Care Plans forGeneral Motors Global Compensationand BenefitsBoard Member, The Leapfrog Group
• More than 180,000 people die every year from hospital infections, injuries, and errors (Office of Inspector General; November 2010)• A Medicare patient has a one-in-four chance of experiencing injury, harm or death when admitted to a hospital• One out of every six of your employees admitted to a hospital will suffer an adverse event• Today alone, 493 people will die because of a preventable hospital error; 20 of them during this presentation
• Founded in 2000 by large employers interested in driving a market for safety and quality in hospitals• Annual Leapfrog Hospital Survey reports on hospital performance
• Public reporting/engaging consumers• Benefits design and contracting• Value based purchasing• Direct communication between purchasers and hospitals• Drive a market for nursing priorities
Local, Regional, National • Regions Drive Survey Data Collection • 45 Regional Roll Outs invite hospitals to complete the survey • Use various incentives and recognition to drive further improvements
Shows variation: Show how your performance compares and contrasts to the broadest spectrum of highs and lowsRelevant: Measure what matters to consumersUnbiased: Report through an independent arbiter. An advertisement is not an example of transparency.
The Hospital Safety Score isan A, B, C, D, or F lettergrade reflecting howhospitals perform at keepingpatients safe from harm anderror
• Scores assessed for 2,600 general, acute-care hospitals• Data was gathered that is publicly reported at the national level, including measures reported by the Center for Medicare Services (CMS) and the annual Leapfrog Hospital Survey – Specialty hospitals and hospitals not required to report data to CMS were not included• Methodology developed by the Blue Ribbon Expert Panel
ROLE: The Panel provided guidance to Leapfrog on calculating one numerical score for each general hospital. Leapfrog calculated the final scores and set the letter grades)• John Birkmeyer (University of Michigan)• Ashish Jha (Harvard University)• Lucian Leape (Harvard University)• Arnold Milstein (Stanford University)• Peter Pronovost (Johns Hopkins University)• Patrick Romano (University of California, Davis)• Sara Singer (Harvard University)• Tim Vogus (Vanderbilt University)• Robert Wachter (University of California, San Francisco)
• 600+ Press Mentions in first week after release – Newspaper- 250 – Broadcasting- 190 – Trade publications- 80 – Online news- 75 – Other- 75 – National includes: CNN, ABC News, Kaiser, Modern Healthcare• 600 hits per minute day one and two (similar to NYT)• 575,000 Pages Served first 3 days• 96,000 Web Visits first 3 days• Overall, it appears consumers do care about patient safety
• Use the Hospital Safety Score as one tool in the process of selecting a hospital to receive care – Also consult CMS Hospital Compare, Leapfrog Hospital Survey results, HealthGrades, etc.• Talk to a doctor or nurse about hospital safety• Ask hospital administrators what the hospital is doing to improve their patient safety record• Become educated on how to stay safe in the hospital
• Hospital Safety Scores will be rereleased in November, 2012• Twice a year updates going forward• Look for: a new app• The Expert Panel will continue adapt the methodology before each release of the score• Leapfrog and the Expert Panel will search for ways to evaluate hospitals not scored this round, including specialty hospitals, military/veterans hospitals, and hospitals in Maryland, Guam, and Puerto Rico
• NURSING WORKFORCE• A Leapfrog measure: if a hospital does not voluntarily report to Leapfrog, nursing is not directly accounted for in the score• Magnet Status automatically accounts for full credit on nursing workforce, and is highlighted by Leapfrog as well
• Included senior nursing leadership as part of the hospital senior management team• Held the Board and senior administrative leadership accountable for the provision of financial resources for nursing services• Collected and analyzed data of actual unit-specific nurse staffing levels• Performed a risk assessment and an evaluation of the frequency and severity of adverse events that can be related to nurse staffing.
• Infection prevention• Culture of Safety• Hand Hygiene policies• Medication reconciliation• Deaths from preventable surgical complications• CPOE• Preventing falls and pressure ulcers• Leadership structures to promote safe practices
• Pressure ulcer—Stage 3 and 4• Falls and trauma• Central Line-Associated Bloodstream Infection• Iatrogenic Pneumothorax• Postoperative: – Respiratory failure – Clots – Wound Dehiscence
Leah Binder, Leapfrog President & CEOMarsha Manning, Leapfrog Board Member, Co-Chair of the Board Committee on theHospital Safety Score &Manager, Health Care Initiatives and Employee Benefits Public Policy, General Motorshttp://blogs.forbes.com/leahbinder/The Leapfrog Group1660 L Street NW Ste. 308Washington, DC 20036www.leapfroggroup.orgwww.hospitalsafetyscore.org