Over five years, hospitals across Florida reduced readmissions 15 percent, surgical complications 14.5 percent, central line-associated bloodstream infections 41 percent and catheter-associated urinary tract infections 37 percent, saving more than $47 million. These improvements came out of several Florida Hospital Association-led collaborations among hospitals in the state, 160 of which participated in at least one quality improvement project.
Just the beginning
Sherrie Sitarik
A key theme in a media conference call with FHA leaders was that these five-year results are only the start of quality improvement at Florida hospitals. "We know our work is not done," said Steven D. Sonenreich, FHA board chair and president and CEO of Mount Sinai Medical Center in Miami Beach. "This is only the beginning."
Much of the continuing work will occur through FHA's Partnership for Patients initiative with the Health Research & Educational Trust and hospital engagement networks. Under this initiative, participating Florida hospitals will aim to reduce readmissions by 20 percent, patient harm by 40 percent and early elective deliveries to fewer than 3 percent by the end of the year. FHA will also continue to provide patient safety guidance and collect hospital data through the Patient Safety Organization of Florida. In addition, the American College of Surgeons, which helped FHA develop the Florida Surgical Care Initiative, has extended the initial two-year program an additional three years to 2016.
Applying lessons learned
Steven Sonenreich
Florida hospitals' future quality initiatives will be enhanced by lessons learned during the past five years of collaborations. In a report, "Five Years of Quality: Working Together to Prevent Harm, Save Lives and Reduce Costs," FHA described the four key lessons learned:
• Collaboration drives fast, efficient progress on quality
• Culture is critical to enhancing quality
• Data are necessary to understand the problem and track progress
• Partnerships spread quality efforts and learning
Collaboration speeds improvement
An important aspect of the past five years' quality initiatives is the level of collaboration across the participating hospitals. Hospitals shared successes and challenges through monthly conference calls, emails, webinars and other means, which sped the rate of improvement at different hospitals. For example, Sherrie Sitarik, president and CEO of Orlando (Fla.) Health, said the system established a single protocol for central line insertion and maintenance that decreased central line infections 75 percent since 2008. This protocol was shared with other hospitals in the bloodstream infection collaborative, including Naples-based NCH Healthcare System, which has since gone 44 months without a central line infection in its intensive care units and has seen a 50 percent reduction in these infections across the system, according to Allen Weiss, MD, CEO of NCH Healthcare System and chair of FHA's Quality and Patient Safety Committee.
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| Dr. Allen Weiss |
"In joining with other hospitals around the state, we have been able to collaborate, [which has] accelerated our learning," Ms. Sitarik said in the conference call. "We may be competitors from a business sense, but when it comes to quality, we all do better when we share best practices and work together."
Building a culture of safety and quality
Sharing best practices and collaborating with providers both within and across hospitals has helped build a culture of safety and quality in these hospitals. One of the practices that fostered this culture was engaging everyone from executive leadership to front-line staff, according to Dr. Weiss. "A culture of quality is essential for quality improvement," he said in the call.
Using robust data
The backbone of all improvement programs is robust data. In 2008, Florida became the first state to publicly report readmission rates by hospital, which helped guide the FHA's readmission reduction collaborative. Similarly, the Surgical Care Initiative reviewed patient charts and followed up directly with surgical patients to collect data instead of using only claims and administrative data. "All our efforts rely on robust quality data. We can't fix the problem if we don't have a clear understanding of what the problem is and why it's occurring," Dr. Weiss said.
Partnering to extend improvement
In addition to collaborating among hospitals, FHA's initiatives leveraged partnerships with other organizations, such as the American College of Surgeons for the Surgical Care Initiative. Mr. Sonenreich described a federally funded Community-Based Care Transitions program Mount Sinai Medical Center is participating in to reduce readmissions. The program involves eight other hospitals and post-acute care providers, as well as the Miami-based Alliance for Aging. "Healthcare is very fragmented. There needs to be collaboration with post-acute care providers and others," he said.
The challenge of Florida
The health system leaders emphasized the fact that significant quality achievements were made in the face of challenging characteristics of the state of Florida. For example, Florida not only is the state with the second most Medicare beneficiaries at 3.52 million, but it also has the fourth largest percentage of uninsured adults among its population, accounting for 8 percent of the nation's uninsured, according to State Health Facts, a project of the Henry J. Kaiser Family Foundation.
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