This contributed Q&A is the fourth in a content series as a lead-in to Becker’s 9th Annual CEO+CFO Roundtable: Nov. 9-12, 2020.
During this premier gathering of the country’s most distinguished and accomplished healthcare executives, Becker’s will present the inaugural Future of Pediatric Healthcare Forum in collaboration with Phoenix Children’s and other terrific pediatric leaders.
Phoenix Children’s is honored to work with Becker’s in elevating the conversation of pediatrics as a substantive component of the overall healthcare value chain. Over the next several months, we are excited to bring you a robust offering of informative and insightful pediatric content. We encourage healthcare leaders to engage in the dialogue and participate in The Future of Pediatric Healthcare Forum by RSVP'ing your spot here.
Becoming a world-class health system and continuously improving performance depends on solving medicine’s triple challenge of access, quality and cost. But these three concepts look significantly different in the pediatric realm than in the adult care environment.
In this three-part Q&A, Phoenix Children’s leaders discuss the access, cost and quality dynamic.
Part III: Quality in Pediatrics: A conversation with Kelly Kelleher, MD, Chief Quality and Safety Officer, Phoenix Children’s
Question #1: How do we define quality at Phoenix Children’s?
We define quality as everything that goes into a patient’s overall experience at Phoenix Children’s. It means following evidence-based practice and ensuring we’re doing all we can to achieve the best possible clinical outcomes. Safety and patient family satisfaction also are important parts of the equation. We don’t just look at a single measure – we take a holistic approach.
Question #2: The Joint Commission Center for Transforming Healthcare works to advance a goal of zero-preventable harm events for hospitals and health systems. Can you discuss zero harm initiatives?
Zero harm events is a lofty but important goal, and it’s one our leadership and team members believe Phoenix Children’s can achieve. We put a laser focus on preventing serious safety events and eliminating hospital-acquired conditions. For example, our IT department has created dozens of patient safety dashboards that continuously monitor inpatients for sepsis, acute kidney injury and medication errors. These systems issue early warning alerts that prompt providers to take action to prevent any adverse outcomes. Care teams use these dashboards during daily patient safety rounds in all high-reliability units to monitor compliance with care bundles and intervene in real time.
We also work to improve the health of employees. In recent years, we’ve enhanced our focus on staff well-being and now include employee injuries among overall preventable conditions – and we work just as hard to eliminate them. Phoenix Children’s has a multidisciplinary committee comprised of institutional experts who work to identify opportunities for process improvements and elimination of employee harm events. Our goal is to create an environment where team members feel safe and comfortable coming to work every day.
Question #3: As Phoenix Children’s expands its geographical footprint, how do you scale the safety and quality protocols?
As Phoenix Children’s continues to grow, safety and quality take on even greater importance. We have spent considerable time and effort laying a solid foundation and work hard to ensure this consistently carries over in our new locations and with new providers. With COVID-19, we took an opportunity to drill down into our procedures and policies to identify opportunities for improvement. Across the enterprise, we engaged with team members to create more reliability in areas such as nursing, pharmacy and lab. Examples of these partnerships include collaboration between the laboratory and nursing to decrease the contamination rates of specific lab tests in order to eliminate the need for repeat blood draws for our patients.
My colleagues and I spend a lot of time thinking, “How do we make a fail-proof process?” We know that medicine can’t be entirely systematic – there is an art to medicine that we never want to lose – but we’re eager to refine and perfect systematic processes to remove gaps in practice variation and eliminate risk for error.
Question #4: How did COVID-19 impact your view of quality and the enterprise-wide adoption of telehealth?
The pandemic certainly has brought quality into even sharper focus for Phoenix Children’s. I can’t say enough about our IT department and their incredible work to transition our health system to telemedicine in March. In less than one week, we moved 6,000 weekly patient appointments from in-person to telehealth; we’ve had nearly 90,000 virtual visits to date.
Access to care is one of my top priorities as a pediatrician and leader. Telehealth has improved access dramatically. It has also allowed us to connect with families we may not have been able to reach in the past. Similarly, the technology has made health maintenance visits – which are exceptionally important in pediatric years – much easier for the families we serve. Likewise, it has enabled patients who are treated by our specialists (and who continue to need care during the pandemic) to connect with our providers and access the services and expertise where and when they need it most. When virtual care can be done safely, there’s no doubt in my mind that it’s here to stay and will continue to grow in sophistication.
Quality measures for in-person care still hold true with telehealth. We value all of the same measures – we just have to approach care delivery in a different way to ensure we’re achieving the same outcomes in telehealth.
Question #5: Can you discuss the importance of medical dashboards at Phoenix Children’s?
The efforts of our IT team have been transformative for clinical care. Our Chief Medical Information Officer, Dr. Vinay Vaidya, has created medical dashboards targeting safety and clinical outcomes that put real-time patient data at providers’ fingertips. In my role as Chief Quality and Safety Officer, I can get a snapshot of patient safety anytime I want – from a 30,000-foot view, by unit or for an individual child. The dashboards also alert me to trends in the data and provide the tools I need to deep dive and huddle with individual units to proactively address any issues or dig into the details of our successes.
Another innovation from our IT team is our chronic disease dashboards for management of patients with juvenile arthritis, diabetes, asthma and several other conditions. For example, a doctor who specializes in juvenile arthritis may have hundreds of patients in her practice, and it may prove challenging to ensure each child receives the requisite care. The dashboards issue alerts when patients are overdue for appointments, like routine eye exams, quarterly hemoglobin A1C monitoring or annual imaging required by sickle cell patients. It all comes together to improve overall outcomes. We want patients to go to school, develop as normally as possible and participate in activities, so they can transition to adulthood with the disease under control.
Question #6: On the topic of dashboards, can you talk about how they help prevent harm events?
When we think about preventing harm, it’s really easy to fixate on retrospective analysis. An event occurs and then you go back and analyze the event. We have worked diligently to flip that approach and focus instead on prospective prevention. Our dashboards are invaluable in this regard because they alert us early on and allow us to intervene before anything serious happens.
A perfect example is our Acute Kidney Injury (AKI) dashboard. This dashboard monitors the kidneys of every patient in the hospital and tracks even the most subtle changes in creatine. It also monitors the number of medications given to a patient that may be harmful to their kidneys. If the creatine, the number of medications or both begin to approach dangerous levels for patients, an alert is generated and sent to providers who can intercede before an adverse outcome occurs.
Dashboards like this one have been invaluable for patient safety. The dashboards serve as an important tool for our clinicians in detecting even the smallest changes in patients as quickly as possible.
It’s worth noting that Phoenix Children’s went more than a year without a serious safety event starting in 2018 and continuing well into 2019. It was a remarkable milestone. During that time, we made significant improvements in our oncology population by improving our diagnostic accuracy and treatment of sepsis. Elimination of events within this highly complex and vulnerable patient population proves to me that it’s possible to eliminate harm across our entire health system.
Question #7: How do you balance safety with cost considerations?
At Phoenix Children’s, patient safety is the top priority. Financials will always be part of the conversation, but our leadership hasn’t said no to an important patient safety effort because the cost was too high.
Our CEO, Bob Meyer, and our entire executive team put patient safety first. We want to deliver the very best outcomes possible and we work tirelessly to that end.
Question #8: You mentioned patient experience as an important part of the quality equation. Can you elaborate?
As a physician, clinical outcomes represent the majority of my time, effort and energy, and our health system is committed to providing hope, healing and the best possible experience to our patient families. Phoenix Children’s has an excellent Child Life team, a robust core of volunteers and a dedicated team of non-clinical staff, all dedicated to providing a personalized patient experience every day. This comes to life by including parents every step of the way, ensuring they’re active participants in their child’s care and understand their child’s care plan at all times.
Phoenix Children’s is committed to the health and well-being of all children. We look forward to collaborating and sharing information, insights and best practices with the Becker’s community and patrons of Becker's 2020 CEO/CFO Roundtable: The Future of Pediatric Healthcare Forum.
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