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PRoF Award 2015
Chair UGent
prof. dr. R. Peleman
Twitter : #profchair
PRoF Award 2015
Program
16.30 – 16.45: Welcome,
Mr. Jan Van Hecke, CEO Boone nv. PRoF Consortium
16.45 – 17u15: Presentation PRoF
Prof. dr. Renaat Peleman, CMO University Hospital Gent
17.15 – 18.30: Presentation of nominated projects (5 x 15 min)
18.30 – 18.45: Deliberation
18.45: Presentation of the PRoF Award 2015 by prof. dr. Herman
van Rompuy, former President of the European Council
19.30: Invitation to the reception
21.00: End
Market-, customer-, socioeconomic
and technological trends that will
determine the hospital of the future
3
Recognition of the need to change
• Demographics changes
• Changes in morbidity
• Changes in life style
• Changes in technology
• Environmental changes
Future Health Care Trends
• The population is ageing
• The workforce is changing and ageing
• Current lifestyles present major risks to the
future health of the population
• The disease profile is changing
• Health inequalities remain challenging
EU Health Workforce (8% of total EU workforce)
Ageing population and
workforce
Rise of chronic diseases and
co-morbidities
Mobility of health workers
12,000
12,200
12,400
12,600
12,800
13,000
13,200
13,400
194,000
196,000
198,000
200,000
202,000
204,000
206,000
208,000
Trends in employment in the human health sector Trends in employment in all other sectors
Increasing demand for health workers
Change in models of care delivery
(less hospital-centric, more primary care)
Shortage and unequal distribution
Limited data causes fragmentation of
workforce planning
Underlying issues Challenges
 Complex and diverse with little data
 Two European research projects : Prometheus and Mobility of Health
Professionals
 Huge challenge for Central and Eastern European countries
HEALTH
PROMeTHEUS
17 countries
WismarCHALLENGE: Mobility of
Health Professionals
Number of physicians by age group in 17 EU member
States in 2004 and 2008
•In 2009, about 30% of all doctors in the EU were over 55 years of age
•By 2020 more than 60 000 doctors or 3.2% of all European doctors are expected to
retire annually.
•The average age of nurses employed today is between 41-45 years.
Future Health Care Trends
• The population is ageing
• The workforce is changing and ageing
• Current lifestyles present major risks to the future health of
the population
• The disease profile is changing
• Health inequalities remain challenging
Future Health Care Trends
• The population is ageing
• The workforce is changing and ageing
• Current lifestyles present major risks to the future health of
the population
• The disease profile is changing
• Health inequalities remain challenging
Poor mental health among manual workers in Spain by type of contract
• Organisation of healthcare becomes a priority for EU
• Role of national policies is fading
Societal changes
16
Real annual growth in health spending, exeeds real annual
growth in GDP
OECD Health Policy Studies. Value for Money in Health Spending, 2010, 204pp
17
Australian Institute of Health and Welfare
18
• The European Institute for
Health Records (EuroRec)
– common criteria for EHR
records across Europe
– EHR-Q focuses on quality
and certification of EHR
systems
Global healthcare ecosystem
Network of “networks”
The hospital of the next decade
• High-Risk Patients (5%)
A relatively small number of patients requiring the highest-intensity care.
• Rising-Risk Patients (15%–35%)
Those with one or two emerging comorbidities who may rise to the high-
risk pool. Rising-risk patients should be managed by a patient-centred,
multidisciplinary team anchored in primary care to achieve efficient,
economical care management and avoid unnecessary spending down the
road.
• Low-Risk Patients (60%–80%)
Patients for whom self-service care management will work. Reinforce low-
risk patients’ access to information and resources that will keep them
healthy and connected to the system, creating a convenient experience that
results in a high level of patient satisfaction.
Hospitals become “Health Centres”
• Standardisation
• Point-of-care testing
– Hospital, out-patient clinc, at home
• Hospitals: smaller, highly specialised, high-tech, “last
resort” function
– Emergency care
– Multidisciplinary care units
• “Branding” in a very specific segment
– Specialism, form of therapy
• Short stay, “care” hotels
23
24
PRoF: Chair UGent
Challenges in healthcare
Consequences for the hospitals:
- Management of care for chronic disease in the first line of care
- Second line = coach for the first line
- New role for the hospitals :
- shorter and less hospital stays
- specialized centers of expertise
- multidisciplinary teams
• Acute care: preliminary phase and follow up phase move from the
hospital to home care and flexible day care centers (care hotels)
• Patient centered healing environment
• Focus on privacy, safety and comfort
• Focus on efficiency for the care providers
PRoF: Chair UGent
Challenges in healthcare
Consequences for the financing of the care
• No longer based on volume nor activities
• Based on the level of care, quality and efficiency
• Scarce resources must be used optimally
Vision for the future:
• Hospitals and care centers for basic care
• Centers of expertise for advanced care
• Need for innovation and scientific research
 Urgently needed: a new model for financing our healthcare!
ProF-Chair at UGent
• Think tank PRoF : stimulating innovation and quality improvement of care
• Yearly award for innovation
• Knowledge exchange between different research groups and faculties
PRoF: international open innovation consortium
• Start in 2009
• > 300 care professionals from multiple disciplines and
organizations
• Creating visions about the future evolution of care systems
• Interdisciplinary approach:
– care organizations
– research centers, universities
– Companies
• Each vision has been realized as a concept room
• PRoF location in Poperinge – Belgium.
The PRoF consortium
• 2011: PRoF 1.0 - Patient Room of the Future
• 2012: PRoF 2.0 - Personalized Residence of the Future
• 2013: PRoF 3.0 - Private caRe room of the Future
• 2014: PRoF 4.0 - Patient Recovery room of the Future
PRoF : the history
• “Patients will be in single rooms designed for safety
and infection prevention. Outfitted with wall-sized
video screens as well as cameras capable of extreme
close-ups and wide angels.”
Visionary PRoF 2011:
Patient Room of the Future
• “For the patient with multiple chronic diseases, much
of the care that currently involves hospitalizations
and visits to doctors’ offices will be conducted
through televisits and IT-enabled home care.”
Visionary PRoF 2012: Personalized
Residence of the Future
• “Patients will have a much greater role, and voice, in
the new healthcare system, and the technology of
the future will help them to manage their new
responsibilities. To sort out new symptoms,
customized research tools will be available.”
Visionary PRoF 2013:
Private caRe room of the Future
• “ The confused patient who begins to climb out of
the bed will hear the recorded voice of a trusted
relative, triggered by a bed sensor: “Mom, it’s Linda.
It’s okay, get back to bed.”
• A patient will simply say, Nurse, I’m in pain” and the
nurse will appear on the screen.”
Visionary PRoF 2014:
Patient Recovery room of the Future
Awards:
• PRoF Honorary Award 2013: European President Herman Van Rompuy ROMPUY
Chairman of the European Council
• PRoF Honorary Award 2014: Prof. dr. Renaat Peleman, CMO University Hospital
GENT
PRoF Chair:
• 2014: First PRoF- Chair in Ghent University
– development of new visions in an independent way
– in cooperation with European universities
• 2015: Award and Symposium
PRoF : the history
awareness
comfort
safety
privacy
inter generational
flexibility
PRoF Keywords
• Awareness: sick, disabled or elderly people should have a good feeling
about the concept.
• Minimal Comfort: the minimal level of comfort that patients or elderly
people need.
• Safety : bringing a feeling of safety to patients and elderly people .
• Privacy: personal privacy and cocooning are critical.
• Loneliness: elderly persons are increasingly lonely in modern societies.
• Non-stigmatizing : technically a product can be perfect but people may be
ashamed or humiliated when they have to use it.
• Intergenerational: provide the opportunity to stay at home as long as
possible and be surrounded by care from younger generations when they
become older.
• Flexibility: hospitals, healthcare facilities, and elderly houses should use
the space in a flexible way.
The PRoF keywords
The patient Recovery Room of the Future: PRoF 4.0 provides an answer to the trend
for more day care hospitalization
- Ageing population with more chronic diseases
- A new way of organizing care around the patient
- Financial restrictions
- Different role for the hospitals :
- part of a care chain
- only acute care
- short stays
- shortage of staff
- no longer a lot of beds and a bathroom in every room
- PRoF 4.0 = a combination of an open plan and recovery rooms like business seats
in an airplane
- Meets the key words: privacy, safety, comfort, not stigmatizing, intergenerational
and flexible
Social entrepreneurship is the attempt to draw upon business
techniques to find solutions to social problems.
PRoF: Social entrepreneurship
Call for candidates for the competition via the University of Ghent:
• Innovative projects in the broad domain of healthcare applications
• Criteria:
– new concepts or theories in healthcare models (medical, care, ageing society)
– new insights regarding healthcare infrastructure (architecture and/or equipment)
– innovating healthcare processes and/or procedures
– innovating healthcare products and/or services
– at least at research proof-of-concept stage or early market phase (pilot phase, first
market introduction)
– effect on the future healthcare system and the relevant stakeholders
– innovation matches with the values of the PRoF consortium
• Top 5 innovating projects selected by the jury for presenting their projects
• Selection of the winner at the Symposium: PRoF award (10.000 €).
The 2015 PRoF Award
• 32 applications
• From Belgium (23), Germany (2), Greece (1), Italy (2), The Netherlands (1),
Turkey (1), United Kingdom (2)
• Topics:
• behavioral studies
• care for dementia
• care for the elderly
• care models
• education of care takers
• education of care takers in mental health services
• monitoring and screening methodologies
• patient participation in hospital design
• rehabilitation programs
• telemedicine
• trans mural data sharing
• wound care
The 2015 PRoF Award participants
The 2015 PRoF Award nominees
project name nominees partners
EXercise Prescription in Everyday
practice & Rehabilitative Training
Flowchart Project
Prof. dr. Dominique Hansen
32 experts in the rehabilitation of chronic internal diseases from 11 European
countries, coordinated by the EACPR (European Association for
Cardiopulmonary rehabilitation)
Hasselt University, Expertise centre for Digital Media (EDM)
Converge Dr Nick Rowe
Dr Nick Rowe - Associate Professor and Director of Converge - Faculty of Arts -
York St John University
Jill Copeland - Chief Operating Officer, Leeds and York Partnership NHS
Foundation Trust
Leeds and York Partnership NHS Foundation Trust
Cycling through your past
Jan Smolders
Wannes Meert
Roel Smolders
Woonzorgcentrum Witte Meren (Mol)
the Flemish Institute of Technological Research (Vito, Mol) the Computer
Sciences Department of the Catholic University Louvain (Leuven).
students from Group T (Leuven)
We take care! Paul Braem
WZC Regina Coeli Brugge
SEL Brugge Noord West Vlaanderen
AV Sint-Jan Brugge-Oostende
AZ Sint Lucas Brugge
Cura thuisverpleging
Foton expertisecentrum dementie Brugge
Different school collaborations: HOWEST bachelor education in social
sciences - LUCAS – KU-Leuven master education
Pilot Project Astor Geel Els Kuypers
Astor VZW - Medisch Pedagogisch Instituut (MPI) Oosterlo Het Openbaar
Psychiatrisch Zorgcentrum (OPZ) – Geel
Development of a digital algorithm to assist
healthcare professionals and physicians to prescribe
clinically effective and medically safe exercises for
patients with metabolic and cardiovascular diseases.
Rehabilitation in Internal Diseases
Hasselt University, Faculty of Medicine and Life Sciences, REVAL-BIOMED
Dr Nick Rowe - Associate Professor and Director of Converge - Faculty of Arts - York St John University
Jill Copeland - Chief Operating Officer, Leeds and York Partnership NHS Foundation Trust
A university and a mental health service provider
work together to offer educational opportunities to
people who use mental health services
Development of an intuitive platform for nursing
home inhabitants to break down the four walls
and rediscover the outside world while cycling on a
home trainer.
Paul Braem
WZC Regina Coeli Brugge
SEL Brugge Noord West Vlaanderen
AV Sint-Jan Brugge-Oostende
AZ Sint Lucas Brugge
Cura thuisverpleging
Foton expertisecentrum dementie Brugge
Different school collaborations: HOWEST bachelor education in social sciences - LUCAS – KU-Leuven master education
Regional care-network for people suffering
from early onset dementia and their
relatives
“Living Apart Together” – floating care labels for
a diverse life long home environment
Els Kuypers
Astor VZW
Medisch Pedagogisch Instituut (MPI) Oosterlo
Het Openbaar Psychiatrisch Zorgcentrum (OPZ) – Geel
Pilot Project Astor Geel
Twitter : #profchair
PRoF Award 2015
Chair UGent

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PRoF-UGhent symposium 2015 - prof. Peleman

  • 1. PRoF Award 2015 Chair UGent prof. dr. R. Peleman Twitter : #profchair
  • 2. PRoF Award 2015 Program 16.30 – 16.45: Welcome, Mr. Jan Van Hecke, CEO Boone nv. PRoF Consortium 16.45 – 17u15: Presentation PRoF Prof. dr. Renaat Peleman, CMO University Hospital Gent 17.15 – 18.30: Presentation of nominated projects (5 x 15 min) 18.30 – 18.45: Deliberation 18.45: Presentation of the PRoF Award 2015 by prof. dr. Herman van Rompuy, former President of the European Council 19.30: Invitation to the reception 21.00: End
  • 3. Market-, customer-, socioeconomic and technological trends that will determine the hospital of the future 3
  • 4. Recognition of the need to change • Demographics changes • Changes in morbidity • Changes in life style • Changes in technology • Environmental changes
  • 5.
  • 6. Future Health Care Trends • The population is ageing • The workforce is changing and ageing • Current lifestyles present major risks to the future health of the population • The disease profile is changing • Health inequalities remain challenging
  • 7. EU Health Workforce (8% of total EU workforce) Ageing population and workforce Rise of chronic diseases and co-morbidities Mobility of health workers 12,000 12,200 12,400 12,600 12,800 13,000 13,200 13,400 194,000 196,000 198,000 200,000 202,000 204,000 206,000 208,000 Trends in employment in the human health sector Trends in employment in all other sectors Increasing demand for health workers Change in models of care delivery (less hospital-centric, more primary care) Shortage and unequal distribution Limited data causes fragmentation of workforce planning Underlying issues Challenges
  • 8.  Complex and diverse with little data  Two European research projects : Prometheus and Mobility of Health Professionals  Huge challenge for Central and Eastern European countries HEALTH PROMeTHEUS 17 countries WismarCHALLENGE: Mobility of Health Professionals
  • 9. Number of physicians by age group in 17 EU member States in 2004 and 2008 •In 2009, about 30% of all doctors in the EU were over 55 years of age •By 2020 more than 60 000 doctors or 3.2% of all European doctors are expected to retire annually. •The average age of nurses employed today is between 41-45 years.
  • 10. Future Health Care Trends • The population is ageing • The workforce is changing and ageing • Current lifestyles present major risks to the future health of the population • The disease profile is changing • Health inequalities remain challenging
  • 11.
  • 12.
  • 13. Future Health Care Trends • The population is ageing • The workforce is changing and ageing • Current lifestyles present major risks to the future health of the population • The disease profile is changing • Health inequalities remain challenging
  • 14. Poor mental health among manual workers in Spain by type of contract
  • 15. • Organisation of healthcare becomes a priority for EU • Role of national policies is fading Societal changes
  • 16. 16 Real annual growth in health spending, exeeds real annual growth in GDP OECD Health Policy Studies. Value for Money in Health Spending, 2010, 204pp
  • 17. 17
  • 18. Australian Institute of Health and Welfare 18
  • 19. • The European Institute for Health Records (EuroRec) – common criteria for EHR records across Europe – EHR-Q focuses on quality and certification of EHR systems Global healthcare ecosystem
  • 21. The hospital of the next decade • High-Risk Patients (5%) A relatively small number of patients requiring the highest-intensity care. • Rising-Risk Patients (15%–35%) Those with one or two emerging comorbidities who may rise to the high- risk pool. Rising-risk patients should be managed by a patient-centred, multidisciplinary team anchored in primary care to achieve efficient, economical care management and avoid unnecessary spending down the road. • Low-Risk Patients (60%–80%) Patients for whom self-service care management will work. Reinforce low- risk patients’ access to information and resources that will keep them healthy and connected to the system, creating a convenient experience that results in a high level of patient satisfaction.
  • 22. Hospitals become “Health Centres” • Standardisation • Point-of-care testing – Hospital, out-patient clinc, at home • Hospitals: smaller, highly specialised, high-tech, “last resort” function – Emergency care – Multidisciplinary care units • “Branding” in a very specific segment – Specialism, form of therapy • Short stay, “care” hotels
  • 23. 23
  • 24. 24
  • 25. PRoF: Chair UGent Challenges in healthcare Consequences for the hospitals: - Management of care for chronic disease in the first line of care - Second line = coach for the first line - New role for the hospitals : - shorter and less hospital stays - specialized centers of expertise - multidisciplinary teams • Acute care: preliminary phase and follow up phase move from the hospital to home care and flexible day care centers (care hotels) • Patient centered healing environment • Focus on privacy, safety and comfort • Focus on efficiency for the care providers
  • 26. PRoF: Chair UGent Challenges in healthcare Consequences for the financing of the care • No longer based on volume nor activities • Based on the level of care, quality and efficiency • Scarce resources must be used optimally Vision for the future: • Hospitals and care centers for basic care • Centers of expertise for advanced care • Need for innovation and scientific research  Urgently needed: a new model for financing our healthcare! ProF-Chair at UGent • Think tank PRoF : stimulating innovation and quality improvement of care • Yearly award for innovation • Knowledge exchange between different research groups and faculties
  • 27. PRoF: international open innovation consortium • Start in 2009 • > 300 care professionals from multiple disciplines and organizations • Creating visions about the future evolution of care systems • Interdisciplinary approach: – care organizations – research centers, universities – Companies • Each vision has been realized as a concept room • PRoF location in Poperinge – Belgium. The PRoF consortium
  • 28. • 2011: PRoF 1.0 - Patient Room of the Future • 2012: PRoF 2.0 - Personalized Residence of the Future • 2013: PRoF 3.0 - Private caRe room of the Future • 2014: PRoF 4.0 - Patient Recovery room of the Future PRoF : the history
  • 29. • “Patients will be in single rooms designed for safety and infection prevention. Outfitted with wall-sized video screens as well as cameras capable of extreme close-ups and wide angels.” Visionary PRoF 2011: Patient Room of the Future
  • 30. • “For the patient with multiple chronic diseases, much of the care that currently involves hospitalizations and visits to doctors’ offices will be conducted through televisits and IT-enabled home care.” Visionary PRoF 2012: Personalized Residence of the Future
  • 31. • “Patients will have a much greater role, and voice, in the new healthcare system, and the technology of the future will help them to manage their new responsibilities. To sort out new symptoms, customized research tools will be available.” Visionary PRoF 2013: Private caRe room of the Future
  • 32. • “ The confused patient who begins to climb out of the bed will hear the recorded voice of a trusted relative, triggered by a bed sensor: “Mom, it’s Linda. It’s okay, get back to bed.” • A patient will simply say, Nurse, I’m in pain” and the nurse will appear on the screen.” Visionary PRoF 2014: Patient Recovery room of the Future
  • 33. Awards: • PRoF Honorary Award 2013: European President Herman Van Rompuy ROMPUY Chairman of the European Council • PRoF Honorary Award 2014: Prof. dr. Renaat Peleman, CMO University Hospital GENT PRoF Chair: • 2014: First PRoF- Chair in Ghent University – development of new visions in an independent way – in cooperation with European universities • 2015: Award and Symposium PRoF : the history
  • 35. • Awareness: sick, disabled or elderly people should have a good feeling about the concept. • Minimal Comfort: the minimal level of comfort that patients or elderly people need. • Safety : bringing a feeling of safety to patients and elderly people . • Privacy: personal privacy and cocooning are critical. • Loneliness: elderly persons are increasingly lonely in modern societies. • Non-stigmatizing : technically a product can be perfect but people may be ashamed or humiliated when they have to use it. • Intergenerational: provide the opportunity to stay at home as long as possible and be surrounded by care from younger generations when they become older. • Flexibility: hospitals, healthcare facilities, and elderly houses should use the space in a flexible way. The PRoF keywords
  • 36. The patient Recovery Room of the Future: PRoF 4.0 provides an answer to the trend for more day care hospitalization - Ageing population with more chronic diseases - A new way of organizing care around the patient - Financial restrictions - Different role for the hospitals : - part of a care chain - only acute care - short stays - shortage of staff - no longer a lot of beds and a bathroom in every room - PRoF 4.0 = a combination of an open plan and recovery rooms like business seats in an airplane - Meets the key words: privacy, safety, comfort, not stigmatizing, intergenerational and flexible Social entrepreneurship is the attempt to draw upon business techniques to find solutions to social problems. PRoF: Social entrepreneurship
  • 37. Call for candidates for the competition via the University of Ghent: • Innovative projects in the broad domain of healthcare applications • Criteria: – new concepts or theories in healthcare models (medical, care, ageing society) – new insights regarding healthcare infrastructure (architecture and/or equipment) – innovating healthcare processes and/or procedures – innovating healthcare products and/or services – at least at research proof-of-concept stage or early market phase (pilot phase, first market introduction) – effect on the future healthcare system and the relevant stakeholders – innovation matches with the values of the PRoF consortium • Top 5 innovating projects selected by the jury for presenting their projects • Selection of the winner at the Symposium: PRoF award (10.000 €). The 2015 PRoF Award
  • 38. • 32 applications • From Belgium (23), Germany (2), Greece (1), Italy (2), The Netherlands (1), Turkey (1), United Kingdom (2) • Topics: • behavioral studies • care for dementia • care for the elderly • care models • education of care takers • education of care takers in mental health services • monitoring and screening methodologies • patient participation in hospital design • rehabilitation programs • telemedicine • trans mural data sharing • wound care The 2015 PRoF Award participants
  • 39. The 2015 PRoF Award nominees project name nominees partners EXercise Prescription in Everyday practice & Rehabilitative Training Flowchart Project Prof. dr. Dominique Hansen 32 experts in the rehabilitation of chronic internal diseases from 11 European countries, coordinated by the EACPR (European Association for Cardiopulmonary rehabilitation) Hasselt University, Expertise centre for Digital Media (EDM) Converge Dr Nick Rowe Dr Nick Rowe - Associate Professor and Director of Converge - Faculty of Arts - York St John University Jill Copeland - Chief Operating Officer, Leeds and York Partnership NHS Foundation Trust Leeds and York Partnership NHS Foundation Trust Cycling through your past Jan Smolders Wannes Meert Roel Smolders Woonzorgcentrum Witte Meren (Mol) the Flemish Institute of Technological Research (Vito, Mol) the Computer Sciences Department of the Catholic University Louvain (Leuven). students from Group T (Leuven) We take care! Paul Braem WZC Regina Coeli Brugge SEL Brugge Noord West Vlaanderen AV Sint-Jan Brugge-Oostende AZ Sint Lucas Brugge Cura thuisverpleging Foton expertisecentrum dementie Brugge Different school collaborations: HOWEST bachelor education in social sciences - LUCAS – KU-Leuven master education Pilot Project Astor Geel Els Kuypers Astor VZW - Medisch Pedagogisch Instituut (MPI) Oosterlo Het Openbaar Psychiatrisch Zorgcentrum (OPZ) – Geel
  • 40. Development of a digital algorithm to assist healthcare professionals and physicians to prescribe clinically effective and medically safe exercises for patients with metabolic and cardiovascular diseases. Rehabilitation in Internal Diseases Hasselt University, Faculty of Medicine and Life Sciences, REVAL-BIOMED
  • 41. Dr Nick Rowe - Associate Professor and Director of Converge - Faculty of Arts - York St John University Jill Copeland - Chief Operating Officer, Leeds and York Partnership NHS Foundation Trust A university and a mental health service provider work together to offer educational opportunities to people who use mental health services
  • 42. Development of an intuitive platform for nursing home inhabitants to break down the four walls and rediscover the outside world while cycling on a home trainer.
  • 43. Paul Braem WZC Regina Coeli Brugge SEL Brugge Noord West Vlaanderen AV Sint-Jan Brugge-Oostende AZ Sint Lucas Brugge Cura thuisverpleging Foton expertisecentrum dementie Brugge Different school collaborations: HOWEST bachelor education in social sciences - LUCAS – KU-Leuven master education Regional care-network for people suffering from early onset dementia and their relatives
  • 44. “Living Apart Together” – floating care labels for a diverse life long home environment Els Kuypers Astor VZW Medisch Pedagogisch Instituut (MPI) Oosterlo Het Openbaar Psychiatrisch Zorgcentrum (OPZ) – Geel Pilot Project Astor Geel
  • 45. Twitter : #profchair PRoF Award 2015 Chair UGent

Editor's Notes

  1. HPOE is the AHA strategy for accelerating performance improvement. HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow). In the last few months HPOE added 2 more topics: care coordination and implementing HIT. The next topic for HPOE is improving efficiency.