Introduction to the Hospital Engagement Network (HEN) February 21, 2014 Sara Bader and Adam Kohlrus

Introduction to the Hospital Engagement Network (HEN)

February 21, 2014Sara Bader and Adam Kohlrus

WELCOME NEW HENs!!! We’re Glad You Decided to Join!

• Objectives for the hour• Review Origins of the Hospital Engagement Network and Illinois

program and progress• AHA/HRET HEN overall goals• AHA/HRET IHA Program support

• Comprehensive Data System (CDS)• Website and Listserv• IHA HEN Coaches• Improvement Leader Fellowship• Education and certification

• State of the AHA/HRET Illinois HEN• Measure alignment• Eliminating Harm Across the Board

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Partnership for Patients

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5

Overview – HEN

Partnership – IHA & HRET/CMS– 1600 hospitals in 31 states– Original 2 year program, ending December 31, 2013– Optional 3rd year goals, continue work of the first 2 years

• Reduce harm by 40% - (CLABSI, CAUTI, SSI, VTE, ADE, Falls, OB Harm, EED, PU, VAP)

• Reduce readmissions by 20% • Equip hospitals with leadership, change management, facilitation,

quality improvement & teamwork skills• Focus on improving the safety culture• Provide option to report/track on 7 new areas of harm

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Illinois HEN 2014

• 70 hospitals +• Option year new members

– 16 and counting…• Enhanced focus on:

• Improvement• Data Submission• Measure Alignment• Pay for performance

Overview – HEN

Partnership – IHA & HRET– Partnership for Patients funded resources

• Help to identify HAC’s in need of intensive & moderate support• 3 levels of improvement activity at the HRET level

– Stand-alone webinars – Boot Camps (Intensives)– Coaching calls– Improvement Leader Fellowships

» 3 levels: Junior, Senior, and Champion» An improvement leader at every hospital

8

Overview – HEN

Partnership – IHA & HRET

– Partnership for Patients funded resources • Topic specific toolkits, guidelines & checklists, including

new optional areas (upcoming in 2014)• Ongoing access to subject matter experts in all 10 areas• Intensive support for hospitals or regions with

significant challenges• Targeted interventions for specific hospital types

(children’s, LTACH, psychiatric)

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HRET/HEN Website

• http://www.hret-hen.org/

• Resources and tools for the ten focus areas (webinars, podcasts, toolkits, and links to other helpful information)

• Registration required for membership access

Overview – HEN

– Partnership for Patients funded resources • Dedicated program website where all calls and webinars will be

archived along with written material and important links• LISTSERVs® and monthly Harm Across the Board Reports – New

2014

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Overview – HEN

Partnership – IHA & HRET

Join the AHA/HRET HEN LISTSERV®

Please email [email protected] and request to be added to the LISTSERV® . Put the name of the HAC you would like to be added to in the Subject line. Please allow 3-5 business days for your request to be processed. Please note this is a closed LISTSERV® and your hospital needs to be signed up with the AHA/HRET HEN to participate.

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mailto:[email protected]?subject=Request%20to%20be%20added%20to%20the%20Adverse%20Drug%20Event%20LISTSERV(R)

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• 40 percent reduction in 10 harm topics with over 80 percent of hospitals reporting data

• In order to achieve these goals we will utilize data from COMPdata but we also need your commitment to confer rights from NHSN and submit data on ADE, EED and Falls

HEN Performance Target for 2014: 40% Reduction in Harm-20% Readmissions

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2014 Level of Individual Hospital Progress on Meeting HEN Goals

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Overview – HEN

Partnership – IHA & HRET– Partnership for Patients funded resources

• Data collection and progress monitoring & support– Encyclopedia of Measures (EOM)– Selection of measures that minimize data collection burden– Comprehensive Data System (CDS)

» secure, web-based data collection system. Users must have a connection to the Internet and a browser which supports SSL (secure socket layer) encryption.

» 1000’s of registered users with majority of hospitals submitting data on at least one measure

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Encyclopedia of Metrics-EOM

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Data Review-Hospital Responsibilities

Overview – HEN

IHA– Illinois HEN Data Plan & Data Alignment

• ADE - hospital• CAUTI - IHA COMPdata, NHSN• CLABSI - IHA COMPdata, NHSN• Falls - IHA COMPdata, hospital• OB/EED - IHA COMPdata, hospital (EED data)• PU - IHA COMPdata• Readmission – IHA Database• SSI - IHA COMPdata, NHSN• VAP - IHA COMPdata, NHSN• VTE - IHA COMPdata, NHSN

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1) Adverse drug events (Hospital)

2) Elimination of Early Elective Deliveries (Hospital)

3) Falls with injury (Hospital)

4) CLABSI (NHSN)

5) CAUTI (NHSN)

6) SSI (NHSN)

7) VAP (NHSN)


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Comprehensive Data System-CDS

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HEN Dashboard

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HEN Dashboard

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Data Submission and Alignment

Renewed emphasis and incentives on data submission and measurement alignment

• HRET has emphasized the alignment of specific measures

• Submission of outcome metrics on the following HACs are imperative in 2014:-ADE-EED-Falls

• Conferring rights to NHSN-host of new metrics HRET is seeking

• Work as a team to share data mining techniques

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Education on other topics:• These topics will not have a data reporting component, but

there will be educational events offered on the following topics:

- Sepsis - MRSA

- C-diff - Acute renal failure- Procedural harm

Expanded focus on Healthcare Disparities :• HRET will be hosting webinars focusing on

diversity, cultural competency and data collection and use

2014 Additional Topics

2014 HEN Commitments

Data Participation1. Submission of ADE Measures

• Anticoagulation• Hypoglycemia• Opioids

2. Submission of EED data

3. Submission of Falls data

4. Conferring Rights in NHSN as applicable (CAUTI, CLABSI, VAP/VAE, SSI)

5. PEFL Survey

1. Completion of Harm Across the Board Template(s)

2. Attendance at Statewide Workshops

3. Completion of at least 2 Site Visits

4. Participation in Improvement Leader Fellowship

5. Webinar attendance

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IHA HEN Team Coaches:

AKA: Disney PrincessGrace and Poise Under

Pressure

AKA: SupermanAll Things Data

AKA: The BrainSmart and Fast

Marie Cleary-Fishman

Adam Kohlrus

Sara Bader

Teresa Baumgartner

Mary StankosAKA: Pollyanna

Quick with Answers

AKA: The NewbieDetermined To Help

HEN Coaches

IHA• IHA HEN Coach

– Each hospital will have a primary HEN staff member assigned to them who will act as your “point person”

– You may direct any questions, concerns or any HEN related activity through your point person

– They will be acting as your mentoring coach and will work with you as you plan your implementation, monitor your progress and move forward throughout the initiative

– Two coaching site visits are planned for 2014, one visit prior to June 30 and the second prior to November 30

Quality team and leaders are expected to participate

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Weekly Update

IHAIHA P4P HEN Weekly Update

– Sent out each Friday• Upcoming Events (webinars, workshops, etc.)• Hospital Highlights• Reminders• Other resources to help you

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Statewide Workshops

• Goal : to leave the meeting with a set plan of action and necessary tools to achieve the 40%/20% targets

• 4 Upcoming workshops in Springfield and Naperville

-February 19th and 21th -May 22th and 23rd

-September 18th and 19th-November 20th and 21st

-HRET Improvement Leader Fellowship

Eliminating Harm Across the Board

• Must complete Eliminating Harm Across the Board (HAB) template• Utilization of the Improvement Calculator• Story Board of who you are, where you are, what action

you have taken, what you’ve learned, and what opportunities do you see

• Monthly, single HAC focused HAB update submitted via the listserv

• Expectations for transparency

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Harm Across the Board (HAB): Monthly Update

Hospital: ________________ State: ______ Month: _________

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Opportunities in the HEN 2014

• CPHQ Certification

• CPPS Certification

• Quality Boot Camp

• ABQUARP Certification for physicians • IHI

• NPSF Conference

• Regional SWW

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Opportunities Under Consideration in 2014

• CIC Certification

• Advanced Quality Boot Camp

• TEAMSTEPPS

• Planetree-Making Patient-Centered Care a Reality-Online Nursing Course

• High Reliability Organizations

Hospital Engagement Network: Questions?

HEN: 2014 Priorities, Expectations and Opportunities

Marie Cleary-Fishman, Sara Bader, Adam KohlrusFebruary 19, 2013

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Agenda

• HEN Overview

• 2014 Data and Performance

• 2014 Commitments

• 2014 Illinois HEN Scoring

• Leadership for a New Era: Adding Harm Across the Board to your Toolkit

• 2014 Harm Across The Board

• 2014 Improvement Leader Fellowship

HEN Performance 2013: 30/6/60

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2014 Hospital Level Progress Report

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1. The 40/20 goal is here…

2. Renewed emphasis and incentives on data submission and measurement alignment

3. Your participation and engagement will drive funding-Pay for Performance

4. Monetary incentives exist if data commitments are met

5. IHA is instituting a value-based scoring system which will determine your invitation to IHI and overall performance in 2014

5 Things you need to know in 2014

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2014 Calendar

• 2014 SWW #1-February 19th (Springfield) and 21st (Naperville)

• 2014 SWW #2-May 15th (Naperville)

• 2014 SWW #3-September 18th (Springfield) and 19th (Naperville)

• 2014 SWW #4-November 20th (Springfield) and 21st (Naperville)

• HRET In Person Fellowship Meeting (Naperville)-TBA

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• QHR 3rd Annual New Quality Director Boot Camp-May 19-23rd Advanced Quality Director Boot Camp to be offered as well

• TeamSTEPPS-TBD

• CPHQ Certification-TBA

• CPPS Certification-TBA

• CIC Certification-TBD

2014 Opportunities

HEN: 2014 Data and Performance


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HEN Performance 2014: ACT Data Scoring Criteria

• Element 1: Measure Alignment with PfP 40/20 Goals-(Points awarded for meeting measure alignment for at least 30 percent of hospitals)

• Element 2: Completeness of Data-(Points awarded for level of reporting: 70 percent, 80 percent)

• Element 3: Measure Trends and Meeting Benchmark-(Points awarded based on improvement)

CMS has implemented a scoring criteria to determine the success of each state from a data reporting and improvement perspective. This

criteria is comprised of 3 elements.

ACT SCORE ELEMENTS (A = alignment with 40/20 goals, C = completeness of data, T = trend or benchmark)

AHA State ACT: Illinois, December 2013

AHA State ACT and PEPL Report: Illinois, December 2013


Score Component ADE CAUTI CLABSI Falls OB-EED OB-Oth PrU SSI VAP VTE Readm Points Earned

Maximum Possible Points

Element 1: Measure Alignment with PfP 40/20 Goals(Points awarded for meeting measure alignment for at least 30 percent of hospitals)

0 1 1 0 2 0 0 0 1 0 2 7 22

Element 2: Completeness of Data(Points awarded for level of reporting in the AEA: 70 percent, 80 percent, or 80 percent and measure alignment (at least 1 point) in the AEA)

0 0.5 2 1.5 1 1.5 1.5 1.5 2 1.5 2 15 22

Percent reporting outcome data across AEA 9% 68% 98% 99% 78% 98% 99% 99% 98% 99% 99%

Element 3: Measure Trends and Meeting Benchmark(Points awarded based on measure with highest improvement in the AEA and at least 60 percent reporting, as well as considering improvement occurring during PfP period of work)

0 2 3 0 3 3 0 4 0 1 0 16 44

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Bonus: At least one measure meets all trend criteria (overall improvement, recent improvement, measure quality) AND currently meets benchmark

Yes Yes 2 11

Illinois Compared to HRET HEN and PfP Average

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Score Type

PfP

HRET HEN

Illinois

ACT Points (rescaled to 100)

41 43

ACT Bonus (max=11) 1 2

ACT Score 52 41 45

COMPdata Metrics Uploaded to CDS

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IHA/HRET Hospital Engagement Network

Outcome Measures Supplied by IHA to HRET/CDS

Num CategoryNew 2014 TITLE

EOM/CDS Reference Number NUMERATOR DENOMINATOR SOURCE

1 ADE Adverse Drug Event - Manifestations of Poor Glycemic Control EOM-ADE-110 ICD-9 Diagnosis code: 250.11-250.13, 250.20-250.23,

251.0, 249.10-249.11, 249.20-249.21 All Patients CMS HAC

2 CAUTI Catheter-Associated Urinary Tract Infection IL-CAUTI-2-1 ICD-9 Diagnosis code: 996.64 All Patients CMS HAC

3 CLABSI Central Line-Associated Bloodstream Infection IL-CLABSI-3-1 ICD-9 Diagnosis code: 999.31, 999.32 All Patients

CMS HAC (bloodstream infections only, does not include local infections [999.33])

4 FALLS Falls & Trauma EOM-FALLS-39ICD-9 Diagnosis code (must also be on CMS CC or MCC list): 800-829, 830-839, 850-854, 925-929, 940-949, 991-994

All Patients CMS HAC

5 OB OB Trauma - Vaginal Delivery with Instrument (AHRQ PSI 18) EOM-OB-54

All vaginal delivery with instrument and 3rd and 4th degree OB trauma

ICD-9-CM Obstetric trauma diagnosis codes:66420 DEL W 3 DEG LACERAT-UNSP; 66421 DEL W 3 DEG LACERAT-DEL; 66424 DEL W 3 DEG LAC-POSTPART; 66430 TRAUMA TO PERINEUM AND VULVA DURING DELIVERY, FOURTH-DEGREE PERINEAL LACERATION; 66431 TRAUMA TO PERINEUM AND VULVA DURING DELIVERY, FOURTH-DEGREE PERINEAL LACERATION; 66434 TRAUMA TO PERINEUM AND VULVA DURING DELIVERY, FOURTH-DEGREE PERINEAL LACERATION

All vaginal delivery discharges with any procedure code for instrument-assisted delivery. (see source document for specific codes)

AHRQ QI - PSI 18

Data will be uploaded to HRET/CDS no later than one week after the close of the calendar quarter

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ILLINOIS

No hospital specific data will ever be sent to CMS

CMS Special: Illinois HEN State-Wide Burrito loaded with extra data and

improvement

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ADE: Data Reporting

• Currently at zero in elements 1/2/3

• Only 9% of hospitals reporting ADE metrics

• Hypoglycemia/Anticoagulation/Opioid






0 1 1 0 2 0 0 0 1 0 2 7 22


0 0.5 2 1.5 1 1.5 1.5 1.5 2 1.5 2 15 22



0 2 3 0 3 3 0 4 0 1 0 16 44

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• Manifestations of Poor Glycemic Control (ADE HAC) will still not be accepted by CMS.

• ADE continues to have the lowest data submission.

• ADE is a key target area for IHA, AHA/HRET, CMS.

• Hospitals will need to collect and report all three measures into the AHA/HRET CDS.

Aligned Measures-ADE

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• Current Top Two Most Popular Measures

• New Measure

• Focus and report on all three measures

Aligned Measures-ADE

Results: ADE

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Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Baseline

Excessive anticoagulation with warfarin - Inpatients: % of Patients With Excessive An-ticoagulation

% o

f Pati

ents

With

Exc

essiv

e An

ticoa

gula

tion

Improvement: -7.25%n=5 (7.35%)

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0 1 1 0 2 0 0 0 1 0 2 7 22


0 0.5 2 1.5 1 1.5 1.5 1.5 2 1.5 2 15 22



0 2 3 0 3 3 0 4 0 1 0 16 44

EED: Data Reporting

• Currently at 2 points (element 1), 1 point (element 2) and 3 points (element 3)

• Only 78% of hospitals reporting EED metric

• Continuous reporting is essential

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• Current Most Popular Measure

• Hospitals will need to enter data into AHA/HRET CDS for EED or provide data to IHA for upload.

Aligned Measures-EED

Results: EED

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Improvement: 74.46%n=38 (77.5%)

Nov-11

Dec-11

Feb-12

Apr-12

May-12

Jul-12Aug-12

0

1

2

3

4

5

6

7

Baseline

Elective Deliveries at >= 37 Weeks and < 39 Weeks (JC PC-1): EED rate

EED

rate

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0 1 1 0 2 0 0 0 1 0 2 7 22


0 0.5 2 1.5 1 1.5 1.5 1.5 2 1.5 2 15 22



0 2 3 0 3 3 0 4 0 1 0 16 44

Falls: Data Reporting

• Currently at 0 points (element 1), 1.5 point (element 2) and 0 points (element 3)

• Have over 80% reporting

• EOM 37 or 38 to ramp up element 2 and 3

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• Current Top Two Most Popular Measures• EOM 37 & EOM 38• Hospitals will need to collect and report at

least one measure into the AHA/HRET CDS.• IHA considers EOM-Fall-38 Falls with Injury

the priority measure. • The CMS falls HAC measure will not be

accepted by CMS.

Aligned Measures-Falls

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Measure Definition Numerator Denominator Source

Falls With or Without Injury (NSC 4)

All documented falls, with or without injury, experienced by patients

Number of patient falls, with or without injury to the patient. A patient fall is an unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury to the patient, and occurs on an eligible reporting nurse unit. All types of falls are to be included whether they result from psychological reasons (fainting) or environmental reasons (slippery floor). Include assisted falls-when a staff member attempts to minimize the impact of the fall

Patient days included populations:• Inpatients, short stay

patients, observation patients and same day surgery patients who receive care on eligible inpatient units for all or part of a day.

• Adult critical care, step-down, medical, surgical, medical-surgical combined units.

• Any age patient on an eligible reporting unit is included in the patient day count.

NQF NSC 4

Falls With Injury (Minor or Greater) (NSC 5)

All documented patient falls with an injury level of minor or greater

Total number of patient falls of injury level minor or greater (whether or not assisted by a staff member) during the calendar month

Patient days included populations: • Inpatients, short stay

patients, observation patients and same day surgery patients who receive care on eligible inpatient units for all or part of a day.

• Adult critical care, step-down, medical, surgical, medical-surgical combined, critical access and adult rehabilitation inpatient units.

• Any age patient on an eligible reporting unit is included in the patient day count.

http://www.qualityforum.org/measuredetails.aspx?actid=0&submissionId=1119#k=Falls%2520with%2520Injury&e=1&st=&sd=&s=n&so=a&p=1&mt=&cs=&ss

Aligned Measures-Falls

http://www.qualityforum.org/measuredetails.aspx?actid=0&submissionId=1119







Results: Falls

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Improvement: -44.62%n=68 (98.5%)

Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0.00

0.10

0.20

0.30

0.40

0.50

0.60

Baseline

Measure: Injuries from Falls and Trauma (MCR FFS) (CMS HAC): Rate of Injuries From Falls And Trauma (CMS HAC)

Rate

of I

njur

ies F

rom

Fal

ls An

d Tr

aum

a (C

MS

HAC)

HEN Performance 2014: Data Reporting

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• NHSN (CAUTI-CLABSI-SSI-VAE)

• We are asking that you confer “all data”

• If you have already conferred rights we ask that you go back and make sure that you have conferred all data






0 1 1 0 2 0 0 0 1 0 2 7 22


0 0.5 2 1.5 1 1.5 1.5 1.5 2 1.5 2 15 22



0 2 3 0 3 3 0 4 0 1 0 16 44

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• New Measures

• Focus and report on EOM-18, EOM-19 and utilization ratio• Strongly encourage a focus to reduce catheter insertion in the ED

Aligned Measures-CAUTI

Results: CAUTI

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Improvement: 1.51%n=68 (98%)

Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

Baseline

IL: Catheter-Associated Urinary Tract Infection: Rate of ICD-9 Diagnosis Code: 996.64 Per 1000 Patient Days

Rate

of I

CD-9

Dia

gnos

is Co

de: 9

96.6

4 Pe

r 100

0 Pa

tient

Da

ys

65


• New Measure

• Hospitals will continue to confer rights to NHSN and expand data entry beyond the ICU.

• For larger hospitals, a utilization ratio (EOM-122) is encouraged.

Aligned Measures-CLABSI

Results: CLABSI

66


Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

Baseline

IL: Vascular Catheter-Associated Infection: Rate Per 1000 Patients

Rate

Per

100

0 Pa

tient

s

67


• Expanding to more Surgical Classes through COMPdata

• Hospitals need to continue to confer rights in NHSN for two measures listed above.

Aligned Measures-SSI

Results: SSI

68


Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Baseline

: IL: Surgical Site Infection following Certain Orthopedic Procedures

IL: S

urgi

cal S

ite In

fecti

on fo

llow

ing

Cert

ain

Ort

hope

dic

Proc

edur

es

69


VAC Rate-All Units (CDC NHSN)

EOM-96a

Ventilator-Associated Condition (VAC); including those that meet the criteria for IVAC and Possible/ Probable VAP rate

Number of events that meet the criteria of VAC; including those that meet the criteria for IVAC and Possible/Probable VAP

Number of ventilator days

CDC NHSN

IVAC

EOM-96b

Infection-Related Ventilator-Associated Condition (IVAC); including those that meet the criteria for Possible/Probable VAP rate

Number of events that meet the criteria of IVAC; including those that meet the criteria for Possible/ Probable VAP

Number of ventilator days

CDC NHSN

VAP

EOM-96c

Pneumonias that are ventilator-associated

Ventilator-associated pneumonia rate (Incidence of VAP)

Number of ventilator days (collected daily)

CDC NHSN

• 6 Measures within NHSN-All Units/ICU

Aligned Measures-VAP

70


VAC Rate-All ICU Units (CDC NHSN)

Ventilator-Associated Condition (VAC) in ICU Units; including those that meet the criteria for IVAC and Possible/ Probable VAP rate

Number of events that meet the criteria of VAC in ICU Units; including those that meet the criteria for IVAC and Possible/Probable VAP

Number of ventilator days in the ICU

CDC NHSN VAE

IVAC Rate-All ICU Units (CDC NHSN)

Infection-Related Ventilator-Associated Condition (IVAC) in ICU Units; including those that meet the criteria for Possible/Probable VAP rate

Number of events that meet the criteria of IVAC in ICU Units; including those that meet the criteria for Possible/ Probable VAP


CDC NHSN VAE

Possible/Probable VAP Rate-All ICU Units (CDC NHSN)

Possible/Probable VAP in ICU Units rate

Number of events that meet the criteria of Possible/Probable VAP in ICU Units


CDC NHSN VAE

Aligned Measures-VAP

• ICU Measures

Results: VAP

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Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0.00

0.05

0.10

0.15

0.20

0.25

Baseline

IL: VAP: Rate per 1000 Patients

Rate

per

100

0 Pa

tient

s

72

1) Adverse drug events (Hospital)

2) Elimination of Early Elective Deliveries (Hospital)

3) Falls with injury (Hospital)

4) CLABSI (NHSN)

5) CAUTI (NHSN)

6) SSI (NHSN)

7) VAP (NHSN)


Results: OB Adverse Events

73


Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Baseline

OB Trauma - Vaginal Delivery with Instrument (AHRQ PSI-18): Rate of All Instrument-Assisted Vaginal Deliveries

Rate

of A

ll In

stru

men

t-As

siste

d Va

gina

l Del

iver

ies

Results: Pressure Ulcers

74

Improvement: 28.68%n=68 (98.5%)

Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

Baseline

Pressure Ulcer (MCR FFS) (CMS HAC): Rate of Patients w Hosp-Acquired PU Per 1000 Medicare DCs

Rate

of P

atien

ts w

Hos

p-Ac

quire

d PU

Per

100

0 M

edica

re D

Cs

Results: VTE

75

Improvement: 16.34%n=68 (98.5%)

Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

Nov-13

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Baseline

IL: Deep Vein Thrombosis and Pulmonary Embolism following Certain Orthopedic Procedures: % of Patients with DVT and PE Following Replacement

% o

f Pati

ents

with

DVT

and

PE

Follo

win

g R

epla

cem

ent

Results: Readmissions

76

Improvement: 4.03%n=68 (98.5%)

Sep-11

Dec-11

Apr-12

Jul-12Oct-12

Jan-13May-13

Aug-13

8

8.5

9

9.5

10

10.5

11

Baseline

Readmission within 30 days (All Cause): % of Patients Readmitted Within 30 Days of Discharge

% o

f Pati

ents

Rea

dmitt

ed W

ithin

30

Days

of D

ischa

rge

77

HEN Performance

78

Education on other topics:• These topics will not have a data reporting component, but

there will be educational events offered on the following topics:

- Sepsis - MRSA

- C-diff - Acute renal failure- Procedural harm

Expanded focus on Healthcare Disparities :• HRET will be hosting webinars focusing on

diversity, cultural competency and data collection and use

2014 Additional Topics

79

CDS Upgrades

• Upgraded CDS technology so users can access CDS with Internet Explorer 10 (and 11!), as well as Google Chrome and Mozilla Firefox

• Updated the Individual Measure and Measure Comparison reports so that drop-downs only include those hospitals, topics, and measures for which data have been submitted!

• Updated the Resource section to eliminate download issues

80

CDS Enhancements In Progress

• NEW report – Individual Measure with Trendline

• NEW report – Measure Comparison report with State & Project Median (EOM and State defined measures only)

• New Measures for core sub-topics and expanded topics

• Days Between Data Entry and Reports

• Data Submission Status Reports

81

Measure Comparison report

82

Individual Measure with Trendline

83

HEN: 2014 Commitments


2014 HEN Commitments


Anticoagulation Hypoglycemia Opiods

2. Submission of EED data3. Submission of Falls data4. Conferring Rights in NHSN (CAUTI,

CLABSI, VAP/VAE, SSI)5. PFE/Leadership Survey



3. Completion of at least 2 Site Visits4. Participation in Improvement

Leader Fellowship5. Webinar attendance

85

Data Commitments

COMMITMENT: ADE data submission

On a monthly/quarterly basis submission of:1. Excessive Anticoagulation with Warfarin –

inpatients (EOM-12); and2. Hypoglycemia in inpatients receiving insulin

(EOM-13); and3. ADEs due to opioids (EOM-111)

86

Data Commitments

COMMITMENT: EED Data Submission

On a monthly/quarterly basis submission of:1. Elective Deliveries at >=37 Weeks and <39

Weeks (JC PC 1) (EOM-40)

87

Data Commitments

COMMITMENT: Falls data submission

On a monthly/quarterly basis submission of:1. Falls With or Without Injury (NSC 4) (EOM-

37); or2. Falls With Injury (Minor or Greater) (NSC 5)

(EOM-38)

88

Data Commitments

COMMITMENT: Confer Rights in NHSN

Confer rights to AHA/HRET HEN for CAUTI, CLABSI, VAE/VAP and SSI by March 31, 2014.

89

Data Commitments

COMMITMENT: Completion of PFE/Leadership Survey

Complete the Patient and Family Engagement and Leadership Survey Questionnaire at least quarterly or as change to your systems are made.

90

Participation Commitments

COMMITMENT: Statewide Workshop Attendance

Attendance by at least 1 staff member at 3 out of 4 Illinois Statewide Workshops.

91


COMMITMENT: Submission of HAB Template

Submission of at least one HAB Template by May 1, 2014. Regular submission thereafter of updated template as reduction of harm across the board occurs.

IHA will help with the data components of the HAB templates

92


COMMITMENT: Participation in at least 2 site visits with HEN Coach and hospital teams.

Target: 1st visit March – June; 2nd visit August -November. Invite senior leadership, topic leads, front line staff, etc.

93


COMMITMENT: Improvement Leader Fellowship

Active participation by at least one fellow from each hospital (webinar participation, pre-work, sharing, etc.)

Attendance by fellows at in-person fellowship

94


COMMITMENT: Webinar Participation

Regular participation in topic specific webinars, virtual boot camps, etc.

Opportunities to present and share your story

95

Scoring System

We will be offering a limited number of places to the IHI Summit in Orlando.

To determine who will go, we are developing a scoring system based on the 2014 goals.

We want your input!

96

2014 HEN Commitments: SCORING


Anticoagulation Hypoglycemia Opioids

2. Submission of EED data3. Submission of Falls data4. Conferring Rights in NHSN (CAUTI,

CLABSI, VAP/VAE, SSI)5. PFE/Leadership Survey

TOTAL POINTS AVAILABLE: 59



3. Completion of at least 2 Site Visits4. Participation in Improvement

Leader Fellowship5. Webinar attendance


97

Data Commitments

COMMITMENT: ADE data submission

On a monthly/quarterly basis submission of:1. Excessive Anticoagulation with Warfarin –

inpatients (EOM-12); and 1 Point x 10 Months = 10 Points

2. Hypoglycemia in inpatients receiving insulin (EOM-13); and 1 Point x 10 Months = 10 Points

3. ADEs due to opioids (EOM-111) 1 Point x 10 Months = 10 Points


Data Commitments

COMMITMENT: EED Data Submission

On a monthly/quarterly basis submission of:1. Elective Deliveries at >=37 Weeks and <39

Weeks (JC PC 1) (EOM-40) 1 Point x 10 Months = 10 Points


99

Data Commitments

COMMITMENT: Falls data submission

On a monthly/quarterly basis submission of:1. Falls With or Without Injury (NSC 4) (EOM-

37); or2. Falls With Injury (Minor or Greater) (NSC 5)

(EOM-38) 1 Point x 10 Months = 10 Points


100

Data Commitments

COMMITMENT: Confer Rights in NHSN

Confer rights to AHA/HRET HEN for CAUTI, CLABSI, VAE/VAP and SSI by March 31, 2014.


101

Data Commitments

COMMITMENT: Completion of PFE/Leadership Survey

Complete the Patient and Family Engagement and Leadership Survey Questionnaire at least quarterly or as change to your systems are made. 1 Point x 4 Quarters = 4 Points


102


COMMITMENT: Statewide Workshop Attendance

Attendance by at least 1 staff member at 3 out of 4 Illinois Statewide Workshops. 3 Points per Workshop


103


COMMITMENT: Submission of HAB Template

Submission of at least one HAB Template by May 1, 2014. Regular submission thereafter of updated template as reduction of harm across the board occurs. 5 Points for first HAB + 2 Points if submitted by May 1 + 1 Point for each additional HAB submitted monthly thereafter

IHA will help with the data components of the HAB templates



COMMITMENT: Participation in at least 2 site visits with HEN Coach and hospital teams.

Target: 1st visit March – June; 2nd visit August -November. Invite senior leadership, topic leads, front line staff, etc. 5 Points per Visit


105


COMMITMENT: Improvement Leader Fellowship

Active participation by at least one fellow from each hospital (webinar participation, pre-work, sharing, etc.) 1 Point for each event x 8 events = 8 Points

Attendance by fellows at in-person fellowship 3 Points


106


COMMITMENT: Webinar Participation

Regular participation in topic specific webinars, virtual boot camps, etc. 1 Point per month x 10 months = 10 Points

Opportunities to present and share your story Bonus Points!


107

Bonus Points

There will be an opportunity to gain “bonus points” throughout the year

• Presenting on webinars/in person events• Completion of a Case Study• Others to be announced

108


Data Participation1. Submission of ADE Measures 30

Anticoagulation 10 Hypoglycemia 10 Opioids 10

2. Submission of EED data 103. Submission of Falls data 104. Conferring Rights in NHSN (CAUTI,

CLABSI, VAP/VAE, SSI) 55. PFE/Leadership Survey 4


1. Attendance at Statewide Workshops 12

2. Completion of Harm Across the Board Template(s) 16

3. Completion of at least 2 Site Visits 10

4. Participation in Improvement Leader Fellowship 11

5. Webinar attendance 10


109


Thoughts, Suggestions, Comments, Questions?

110

Leadership for a New Era:Adding Harm Across the Board to your Toolkit

Presentation to Illinois Hospital Association Partnership for Patients

February 19, 2014Jackie Conrad RN, BSN, MBS

Improvement AdvisorCynosure Health

Moving from Micro

• Many pieces• Topic related strategies & teams• Competing priorities• Silos

Many Pieces

To Macro

• Big Picture• Cross Cutting Strategies• Cultural Transformation• Unified Approach to Safety• Population Health

One vision, one goal

How do we make the shift?

Transformational Leadership

TransparencyInnovationEmpowerment

Culture of Safety

Blame freeSystems ApproachReportingLearning Environment

Story Telling

MotivateTeachChange

Leadership

Old, Traditional• Top Down• Linear• Command and control• Do more with less• Code of silence around errors• Data not shared• Risk averse, conservative• Focus on planning large scale

projects

New, Transformational• Bottom up• Dynamic• Influence and inspire• Do more with many• Learn from errors• Transparency• Creative, Innovative• Focus on small scale

execution

So How Do We Do This?

Will → Ideas → Execution

Will

Ideas

Execution

Group Exercise

Table Talk

• In your organization, where is your greatest strength – Transparency– Innovation– Empowerment

• How do you use this strength in your efforts to reduce or eliminate harm?

Culture is Key

• Bricklayer #1:• “Putting one

brick on top of another.”

Bricklayer #2

“Building a wall for the west side of a church”

Bricklayer #3“Creating a

cathedral that will stand for centuries and inspire people to do great deeds”

How do you Grow a

Culture?

BelongingSomething BIG

Meaningful Journey

“I” make a difference

What is Culture?

• Shared values about what is important• Beliefs about how things operate within the

organization• How these beliefs interact with unit and

organizational structures and systems• All of which produce behavioral norms.

Singer, HRET, 2008

What is Culture?

• These principles highlight the key interaction of– personal– interpersonal– work unit and – organizational

contributions in forming shared basic assumptions that individuals within organizations develop over time.

Let’s Simplify

WHAT IS CULTURE?

What is Culture?

“How we do things here.”

How can we change how we do things

to make care safer?

What does the Literature Tell Us?

↑ safety culture ↓ safety events

↑ teamwork ↓ falls with injury

↑ work climate (ICU’s) ↓ occupational injury

↑ safety culture (ICU’s) ↓ length of stay

↑ safety culture ↓ readmissions (AMI,HF)

What are the Key Components?

1. A just culture2. A reporting culture3. A learning culture

Story Telling

Using Harm Across the Board to tell your hospital story of Harm Reduction

ISMP Sept 2011

• “Compelling stories draw attention to problems and encourage people to act”

• “exposing humanity in stories serves as a catalyst for change”

• “story telling is a way to inspire and sustain culture change”

• “no matter how powerful the data, there is nothing more powerful than a story to motivate, teach, change”

Story Telling to Build Culture

• Data tells a story• Patient experiences tell a story

What story do you want to tell?

This?

Or This?

A new way of looking at harm data

Harm Across the Board

Q1 Q2 Q3 Q4 Q1 Q20

0.5

1

1.5

2

2.5

3

3.5

4

4.54

3

2

0

2

0

2012 2013

To

tal

Nu

mb

er o

f H

arm

s

Number of Patients Harmed per Quarter

1 SSI3 EEDs

3 EEDs

2 EEDs

1 CAUTI1 Fall

Targeting Zero Harm: From 2.25 to 2 Harms per Month (CY2012 compared to CYTD 2013)

146

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Total # of Patients Harmed per MonthBaseline Hospital Goal

Why Change?

• The idea of “all harms” or “harm across the board” helps shift organizational culture

• What Else?


• Looks at a composite of all harms• Total Harm – includes all HACs and

Readmissions• Harm Across the Board – includes all HACs,

Readmissions excluded• Harm per Discharge – uses discharges as the

denominator for all HACs

•

Improving Harm Rates (per discharge)

HACs Baseline RateCY 2011

Target Rate40/20 Goal

Current Rate1-2Q 2013

Improvement Status (scale)

ADE 0.005 0.003 0 IDEAL

CAUTI 0.005 0.003 0.003 AT TARGET

CLABSI 0 0 0 IDEAL

Falls with Injury 0.0118 0.0071 0.0032 AT TARGET

OB AE 0 0 0 IDEAL

Pr Ulcer 0 0 0 IDEAL

SSI 0.0067 0.004 0 IDEAL

VTE 0 0 0 IDEAL

EED 0.0303 0.0182 0 IDEAL

Total 0.0588 0.0353 0.0062 AT TARGET

Readmit 0.0571 0.0457 0.0421 AT TARGET

Where was the greatest opportunity during the baseline period?

What is this story?

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12

Jul-12 Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13 Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Baseline

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

0.583333333333333

Hospital

1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0

Goal

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.291666666666667

0.1

0.3

0.5

0.7

0.9

1.1

Total # of Patients Harmed per month

Tota

l # o

f Har

m

Our Hospital Risk Score CardOur Safety Mandate

Annual Volume (Discharges) 526

Total risk: annual harm opportunities 2305Risks per patients (Total Opportunities)/Discharges) 4.38

Number of Risk AreasNumber of PfP Risk Areas Applicable (0 – 11) 9Number of PfP Risk Areas Applicable & Adopted 9

Our ProgressNumber of PfP Areas with Major Improvement Opportunity 1Number of PfP Areas at Improvement Target 2Number of PfP Areas at IDEAL 6

151What is the story on this slide?

4-5 Risks for Harm per Discharge

Discussion

• STEP 1 - Get up and introduce yourself to someone you don’t know.

• STEP 2 – Interview each other to find out:– How can you use harm across the board in your

organization to tell your hospital’s story?• Who would be motivated by the information?• How can you personalize the message to promote

contemplation and reflection?• What message about your culture would HAB reporting

send to your staff, leaders and physicians?

Wrap Up, Next Steps

Contact Information

Jackie Conrad RN, BSN, MBAImprovement Advisor

Cynosure Health708-995-7788

[email protected]

mailto:[email protected]


What is the HAB Report?• The Centers for Medicare and Medicaid Services (CMS) / the National Content Developer

(NCD) introduced the Eliminating the HAB Report last year, as a Partnership for Patients (PfP) tool to understand overall harm at each hospital participating in the American Hospital Association (AHA)/Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN).

• Last year, we piloted this tool in the second half of the year at the National Quality and Safety Roadmap Meeting (in San Diego), and received over one hundred Eliminating HAB Reports.

• This year, in the spirit of quality improvement and to further our journey to make patient care safer, we are replacing the submission of monthly progress reports with monthly Eliminating HAB reports.

• The previous version of the Eliminating HAB Reports were extremely lengthy (e.g. 15 slides); we have PDSA’ed this process to the “Top 7 Key Slides” needed to understand how you are eliminating harm.

157

HAB-WIFM? Harm Across the Board-What’s in It For Me?

We strongly believe that these reports will: – Help shift your organizational culture; – Put a face on harm; – Tell a compelling story to support change; – Promote transparency; – Help you track your overall harm per discharge, which in turn will help your team see where your greatest opportunity is in eliminating harm; and – Tie all aspects of your HEN work together

158



Slide 1

Improving Harm Across the BoardInsert your Team Motto here

Insert a photo of your hospital and logo here.

Insert a photo of your Safety Team, including your CEO, here.

Insert a caption, including names for the Safety Team and CEO, here.

Insert a caption, including the name of your hospital and the city and state

where you are located, here.

160

Improvement Calculator

161

Improvement Calculator

162

Slide 2Insert a title for your “Total Harms” run chart here, e.g.

“Cut Harm Across the Board in ½”

Insert your “Total Harm per Discharge” run chart here, and update this each month. See the example run chart

below.

163

Customize the Heading

0.00000.01000.02000.03000.04000.05000.06000.07000.08000.09000.1000

Jan-

12

Feb-

12

Mar

-12

Apr-

12

May

-12

Jun-

12

Jul-1

2

Aug-

12

Sep-

12

Oct

-12

Nov

-12

Dec

-12

Jan-

13

Feb-

13

Mar

-13

Apr-

13

May

-13

Jun-

13

Jul-1

3

Aug-

13

Sep-

13

Oct

-13

Nov

-13

Dec

-13

Tota

l Har

m/D

isch

arge

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12

Jul-12

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Baseline 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09 0.09

Hospital 0.06 0.07 0.04 0.08 0.02 0.03 0.02 0.04 0.03 0.01 0.01 0.02 0.01 0.01 0.02 0.00 0.01 0.00 0.01 0.00 0.01 0.00

Goal 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04

Total Harm per Discharge

164

Slide 3Insert a title for your “Topic-specific” run chart here, e.g.“2014 Breakthrough in Reducing CAUTI: Journey to Zero”

Insert a your “Topic-specific” run chart here, and update this each month. See the example run chart below.

Customize the Heading

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Jan-

12Fe

b-12

Mar

-12

Apr-

12M

ay-1

2Ju

n-12

Jul-1

2Au

g-12

Sep-

12O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3Ap

r-13

May

-13

Jun-

13Ju

l-13

Aug-

13Se

p-13

Oct

-13

Nov

-13

Dec

-13

CAU

TI R

ate/

1,00

0 Ca

thet

er D

ays

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12

Jul-12

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Baseline 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100. 100.

Hospital 105. 66.6 33.3 100. 83.3 45.4 0.00 0.00 52.6 0.00 0.00 52.6 0.00 0.00 52.6 0.00 52.6 0.00 0.00 0.00 0.00 0.00

Goal 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0 60.0

Catheter Associated Urinary Tract Infections

Slide 4Risk Profile: The Areas of Risk We Are Committed To Controlling

Annual discharges: __________HAC risk opportunities/discharge: _______

HACs Estimated annual number of patients at risk in each area Number of Opportunities

ADE # of discharges:

CAUTI # pts in IP units with catheter in place:

CLABSI # pts in IP units with central lines:

Falls # of discharges:

Ob AE # of women with deliveries:

Pr Ulcer # of discharges:

SSI # of inpatient surgeries:

VAP # of patients on a ventilator:

VTE # of discharges:

EED # of women with elective deliveries

TOTAL Risk opportunities for harm across the board

Readmit # of inpatients at risk of readmit:

Slide 5

Improving Harm Rates (/ Discharge)

HACs Baseline Rate[time period]

Target Rate Current Rate[time period – last 3 months]

Improvement Status (scale)

ADE

CAUTI

CLABSI

EED

OB

Falls

PU

SSI

VAP

VAE

Total

Readmissions

Insert a your harm rates per discharge here, using the following table. For non-applicable topics – please insert “Z”.

166

Our Hospital Risk Score Card

Our Safety Mandate

Annual Volume (Discharges)

Total risk: annual harm opportunities

Risks per patients (Total Opportunities)/Discharges)

Number of Risk Areas

Number of PfP Risk Areas Applicable (0 – 11)

Number of PfP Risk Areas Applicable & Adopted

Our Progress

Number of PfP Areas with Major Improvement Opportunity

Number of PfP Areas at Improvement Target

Number of PfP Areas at IDEAL167

Insert your hospital risk score card here, using the following table.

Slide 6

Pearls

• Bullet your biggest insights about what worked, and what caused it to work here.

• Include what you “tested” and “learned”• Include how you will advance this topic over the

next month (and beyond). • List the most important drivers of safety that

produced these results, but make this list succinct, high-level and clear.

• Include patient and family engagement (PFE), if relevant.

168

Slide 7



170

The Improvement Leader Fellowship

Fellows Across the Country

January 3, 2014 ILF Map

143 in IL!

Framing the Fellowship in 2014

ILF Overarching Aim:In support of the Partnership for Patients aim of making care safer for patients in US hospitals, the ILF will build skills in improvement in SHA and HEN hospital leaders through continuous learning and coaching on improvement methods and tools as applied to the Partnership for Patients content areas.

Goals:

– 1,000: HAB templates completed– 2,000 Actively Participating Fellows – 1,200 Open school modules completed– 60 Hospital Story Sharing

Delivering the Fellowship

In-Person Regional Meetings

– 22 meetings March through November– On site meetings specifically designed to combine

clinical knowledge with improvement techniquesMonthly Live Streamed Meetings

– Fellowship Topics: 1:00 – 3:00 PM CST every third or fourth Wednesday of the month

In-Person Regional Meetings

Promote shared discussion and learningAll Fellows in one room

– Didactic– Hospital story sharing– Coaching

Half-day sessions:– Topic Specific Mini Collaborative: led by

Cynosure IA– Fellowship Topic: led by IHI faculty

Monthly Live Streamed MeetingsWednesday 1:00 – 3:00 pm CST every third or

fourth week of the monthUtilize the in-person audience and discussion

First Meeting: March 19, 2014 Live Streamed from Colorado

Tracking & Evaluating Participation

Attendance– 1 in-person meeting– 8 out of 10 virtual meetings

Commitment to the Program (endorsed by Sr. Leader at their organization) managed by the SHA

HAB completionPre-work assignmentsSpecific requirements for each Fellowship Level

– Open School module completion

Who’s Who?

Junior Fellows:– New hospital to HEN– New to quality improvement– No previous participation in ILF

Senior Fellows:– Previous participation in Track 1 or 2– Working on 1-2 improvement projects– Strong understanding of science of improvement

Champion Fellows:– Previous participation in Track 2– Leading 1-2 improvement projects– Deep understanding of science of improvement

Updated Resources

• HAB Templates• White board videos• IHI Open School• Topic LISTSERVs• In-person and virtual meetings

Questions for Discussion

What Fellowship topics are the most valuable to your hospitals?

Rate your Fellows – would you consider yourself a junior/senior/champion fellow?

Open Forum

Documents

Introduction to the Hospital Engagement Network (HEN) February 21, 2014 Sara Bader and Adam Kohlrus