BRANFORD MEDICAL CENTERCASE EVALUATION

Katie Faella Matt Morrisette

Joe Gandy Christine Cameron

ACME Health Care Consulting, LLC

How it all began…

Jason Prescott-Passed away at age 35

secondary to a MVA September 25, 2010

-Toxicology screen was + for alcohol & narcotics

PmHx: Chronic neck, low back, and shoulder pain following a

motorcycle accident at age 25High volume of narcotics for

chronic pain were prescribed by physician at Branford Medical Center

More pain…

Mary Backus-Passed away at age 40

secondary to an accidental prescription overdose at the end of July, 2010

-Toxicology screen was positive + for narcotics and benzodiazepines

PmHx:-Severe anxiety and chronic

low back pain- High volume of prescriptions

written by physician at Branford Medical Center

“No snowflake in an avalanche ever feels responsible.”

-George Burns

“In recent years, prescription drug poisoning has surpassed automobile accidents as the leading cause of unintentional injury death among people between the ages of 35 and 54...”

http://www.aboutlawsuits.com/fentanyl-overdose-wrongful-death-lawsuit-15551/

“In 2007, there were 38,371 drug overdose deaths reported in the U.S., outnumbering gun and alcohol-related deaths.”

http://www.aboutlawsuits.com/pill-mill-verdict-16012/

“…There was 65% increase in prescription drug overdoses between 1999 and 2005, commonly involving overdoses of morphone, OxyContin, and fentanyl.”

http://www.aboutlawsuits.com/fentanyl-overdose-wrongful-death-lawsuit-15551/

Overview of catalysts for these outcomes:

Root Cause Analysis

Overview of catalysts for these outcomes:

Deaths of Jason

Prescott and Mary Backus

Recommendations

Plan of Action

Unhealthy Work Environment

http://mentalselfhelp.net/blog/wp-content/uploads/2010/10/anger_2.jpg

Changing the Health System Culture

http://www.ismp.org/newsletters/acutecare/articles/20040325.asp

Changing the Health System Culture

http://www.ismp.org/newsletters/acutecare/articles/20040325.asp

Employee Implementation

-Collaborative Skills for Teams

Goals of program: Create more effective team performance Reconcile differences in team member personalities Reduce team conflict Reduce miscommunication Give meetings a purpose Manage time efficiently

http://www.corexcel.com/idX/team-collaboration.htm

Oversight and Effectiveness

Quality Manager Onsite point of contact Oversees behavior

Contract an outside consulting group Unbiased employee satisfaction surveys Monitor from a third person standing

http://www.pinnacleqi.com/products/

Outcomes

http://www.qaproject.org/training/ipc/ref.pdf

Financial Impact

Collaboration Skills Training Program- $995

Human Resources Officer- avg $65,000/year

Consulting Group- price to come

http://www.corexcel.com/idX/team-collaboration.htm

Financial Reward

Quantitative Results General improvement in patient

satisfaction$500,000-$1.2 million in additional revenue annually

Avoided lawsuitssave $53,000 in preparation and $173,000 in payments

http://findarticles.com/p/articles/mi_m3257/is_10_62/ai_n31329893/?tag=content;col1

Financial Balance

- $$$....

+$$$$$$$$$....

Lack of Infrastructure

EHR-Oversight Committee

-24/7 Reporting System

EHR -Amend Bylaws-Pain Committee

Sync BylawsEHR

Unify Communication

Absence of Accountability

Continuing Education

New legislature Bylaws of BMC

Ensure each employee is aware of what is expected of them

Article II, Section 3

“What you permit, you promote”

Recommended additions: System for ensuring this event never happens

again Mandatory patient medication reviews quarterly No prescribing narcotics for chronic pain in ED

Strict guidelines for dealing with substance abuse problems Standard protocol for situations involving substance

abuse Establish standards of behavior for all

employees Have each employee sign off showing understanding

Physician Prescribing Monitoring Require electronic documentation of

each prescription prescribed by physicians at BMC Incorporate system in EMR

Evaluation of prescribing practices are performed monthly and reported quarterly at committee level as per Article XI 3.1.3 Quality and Peer Review specialist in

conjunction with the CEO handles instances that arise

Standard protocol for evaluation and management of illegal prescribing practices

Peer Review

Establish a system of peer review Establish a separate position for Quality Care and

Peer Review specialist Leads and organizes peer review program Position is a part of the executive committee

Article XI 1.1.6 Allows for a continuous review of each employee

The medical staff Executive Committee meets monthly (Article XI 1.3)

At monthly meeting, discuss and evaluate situations with peer review

Upholds Article II, Section 2 of bylaws

Confidential Reporting

A 24/7 system for confidential reporting Allows for anonymous reporting of

problems/situations within the medical center (include hospital and clinic)

Headed by administrator and situations handled by the Quality and Peer Review position

**Details on how system will work Goal for short term: promote/increase

reporting from employees

Monitoring the system

AHRQ’s culture and safety survey Take a baseline measurement for

comparison Helps uphold Article XI 3.1 of bylaws **Add details about the survey

Voluntary employee satisfaction survey Offered quarterly

www.ahrq.gov

A New Day For Branford Medical Center

Market to the community Branford Medical Center’s new approach to healthcare: The patients interests are number 1 BMC’s main focus is to increase the quality of care

offered to each patient – Article II, Section 1 Start by creating a friendly, welcoming environment

for the patient Free healthcare for citizens of Branford to market

new goals and vision of BMC

A New Day For Branford Medical Center

Tell the employees of BMC that their interests are a major concern as well. Show them you are on their side by implementing a

plan to help create a more pleasant, safe, employee friendly work environment

**Add details here Make it known that all employees are looked upon

as equals no matter what position they hold Each employee is a critical component in providing

the best healthcare possible to each patient of BMC

Cost Analysis – Current Costs to BMC

Cost Analysis

Incurred Costs EMR EPA Quality and Peer Review specialist Free public healthcare

Cost Neutral Employee evaluations Confidential reporting system

Savings Lawsuit Rise in malpractice premiums

Timeline for Success

Implementation

Monitoring Progress

** Previous Clarion winners developed a timeline here, explaining how at set future timepoints they would evaluate for improvement of these intervening measures

Cost-analysis

Benefits/ Gains:

Statement of ‘Core Values’

Prev Clarion winners made a statement of ‘Core Values’, which seems to be more of a Mission Statement, something we may want to consider

Overall Vision

References

Image 1- http://www.world-english.org/friends6.htm

Image 2-http://www.motherinc.com.au/magazine/everything-for-mum/life-balance/pamper-me/7-skin-through-the-agestaking-care-of-you

http://www.google.com/images?hl=en&biw=1280&bih=615&gbv=2&tbs=isch%3A1&sa=1&q=fear+eye&aq=f&aqi=g1&aql=&oq=

http://semstreetcred.com/wp-content/uploads/2009/07/4622501_blog-300x300.jpg

Joe’s resources

Hire a human resources officer http://www.payscale.com/research/US/Job=Human_Resources_(HR)_Manager/Salary Outside consulting group - http://www.pinnacleqi.com/

Training resources http://www.corexcel.com/idX/team-collaboration.htm

Monitoring outcomes http://findarticles.com/p/articles/mi_m3257/is_n2_v45/ai_10328657/?tag=content;col1 Surveys and inspections

Financial rewards Rush University Medical Center, Chicago, calculated that improving patient satisfaction scores

resulted in $2.3 million in additional revenues annually from repeat customers (Garman, A.N., Garcia, J., and Hargreaves, M., "Patient Satisfaction as a Predictor of Return-to-Provider Behavior: Analysis and Assessment of Financial Implications," Quality Management in Health Care 13, no. l, 2004).

REVIEWING THE NUMBERS: PATIENT SATISFACTION PAYSImproving patient satisfaction has a clear and direct impact on organizational results:* For a hospital with annual revenues of $120 million, improving patient satisfaction generates an estimated $2.2 million to $5.4 million in additional revenue every year.* For every 10 patients who complain to hospitals, there are up to 200 who do not and will tell their family, friends, co-workers, and physicians.* For every lawsuit avoided by improving patient satisfaction, hospitals save approximately $53,000 in costs to prepare cases and $173,000 in payments.Source: Press Ganey ROI Calculators. Used with permission.Melvin F. Hall, PhD, is president and CEO, Press Ganey Associates, Inc., South Bend, Ind. (mhall@pressganey.com).

http://findarticles.com/p/articles/mi_m3257/is_10_62/ai_n31329893/

Recommendations Infrastructure:- EMR, iPads- Pain management group- Hospital education committee- keep employees up to date- Sync bylaws between clinic and hospital, sync operations

-create institutional framework

Accountability:- Bylaws- Quality & Risk Management Committee, edit drug use policies- Define roles of each employee--- each person should know that he/she is accountable- Create culture of higher standards/ ie.) like MUSC’s ‘Culture of Compliance’- E-value-like system for evaluation from administration and peer evaluation- EMPLOYEE ASSISTANCE PROGRAM- oversee drug, alcohol program for impair workers

Hostile Work Environment:- Edit bylaws to reinforce employee’s rights ie.) to report wrongdoings- Resource line for reporting problems- Conflict resolution, team building retreat, individual empowerment- Make board meetings available to all employees- both through the ‘minutes’ for each meeting

and attendance- create transparency