2012 Nursing and Physician Leadership Congress

2012 Session Presentations

The Patient as an Active Partner. Seriously?

Dave deBronkart, aka e-Patient Dave

Known online as "e-Patient Dave," Dave deBronkart became a leading spokesperson for engaging patients after being diagnosed in 2007 with Stage IV kidney cancer - and surviving. He counsels consumers and clinicians alike to embrace the e-Patient movement, which teaches patients how to be Empowered, Engaged, Equipped and Enabled. "When you get sick, one of the things that limits the ability to create value for yourself is access to information. The Internet changed that. Because of the Web, patients can now connect with physicians and each other in unprecedented ways."

Bending the Curve: The Policy Challenge Ahead

Wendy Everett, ScD, President, New England Healthcare Institute

The New England Healthcare Institute (NEHI) brings together providers, payers, patients, manufacturers and other groups to recommend policies and bring about change on issues that affect everyone. Its current challenge is how to fix a system plagued by $700 billion in waste, including $500 billion attributed to overuse and unexplained practice variation. When healthcare costs consume the largest portion of a state budget, education and other public services suffer. NEHI president Wendy Everett, ScD, shares her moving personal story to illustrate how inefficiency and waste can add up in the course of a single patient's care.

The Road to Clinical Transformation

John R. Combes, MD, Senior Vice President, American Hospital Association

Providers are better paid today than they'll ever be paid in the future. The time is ripe to engage physicians as they reexamine their roles in light of the changing landscape. It's not about the number of physicians you have but the number of engaged physicians. It's not about the cost of an individual inpatient episode but the cost of caring for an entire population. With mounting performance metrics, the case for providing equitable care is strong. If you cannot eliminate variation, you'll never reach the top quartile.

To prepare for health reform, providers must be able to answer these questions: How do we currently perform? Do we have the right people engaged? What level of care are we vulnerable for, and how can we transition our care models to respond innovatively? How do we build the infrastructure to support bundled payments and the trust to allocate reimbursement fairly?

Innovative Strategies to Transform Care

Mary Martin, RN, MBA, Chief Nursing Informatics Officer, Northeast Georgia Medical Center; Patti McCue, Sc.D., RN, MSN, NEA-BC, Senior Vice President for Patient Care Services and Chief Nursing Officer, Centra Health; and Matthew Hanley, MD, CPE, FACEP, FAAEM, Vice President of Medical Affairs, Centra Health.

Patti McCue and Matthew Hanley: In order to sustain the many quality initiatives required under health reform, recently Centra Health replaced its medical silos with 13 operational service lines that reflect how clinicians actually work. When Dr. Hanley joined the organization a year ago and was charged with heading up the quality and safety program, his first directive surprised clinical leaders: "Pick a project that you think will improve quality and do it." His reasoning? He was new to the organization, and many of the executives had more experience than he did. Leaders often know exactly what their staff needs to work on.

Aided by Six Sigma black belts and process engineers, the teams achieved impressive results in one year. These included shaving 30 minutes off of the ED-admit-order to ICU-admit time and reducing unnecessary tests for suspected pulmonary embolism in the ED. "You don't have to develop a point-to-point protocol for every diagnosis or complaint, just agree on a few consensus points and get started."

Mary Martin: While leading a cross-functional team charged with improving throughput in 2010, I realized that one of the team's top IT recommendations had already been implemented two years earlier: an electronic tracking board that uses visual icons to provide real-time patient status at a glance. However, the technology was being underutilized as a patient placement tool, with no clinician adoption. A 90-day rapid optimization project involved creating a governance process to identify the 60 most meaningful icons to display and training 2,600 users. As a result, nurses have recouped an estimated hour of productivity per shift and share a heightened awareness of patient status across their unit. Lessons learned? When rolling out new technology, be sure to ask, "How does it play in the sandbox with everything else?"

Collaborative Behaviors to Drive Change

Kevin O'Connor, ACPE faculty member; Bobbi Farber, MD, Chief Medical Officer, St. Francis Hospital

Kevin O'Connor: Transforming healthcare requires new approaches in every dimension, including interpersonal dynamics. At 211° water gets very hot. At 212° it can produce steam and fuel a locomotive. I encourage the physician executives and business leaders I coach to ask themselves, "What's the one extra degree I need to create steam when I collaborate with others?" Successful collaboration involves more listening and less telling. To quote Earl Nightingale, "Cooperation isn't getting people to do what you want them to do. It's getting them to want to do what you want them to do."

Bobbi Farber: In 2009, St. Francis Hospital experienced five surgical sentinel events. Most of the events resulted from highly variable behaviors, and two related to surgeon intimidation. To right the ship, a team from LifeWings Partners, experts in patient safety and crew resource management (CRM), was engaged to observe several surgeries, conduct an assessment and provide CRM training. Among the key findings: staff had no shared mental model that put everyone on the same page before incision.

A two-day leadership class attended by the chief of every section was followed by four-hour team skills training for every staff surgeon, member of the surgical team and even central supply. Two years later, there was just one surgical sentinel event, and staff were much more willing to speak up to prevent an incident.

Using Data to Improve Care

Skip Valusek, CPHQ, Director, Clinical Analytics, HealthEast Care System; Evon Holladay, MBA, Vice President, Business Intelligence, Catholic Health Initiatives

Evon Holladay: CHI is a large, diverse organization with 46 market-based entities, including about 400 physician offices nationwide. Aggregating that data at the enterprise level is extremely challenging. It's easy to put data in a blender, push the button and push the results back out, but what you'll hear is, "This isn't right." The focus must be on meaningful data. That's especially difficult with clinical data, which still lacks standard definitions that everyone can agree on. Start the dialog early so all stakeholders understand the data and embrace it.

Skip Valusek: As an industrial engineer with a military intelligence background, I have two observations: (1) It's a great time to be an industrial engineer in healthcare and (2) We are not re-engineering healthcare; we are engineering it for the first time. As long as we hold onto the belief that healthcare is full of special considerations, we will never get to standard definitions that allow meaningful measurement and analysis.

Start by establishing a metric clearinghouse owned by an expert who knows how to define measures and use them. Next, know who your "reporters" are, the people pulling data from various systems. Do they know how to extract, transform and load? Finally, who are your analysts? Are they mining the data and applying it? If you can't afford a full-time analytics guru, don't hesitate to tap industry resources like your state hospital organization or the Institute for Healthcare Improvement. Or find an industrial engineer. Change begins with one passionate person.

Lessons from Early Achievers of Meaningful Use

Brenda Tiefenthaler, CNO, Spencer Hospital; Shari Schneider, VP, IT Services, Lutheran Health Network

Brenda Tiefenthaler: We don't employ any physicians, and many of our medical staff are starting to think about retirement, so we knew physician adoption would be a challenge. I identified three physician champions and paid them for their time. One of the three was our most negative and vocal physician; it's important to keep your enemies close. When I didn't think we were getting the adoption we needed, we started posting scores in the physician lounge. It was amazing to see the bottom performers move all the way to the top. Physicians are competitive.

To support your nurses, be sure to dedicate resources on all shifts for at least two weeks. Both nurses and physicians must have ready access to enough devices so no one gets booted off.

Shari Schneider: We used to call our physician advisors the "bomb dropping committee" because they viewed their role as telling us what they didn't like and to fix it. Over time, they came to understand that we shared these issues. Today they own clinical content review and standardized order sets. To support physicians, we created a 24/7 multidisciplinary clinical IT help desk that takes about 500 calls a month. We also created a superuser program called CHAMPS, which stands for Computer Helpers And Multiple Problem Solvers. Most of them are staff nurses and this is part of their clinical ladder, so they are committed.

By operationalizing so many meaningful use-related processes across our facilities, we've been able to sustain 90% compliance with key objectives and CPOE adoption above 70%. The key has been making it easier to deliver care the same way at every facility, for every patient.

2009 General Session Presentations

• Welcome and Introduction
• The Patient Safety Plan
• Leadership Panel
• Pearls to Implement
• Push for Healthcare Policy
• Innovation Panel

2008 General Session Presentations

• Welcome and Introduction—Driving Patient Safety Through Transformation
• Keynote: Transformational Leadership—Achieving the Tipping Point
• Health Policy Roundtable
• Case Study: Using the Baldrige Business Model as the Infrastructure for Creating a Culture of Patient Safety
• Panel: Innovative Solutions for Patient Safety