Fall 2009 : VOL. 7 NO. 4 : WWW.OHIOKEPRO.COM
Common Ground: Partnership and Collaboration in the 9th SOW
“We’re involved in too many projects already.”
“We can only be pulled in so many directions.”
“Everyone has their own twist on the topic and wants us to do it their way.”
Do these arguments sound familiar? When we try to recruit participants for our quality improvement projects, we hear objections like these every day—and so do other organizations, since we are often approaching the same pool
of providers. The truth of the matter is this: We are all pulled in many directions, and we would
all benefit from coming together to find some common ground so that we can work to help each other achieve shared goals.
Collaboration is a fundamental component of any successful quality improvement project, which is why we’ve built our projects on a foundation of partnership. Whether the project falls under the Beneficiary Protection, Patient Safety, or Prevention Theme, our staff would be unable to work to achieve QIO Program goals without the cooperation of Medicare beneficiaries, healthcare providers, stakeholder organizations, and our other partners. What our project participants—as well as participants in any successful collaborative relationship—have come to recognize is that working with partners makes your work easier, not harder. In an effective partnership, there is mutual benefit and mutual reward.
At Ohio KePRO, we strive to make your work easier by providing the tools and resources at our disposal. Collaborating with partners like you provides additional support for both of us in working toward our goals, such as the CMS goal of the right care for every patient, every time. Over the past ten years as Ohio’s QIO, we have been fortunate enough to be able to forge relationships with physician practices, providers in acute care and long-term care facilities, professional organizations, senior advocacy groups, Medicare beneficiaries, and caregivers throughout the state.
This issue of Spotlight on Quality discusses some of these relationships at length, including the Ohio Patient Safety Initiative (OPSI) and the Ohio Department of Health (ODH) (“Partnership and Collaboration for Patient Safety”), Ohio Immunization Partners for Healthy Adults (OIPHA) (“Working Toward a Healthier Senior Population”), and the Health Resources and Services Administration (HRSA) (“Ohio KePRO Joins HRSA Community Collaborative”). Unfortunately, we don’t have space here to mention everyone by name, but this issue is dedicated to all of you, our partners in quality.
– Rita Bowling, RN, MSN, MBA, CPHQ
Project Director
rbowling@ohqio.sdps.org
Partnerships to Improve Care Delivery
Healthcare partnerships are essential to the delivery of quality care; no single provider, organization, or group can fulfill the complex needs of those seeking help. However, these relationships can also be very challenging. Defined as a “cooperative relationship between people or groups who agree to share responsibility for achieving some specific goal,”1 an ideal partnership will facilitate optimal healthcare delivery. A close examination of the three major components of this definition can help clarify how improving and strengthening partnerships can benefit everyone involved the care process.
Cooperation
There are many ways to foster cooperation between individuals and organizations. Here are a few:
Speak with respect toward and about one other.
Share what you know, and get information from your peers; don’t reinvent the wheel.
Give a little; patience and persistence go a long way. Have patience with your partners, and keep trying.
Work together to problem-solve and find solutions.
Develop key messages (individually and jointly), and communicate often with the community.
Working Toward a Healthier Senior Population
Among our collaborative partnerships is Ohio Immunization Partners for Healthy Adults (OIPHA), formerly known as Partners for Healthy Seniors. Ohio KePRO leads this coalition in its efforts to improve immunization rates for the state’s 1.8 million Medicare beneficiaries. OIPHA works at the local and regional level to ensure consistent immunization-related messaging for seniors in order to fulfill its mission of “foster[ing] comprehensive, sustained state and community programs for the immunization of Ohio’s adults against vaccine-preventable diseases.”
With diverse representation from such groups as the Ohio Department of Health (ODH), Palmetto GBA, the Ohio Pharmacists Association (OPA), the Ohio Hospital Association (OHA), as well as local health departments and health plans, OIPHA conducts regularly scheduled meetings to facilitate information-sharing and collaborative strategizing. We work with OIPHA to develop and distribute educational materials to primary care practices, community health centers, senior centers and libraries throughout the state, with an emphasis on areas with low immunization rates.
OIPHA’s website offers easy access to educational materials for providers in all care settings, as well as information on upcoming meetings and educational opportunities. Visit www.ohiokepro.com/OIPHA today to read more!
Shared Responsibility
Regardless of the care setting, all providers share the responsibility of working to bring about good outcomes for their patients/residents.
- Know your individual and organizational strengths and weaknesses.
- Learn the strengths and weakness of your partners so that offering and accepting help becomes the standard way of doing business.
- Refer to other experts as needed.
- Acknowledge that you can’t do it all.
Shared Goals
Keep in mind that, as healthcare providers, you are all on the same side, and that you have many shared goals. Working together to reach these goals will help promote more efficient and effective care transitions, as well as better outcomes for your patients and residents.
Additional Reading
Medical Teamwork and Patient Safety: The Evidence-Based Relation
Patient Safety and Quality: An Evidence-Based Handbook for Nurses
http://www.ahrq.gov/qual/nurseshdbk/
Chapter 33. Professional Communication and Team Collaboration
Tools and Resources
TeamSTEPPSTM
Partnership and Collaboration for Patient Safety
As healthcare providers, you already know that patient safety is a major area of focus across the industry. In addition to the Medicare QIO projects to improve care delivery related to MRSA, pressure ulcers, restraints, surgical care, heart failure, and drug safety, projects driven by government agencies and independent quality improvement agencies are offering assistance and funding to providers to reduce medical errors and improve patient safety. We’ve been fortunate enough to be able to work collaboratively with a number of these organizations to help meet our shared goals.
At the state level, one of these is the Ohio Patient Safety Initiative (OPSI). Established in 1999 by the Ohio Hospital Association (OHA), Ohio State Medical Association (OSMA) and the Ohio Osteopathic Association (OOA), OPSI strives to develop and transform healthcare into a reliable, safe delivery system. We also have a longstanding relationship with the Ohio Department of Health (ODH). Our involvement with ODH includes workgroups focused on improvements related to diabetes, immunizations, cardiovascular care, and Critical Access Hospitals (CAHs). We are currently part of an ODH workgroup examining approaches to effectively reduce the incidence of healthcareassociated infections (HAIs) in acute care hospitals.
Other Ohio KePRO partners include state trade organizations such as The Ohio Hospital Association (OHA), The Ohio Health Care Association (OHCA), The Ohio Academy of Nursing Homes (OANH), Association of Ohio Philanthropic Homes, Housing and Services for the Aging (AOPHA), The Ohio Council for Home Care (OCHC), and Ohio Home Care Organization (OHCO). We work closely with these organizations to promote projects and clinical practices that help improve the quality of care delivery. We have shared resources and communications vehicles with these organizations to aid in our mutual efforts, and to help bring about improved outcomes. We are currently involved in Ohio on the Cusp: Stop BSI, a project coordinated by OPSI in which we are partnering with OHA to study methods to reduce central-line associated bloodstream infections (CLABSIs) in hospital intensive care units (ICUs).
Our involvement extends to national campaigns as well. We support the Advancing Excellence in America’s Nursing Homes campaign as the Local Area Network for Excellence (LANE) Convener for Ohio. In the Institute for Healthcare Improvement’s Improvement Map: From Here to Excellence campaign, we serve in conjunction with OHA as part of the Campaign Node for Ohio. Our goal is to support local efforts to achieve success in these projects nationwide.
Learning Network
One of the goals of our Patient Safety team is to help create a Learning Network in the state to support providers who are interested in making a difference in their patients’ lives related to these project topics. The Network would work to support several functions:
To bring together agencies working on these patient safety topics to share effective clinical practices.
To facilitate the development of a pool of resources (clinical and quality improvement experts as well as material resources) to aid providers in their quality improvement efforts.
To establish common ground for a statewide patient safety agenda and to facilitate collaboration to maximize the impact of each organization’s project efforts.
Once established, the Network will emphasize the similarities, rather than the differences, in projects sponsored by various entities. We will promote the repeated use of interventions successfully offered by one organization or project to benefit other projects and providers.
Mentor Program
Ohio KePRO has established a mentor program for Physical Restraints, Pressure Ulcers, and MRSA to enable those who are still working toward success to get help from those who have already succeeded. Our mentors include experts statewide who are willing to talk, to share, or to assist providers in overcoming their barriers to excellence. Our current project strategy includes the creation of groups of providers to facilitate mutual learning, particularly as regards the practicalities of making the changes necessary for excellent care. Ultimately, our aim is for providers to feel empowered to pursue involvement in multiple concurrent projects because of the help of a support network, and to realize that each project offers many resources or interventions that can be used in multiple ways to improve the outcomes of other projects. As with all collaborative efforts, we hope that these providers come to understand that the accumulation of ideas and materials that they can bring into play, no matter who created them, that will make the difference.
– Rita Bowling, RN, MSN, MBA, CPHQ
Project Director
rbowling@ohqio.sdps.org
Ohio Patient Safety Culture Survey
The culture of a provider organization and its attitude and approach to patient safety is an important factor in the quality of care it delivers to Medicare beneficiaries. An organization’s patient safety culture is not a single item or process; rather, it is comprised of multiple factors that all contribute to the overall result. The AHRQ Patient Safety Culture Survey was developed to measure these multiple factors, including overall perceptions of safety, reporting of events, expectation and promotion of patient safety, training, teamwork, communication and feedback, nonpunitive response to error, staffing, management support, and handoffs and transitions.
Because of the importance of culture and its effect on an organization’s care delivery, Ohio KePRO works with individual facilities to incorporate culture assessments into the focus of interventions used in order to achieve the most impact.
The AHRQ Patient Safety Culture Survey was distributed to the nursing homes and hospitals participating in the 9th SOW Patient Safety projects. Each organization scheduled and conducted the survey with their employees, and submitted the responses to Ohio KePRO for aggregation.
The aggregate results include all facilities that completed surveys by the end of June 2009: a total of 30 hospitals and 78 nursing homes, representing 75 percent of the 144 Identified Participant Group (IPG) facilities.
The aggregated results of this survey provide a baseline for facilities at the beginning of the 9th SOW projects; this starting point gives an indication of areas that need focused attention. As demonstrated in Table 1 on page 7 and Figures 1 and 2 below, one commonality among the facilities surveyed is a need to address the organization’s nonpunitive response to errors.
These overall results will be used in combination with individual facility results to guide the interventions selected for use in Patient Safety project work. Once the projects are near completion (in late 2010 or early 2011), the survey will be repeated in each of the facilities. The results will be compared against the baseline responses to determine the effect of the interventions on patient safety culture during the 9th SOW, particularly in categories targeted for improvement in each facility.
– Linda Stokes, MSPH, ABD
Senior Scientist
lstokes@ohqio.sdps.org
Increasing Immunization Rates: What Works
We all know how important immunizations are for preventive health, especially for those in high-risk populations such as seniors, but increasing immunizations can be a challenge. One of the best ways to improve rates at your organization is by incorporating immunizations into the workflow. This can be accomplished using paper or electronic health record (EHR) systems, with strategies such as provider education, screening questionnaires, standing orders, and reminder recall systems.1
Provider Education
Provider education can help improve patient knowledge and reduce barriers. Sharing information on the safety and effectiveness of vaccines, and using educational tools such as fact sheets and vaccine information sheets, will help reduce fear and increase the likelihood of vaccination. Education that includes information on other avenues of obtaining an immunization such as mass immunizers and immunization coverage by Medicare will also help improve rates. Vaccine Information Sheets are available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/vaccines/pubs/vis/default.htm.
Screening Questionnaires/Standing Orders
Standardized forms such as screening questionnaires and standing orders can help simplify the care process, and are an efficient way to help your organization achieve results. Standing orders can be implemented with the following steps:
Ask specific questions during every visit.
Use screening questionnaires.
Document immunization history in the appropriate file in EHR or form in paper chart.
Examples of standing orders and screening questionnaires are available from the Immunization Action Coalition at www.immunize.org.
Reminders/Recalls
Reminder and recall systems are effective in increasing attendance and improving vaccination rates in various care settings. Approaches vary greatly, and should be adapted to the unique needs of your organization and patient population. Some examples include: postcards, letters, follow-up telephone calls, computer-generated lists, and “immunization due” stamped or clipped on patient charts.
Help your organization improve its immunization rates by visiting the Ohio Immunization Partners for Healthy Adults (OIPHA) website (www.ohiokepro.com/OIPHA) to download recommendations, fact sheets, brochures, questionnaires, and billing resources. Additional tools and resources are available from the “Shopping Bag/Resource Library” on the Ohio KePRO website (www.ohiokepro.com/shopping), including:
|
Adult Immunization Reimbursement Guide Includes codes, cost and reimbursement amounts |
 |
Adult Immunization Coding Guide Includes cost, frequency, and billing codes |
|
Better Life Checklist Simple questionnaire to remind patient to obtain preventive services |
|
Medicare Preventive Services brochure Outlines coverage for beneficiaries |
– Bonnie Hollopeter, LPN, CPHQ, CPHIT
Project Manager
bhollopeter@ohqio.sdps.org
Organizational Culture and Partnerships
As we take on the exciting challenge of working together (whether on a single nursing unit, across units/departments, or with external healthcare providers such as other hospitals and nursing homes), cultural values may at times conflict. We can misunderstand one other, and react in ways that can hinder what are otherwise promising partnerships.
By definition, teamwork implies cooperation, collaboration, joint effort, and solidarity, while partnership implies affiliation, collaboration, alliance, and relationship.
How Culture is Formed
Organizational behavior/culture is the analysis and application of collected knowledge on how individuals or groups react within an organization, at the personal, group and organizational level. This information is used to create person-to-person, unit/team, and company-wide objectives. These combined objectives make up relationships, and eventually an organizational culture.
There are four commonly recognized styles of organizational behavior/culture:
Autocratic – Employees are dependent on the boss and his/her decisions.
Custodial – The need for employee security is met and performance is passive.
Supportive – Staff are highly participative and oriented toward job performance.
Collegial – The culture recognizes partnership and supports the importance of employee participation in constructing a shared ownership of problems and outcomes.
Generally, no organization falls into one specific type; instead, organizational behaviors/culture overlap, with most organizations having some characteristics of more than one category.
Building Strong Foundations
Whether internal or external, partnerships are complex relationships that require deliberate formation and maintenance. In the initial stages of partnership formation, it is critical for leaders to build trust by encouraging and nurturing a climate of openness, and to invest the time necessary to establish a strong foundation.
Successful partnerships are often developed with skilled facilitation by the organization’s leader or another group member, or by an outside professional such as a Quality Improvement Organization. In the beginning stages of a partnership, its success or failure will depend largely on the ability of leadership to build the foundational elements on which all the partners eventually will stand, including: empowering individual team members; engaging partners in the initial definition of the problem being addressed; and reaching a consensus on the specific problem to be solved, the analytical framework(s) to be used, and strategies for implementing the partnership agenda. In order to create a shared definition of the problem, each partner must make an effort to understand the problem from the other partner’s point of view.
An ability of all partners to recognize their interdependency early on in the formation of the partnership is crucial, especially when the challenge undertaken is complex and requires a broad knowledge base or diverse expertise and resources. Partnerships are most effective when members choose to work together from a position of individual strength. While bringing resources and expertise to partnerships is important, it is also imperative that everyone involved feels the partnership will advance their own priorities.
Nurturing Subcultures
Just as cultures exist in an organization, there are subcultures in departments, teams and partnerships. It is imperative that all members of a partnership feel they are respected and that their contribution is valued by other partners. Each partner needs to feel that they have influence on the direction and focus of the vision and partnership strategy. Important behavioral factors to consider in creating power equity are: active and full participation; information sharing; negotiated priorities; clear assignment of roles and responsibilities; and equitable distribution of resources. When partners feel devalued, the partnership process may break down and the goals of the collaboration fall short. The community of subcultures and the interdependency of all units within an organization are the key its success. To read more about organizational culture, see the inset article (“Appreciative Inquiry”) below.
– Susan L. Ferrante, ARM
Quality Improvement Project Coordinator
sferrante@ohqio.sdps.org
– Leasa Novak, LPN, BA
Quality Improvement Project Coordinator
lnovak@ohqio.sdps.org
Reminder of upcoming reporting deadlines and events.
Click here to view and print.
The following information is based on questions and answers published by the Centers for Disease Control and Prevention (CDC) on August 3, 2009. The full document is available on the CDC website at http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
| Q. |
When is it expected that the novel H1N1 vaccine will be available? |
| A. | The novel H1N1 vaccine is expected to be available in the fall. Vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials.
|
| Q. | Will the seasonal flu vaccine also protect against the novel H1N1 flu? |
| A. | The seasonal flu vaccine is not expected to protect against the novel H1N1 flu.
|
| Q. | Can the seasonal vaccine and the novel H1N1 vaccine be given at the same time? |
| A. | It is anticipated that seasonal flu and novel H1N1 vaccines may be administered on the same day. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.
|
| Q. | Who will be recommended as priority groups to receive the novel H1N1 vaccine? |
| A. | The CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the novel H1N1 vaccine when it first becomes available:
|
| Q. | Where will the vaccine be available? |
| A. | Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
|
| Q. | What about the use of antivirals to treat novel H1N1 infection? |
| A. | Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. This fall, antivirals may be prioritized for persons with severe illness or those at higher risk for flu complications.
|
| Q. | Are there other ways to prevent the spread of illness? |
| A. | Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread that way. Stay home if you get sick. The CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. |
Rural Providers to Join Statewide Patient Safety Efforts
With the recent allocation of funding to recruit rural facilities for QIO Program projects, 75 additional rural Ohio hospitals and nursing homes will be able to join statewide efforts in the Patient Safety Theme. These facilities will join the 150 current participants in the Pressure Ulcer and Restraints projects originally initiated in October 2008. Ohio KePRO will support their efforts with one-on-one consultation with quality improvement specialists, teleconferences, opportunities for information-sharing, and interventions to reduce pressure ulcer incidence and restraint use. Welcome to our new project participants!
Ohio KePRO Joins HRSA Community Collaborative
Ohio KePRO has joined forces with Ohio State University School of Pharmacy and Public Health, Omnicare, and Sanofi-Aventis in a community collaborative spearheaded by the Health Resources and Services Administration (HRSA). Known as Version 2.0 of the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC 2.0), this group works to spread the integration of clinical pharmacy services and patient safety principles to improve health outcomes in safety-net populations. Participation in this collaborative, which is modeled after the Institute for Healthcare Improvement’s (IHI’s) Learning Collaboratives, could dramatically improve the health status and safety of Medicare beneficiaries with multiple chronic diseases, high risk drug therapy, complex drug regimens and multiple care delivery sites.
Rock Run Center, Suite 100
5700 Lombardo Center Drive
Seven Hills, OH 44131