When it comes to reducing patient harm, there's always more to accomplish, says Keith Kosel, PhD, MHSA, MBA, vice president and executive director of VHA's Center for Applied Healthcare Studies.
"Even as you ratchet these numbers down, there’s a tremendous number of areas where there's always room for improvement," he says.
VHA, a national network of nonprofit healthcare organizations, is applying that mindset to its Hospital Engagement Network or HEN. The HEN is part of CMS's Partnership for Patients initiative, which aims to make care safer and improve care transitions. As part of the program, some 3,900 hospitals are working within 26 HENs across the country to help identify solutions and disseminate them to other hospitals and providers.
VHA's HEN has nearly 200 participating hospitals, which it helps improve in 10 areas of focus ranging from readmissions to surgical site infections. The Partnership for Patients' objectives are to reduce hospital-acquired conditions by 40 percent and readmissions by 20 percent throughout the course of three years. In October 2013, VHA reported its second year results. Following on-site visits and coaching sessions, its HEN hospitals in aggregate reduced ventilator-associated pneumonia, early elective delivery and central line-associated bloodstream infections by over 40 percent.
Last month, VHA announced it will continue its improvement efforts through the HEN in 2014. "Everyone in the Partnership is working to get to that 40/20," Dr. Kosel says.
In order to achieve those percentages, he says frontline clinicians and C-suite executives alike at the HEN's participating hospitals need to own reducing preventable patient harm. To get hospital leaders on board, VHA has created a leadership model of accountability, with help from Peter Pronovost, MD, PhD, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore.
VHA has given executives and other staff members toolsets to help them develop the competencies to work closely with others in the chain of command to address patient harm, Dr. Kosel says. So far, VHA has implemented the program at 10 hospitals and is rolling it out to the remaining hospitals in the HEN.
"It's really built on this concept that there's a chain of accountability or command that exists all the way from the boardroom to the bedside," he says. "We're also in the process of building toolkits that say, if you're a CNO, these are accountability challenges you would have, and these are tools — for example, capacity planning templates and resource allocation guidelines — that illustrate how to approach what you are accountable for."
The feedback from the 10 hospitals with the leadership model in place so far has been "phenomenal," Dr. Kosel says. "The C-suite tells us, 'We're learning things that we were unaware of before,'" he says. "It's really turning out to be a win-win for both the frontline folks and the executives."
For 2014, VHA is also putting together two new programs of special note for the HEN, he says. The first is a joint effort with the American Nurses Association centered on improving the nursing work environment. The program aims to boost satisfaction, lower turnover rates and improve patient outcomes.
"We know patients generally receive better care from nurses that are more engaged and satisfied," he says.
The second project aims to reduce readmissions by focusing on the concept of "patient activation." Patient activation has four stages: believing the patient role is important, having the confidence and knowledge to take action, actually taking action to improve health and staying the course when challenges present themselves.
According to a recent study published in the Journal of General Internal Medicine, patients that fall into the lower stages or levels of activation are more likely to be readmitted to the hospital. The VHA HEN is looking to tailor patient interventions according to activation levels to achieve better outcomes while using fewer resources, says Dr. Kosel.
So far, he says the HEN has been a "great learning experience," and he hopes CMS will make the decision to extend the Partnership for Patients initiative beyond 2014. He also calls on hospitals that aren't part of a HEN to take the plunge.
"It really is something they need to consider joining," he says. "It's pretty clear that these programs do have a meaningful impact on reducing patient harm, and they can only serve to help hospitals better prepare for the accountable care world that is fast approaching."
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