Strengthening relationships between patients and their care teams to foster

safety

Recommendations for MAPS Action & Next Steps

2

Background

• Patient/Provider relationships & Patient/Family engagement is clearly a safety issue and MAPS priority

• There is an increasing wealth of information, activity & tools

• MAPS previous grant work supports this area– Patients are willing to be engaged but need

specific, actionable steps and information • At Feb. & May Board meeting, several options

considered

3

Next Steps

• Charter a high-level steering committee– See accompanying draft charter

Action Plan1. Synthesize existing tools and best practices across

all settingsa. Develop simple tool for providers = Provider

Guidebook including “gap analysis” toolb. Include legal guidance for including patients and

families inside organizations

2. Develop patient family guidebook for those asked to serve on committees and advise organizations

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Next Steps

3. Host community-wide educational event(s) to establish base of understanding, common priorities & focus (similar to MAPS role in Culture change work)

– Roll out provider and patient “guidebooks” at these events

4. Establish Community-wide Patient/Resident/ Family Advisory Council across settings of care

• Scope & speed of action plan implementation influenced by:– HEN 2.0 grant or other additional funding– Ability to retain project manager & other resources

5

“It is far more important to know what sort of person has a disease than to know what sort of disease a person has.” -Hippocrates

Convening and aligning the community around shared goals for safety &

quality

MAPS Strategic Priority UpdateMay 14, 2015

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Background

• How do we align as a community? What are the leverage points for alignment?

• Measures & reporting matter – help us set priorities and focus our work

• Timing opportunity – AHE 10 year, SQRMS committee work, SIM grant, measure fatigue, IOM report 4/28/15

8

Background

• AHE– Implemented in 2003. First in the nation public report

by hospitals– Tremendous progress in reporting system infrastructure,

event & risk identification, RCA process improvement, CULTURE CHANGE, public understanding

– Misses large parts of the health care system – Hospitals & ASC only

– Measures only small numbers of very rare events, hard to determine trends or track improvement

– Have we plateaued? Are we tracking the most serious risks harming patients?

9

Background

• SQRMS– Implemented in 2008. Groundbreaking reporting system

with huge change in system transparency – Significant public/private collaboration– Started with things that could be measured, not

necessarily the most important things to measure – Desire to minimize reporting burden has resulted in a

process that largely endorses CMS measures (for PPS hospitals)

– Safety rose to the top as a hospital committee priority, a new approach was suggested, an index or composite

– Misses large parts of the health care system & provider types

10

Background

• Environment has evolved significantly since the inception of both systems

• Measures have proliferated at an increasing rate creating “measurement fatigue”

• Stakeholders find it difficult to prioritize measures, and more importantly, the improvement work

• Multiple reports and requirements lead to confusion & lack of focus for provider, payers, patients and public health

• As if they were sitting in on our preliminary conversations, IOM report…

Vital Signs: Core Metrics for Health and Health Care Progress

IOM (Institute of Medicine). 2015. Vital signs: Core metrics for health and health care progress. Washington, DC: The National Academies Press.

www/iom.edu/vitalsigns

The committee reached a number of important conclusions in developing these measures, including: • Current measurement is problematic, inefficient &

redundant - $3.5 - $12 mill per yr.• Measurement is not an end “but rather is a means to

accomplishing health goals.”• The process of reaching agreement as important as

the technical specifications – broad-based, community input

• Composite measures are needed in certain areas, like healthy communities and patient safety.

• Although core measure sets may differ depending on the setting—for instance, a state agency versus a group of cardiologists—all sets should be aligned toward common goals.

12

Vital Signs Report

• Committee uses a 4 domain framework to identify measures most reflective of: Overall health status Care quality Costs of care for individuals and

populations Engagement and experience of

people

• Set of 15 standardized measures

13

14

Next Steps

• Work with a broad-based stakeholder group to:– better understand Minnesota’s issues – address problems, and – work toward alignment

• Role for MAPS?

Possible New Approaches to MAPS Staffing & Support

MAPS May 14, 2015

16

Background & Problem

• Small organization with limited resources, but a need for multiple areas of expertise:– Subject matter expertise (Quality & Safety)– Administrative (including space, IT, mail, phone)– Communications– Web– Program & project management– Membership – Events – Board & Committee support– Accounting & Finance

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Background & Problem

• No one person with skills in all of these areas• MAPS can (and does) purchase several services from

the MMJSO– MMJSO is very capable and delivers excellent, timely,

friendly service– But… We often don’t know what we don’t know– Missing the proactive problem solving and best practices

• MAPS projects & funding can be short term and focused (work flow can vary significantly)

• MAPS completely reliant on two people – vulnerable to significant disruption with any staffing changes

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Potential Options

1. Status Quo2. Status Quo + purchasing/hiring individual

services as needed. 3. Outsourcing through Association

Management Company (AMC)4. Partnering with other, related small not for

profit organizations

Board Composition & Strategic Partner Recommendations

MAPS Board of Directors May, 2015

20

Background

• Currently 12 directors• By-Laws permit up to 15 directors• “Founding Partners” – MMIC, Stratis, MDH, MHA &

MMA- by-laws specified board seats • In 2013 additional board representation identified

& sought – Nursing & Purchaser • In November 2013, Board Approved new

membership proposal -“Strategic Partner” was created

• DHS & MNA added as Board members & Strategic Partners in 2014

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Membership Level: Strategic Partner

• Strategic Partners added (all also represented on the board):• Leading Age• M Health• CareProviders of Minnesota• Department of Human Services• Minnesota Nurses Association• Mayo

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Governance Committee Considered:

• Should MAPS continue to add Directors and/or Strategic Partners?– Thus far Board seats and Strategic Partnerships have

been linked• Criteria for Board Expansion? For Strategic

Partnership?1. Help MAPS achieve strategic priorities2. Increase diversity of MAPS3. History of engagement with and support for MAPS4. Opportunity for larger health systems to consolidate

multi organization memberships

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Governance Committee Recommendations

1. In the future, add Strategic Partners that are not necessarily on the Board. “un-link”– Develop specific benefits for Strategic Partners

including, but not limited to, committee chairs, inclusion in annual strategy development, additional tactical development, more…

2. Increased diversity should be a top priority for Board expansion

– Patients/residents/consumers should be a top priority

– Consider needed expertise (e.g. marketing, business owner, community leader, etc.)