Regional Healthcare Initiative March 2001 PRHI Executive Summary

The Pittsburgh Regional Healthcare Initiative is a collaborative effort of the institutions and individuals that provide, purchase, insure and support health care services in Southwestern . We help our members work together to: Achieve the world’s best patient outcomes …Through superior health system performance . . . By identifying and solving problems at the point of patient care. We believe the major challenges in health care—rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care—share the same cause, and will share the same solution.

and Evaluation Branch, Teresa Horan, M.P.H., Chief, IOM report reinforces Performance Measurement Section, Juan Alonso, M.D. PRHI goals and John Jernigan, M.D., Medical Epidemiologists. The National Academy of Science’s Institute of Medicine (IOM) released a new report on March 1 urging the type of RWJF patient care grant healthcare redesign already under way at PRHI. Entitled The Robert Wood Johnson Foundation (RWJF) has issued Crossing the Quality Chasm: A New Health Care System its request for proposals for its $20.9 million grant pro- st for the 21 Century, (available online at www.nas.edu), gram Pursuing Perfection: Raising the Bar for Health Care the report is a follow-up to the November 1999 report, To Performance. RWJ will award up to $50,000 in planning Err is Human: Building a Safer Health System. grants to 12 sites and, from that group, up to $3.5 million “We’re delighted that the IOM report reinforces our con- over two years for up to six sites that make a commitment victions,” said Karen Wolk Feinstein, PRHI Chair. “The to achieving nearly perfect patient care in all of their ma- challenges facing health care are all symptoms of the jor care processes, and can show that they will make same root problem: we aren’t fosed on getting things right substantial progress in at least two major care processes at the point of patient care.” over two years.

RWJ leaders stated publicly that this program was in- Local press coverage stressed PRHI’s collaboration among spired and shaped by their site visit last summer with the region’s healthcare organizations in pursuit of these PRHI partners. patient safety goals: (1) eliminating medication error and nosocomial infections; (2) achieving the world’s best pa- For information: www.rwjf.org. Due Date: April 16. tient outcomes; and (3) experimenting with the principles Please notify Ken Segel, PRHI Director ([email protected] or of the Toyota Production System (TPS) in health care. 412.594.2558) if you plan to apply so we can provide you with supporting language. New CDC partnership NIMH conference in Pittsburgh February 21-22 saw a visit by five leaders of the Centers Pittsburgh is the site March 24 - 26, for the National In- for Disease Control and Prevention in Atlanta. CDC stitute of Mental Health’s (NIMH) national conference, members trained participating hospitals in the use of its entitled The Unwanted Co-traveler: Depression’s Toll on state-of-the-art tracking system for infections. If your Other Illnesses. Depression is the #1 cause of disability infection control staff missed the training, contact Ed worldwide. Harrison at 412.594-2584. On Sunday, March 25, the Jewish Healthcare Founda- Impressed by PRHI’s model, CDC has not only opened tion, in conjunction with the , its bloodstream infection tracking database to all PRHI will lead a forum at the History Center where key signatories, but has suggested on expanded partnership scientists, insurers, and national policymakers will dis- among all PRHI project areas. Visiting CDC leaders cuss the largest health cost of all—lack of access to care. were: Steve Solomon, M.D., Chief, Healthcare Out- comes Branch, Denise Cardo, M.D., Chief, Prevention Conference regist’n: www.nimh.nih.gov/events/pittsburgh. PAGE 2 PRHI EXECUTIVE SUMMARY MARCH 2001 Center for Shared Patient Safety Programs Learning Vickie Pisowicz Ed Harrison Director, CSL Director, Patient Safety 412.594.2589 412.594.2584 [email protected] [email protected]

The mission of PRHI’s Center for Shared Learning (CSL) is to PRHI partners are working collaboratively to eliminate two support the testing and implementation of a system-based major patient safety concerns: healthcare-acquired infections approach to healthcare management, drawn from the Toyota and medication errors. Production System (TPS) and Business System.

PRHI’s patient safety programs—nosocomial infec- Our primary goal at the Center for Shared Learning tions and medication errors—are pursuing two major (CSL) is to support the experimentation of Toyota Pro- activities: shared learning platforms (reporting sys- duction System principles in a healthcare environment. tems) and interventions based on information de- Currently, there are two such learning lines under way: rived from them. one at UPMC Presbyterian and one at UPMC South Side. Nosocomial Infections The Center has also developed an information session for • PRHI has formalized a working partnership with those people in the community who would like to learn Atlanta’s Centers for Disease Control and Pre- more about: vention (CDC) to establish a region-wide nosoco- • Toyota Production System principles mial infection reporting system. The CDC has gen- • the work currently under way at the two learning lines erously agreed to manage initial data entry and analysis. • the future plans of the Center for Shared Learning.

These information sessions take place twice a month on Initial data collection will target Blood Stream In- Tuesday evenings (April 10, and April 24.) If you would fections (BSIs) on intensive care units. This start- like to attend one, please contact Tony Kelly at 412-594- ing point affords several advantages: 2567. √ Area facilities already collect BSI data. √ BSI frequency is low, minimizing required re- sources. Calendar at a glance, April 2001* √ Reducing BSIs presents real clinical and finan- cial opportunity.

√ Best practices for BSIs are well defined and ac- Tony Kelly, PRHI Administrative Coordinator, 412.594-2567 cepted. [email protected] Once a BSI reporting structure is established, the effort should expand rapidly to include areas such April 2 12-1:30 p PRHI Co-chairs as anti-microbial resistance and wound site infec- 2-3:30 p Patient Safety Executive Committee tions.

April 3 8 a-12 p Nosocomial Infection Work Group As noted on page 1, if you are a PRHI signatory, April 10 3-4:30 p Adverse Drug Effect Advisory Cmte. please contact Ed Harrison (412.594-2584, if your 6-9 p CSL Information Session, call Tony infection control staff missed the February 21-22 to reserve your space. training by the CDC.

April 19 2:30-4 p Buying Healthcare Value 4-6:30 p Clinical Advisory Committee Adverse Drug Events/Medication Errors (Location for these meetings TBA—call Tony ) • PRHI evaluated programs for recording, classify- ing, and evaluating information on medication er- April 24 6-9 p CSL Information Session, call Tony rors, and selected MedMARx, developed and mar- to reserve your space. keted by U.S. Pharmacopeia (USP). Nine area hos-

pitals are already starting MedMarx data collec-

tion. Others have requested an automated means

of transferring data from current systems, and

USP has offered to help.

* all meetings held at PRHI offices unless otherwise noted. MARCH 2001 PRHI EXECUTIVE SUMMARY PAGE 3 Clinical Initiatives PRHI Partner Spotlight

Jon Lloyd, M.D. Geoff Webster PRHI Medical Advisor PRHI Co-Director 412.594.2566 [email protected] 412.456.0973 [email protected]

Southwestern Pennsylvania seeks to achieve the best patient Each month this column will list one segment of PRHI’s net- outcomes of any community in the world. PRHI has established work of partners. This month we feature the original members a partnership among clinicians, businesses, hospitals and insur- of the CEO Working Group, corporate executivves who have ers to achieve those goals in five pilot areas by (1) constructing pledged to provide special support to PRHI health care outcome data sets trusted by those who provide care and (2) partners in exchange for progress on PRHI quality goals. supporting collaborative efforts to improve care. Paul O’Neill, Founding Co-chair Martin G. McGuinn, Corp. • The Depression Subcommittee, coupled with spe- Edward A. Nicholson, Robert Morris College cialty focus groups, has engaged a variety of physicians Thomas A. Corcoran, who treat depression to deliver a report in April. This Thomas H. O’Brien, PNC fourth of five reports will include utilization informa- Raymond W. LeBoeuf, PPG tion as well as HEDIS data on chronic disease manage- William R. Johnson, H.J. Heinz Co. ment, inpatient measures of readmission, and Electro Peter J. Kalis, Kirkpatrick & Lockhart Convulsive Therapy. If you’d like to be involved, please George A. Davidson, Jr., Dominion Resources call Geoff Webster at the number listed above. J. Christopher Donahue, Federated David D. Marshall, Duquesne Light Co. • Some 27 clinicians and data analysts from competing William Strickland, Bidwell Training Center institutions as distant as DuBois braved snow and a Helge H. Wehmeier, Bayer Corporation power failure—using candles and flashlights for the Dr. Jarod Cohon, Carnegie Mellon University entire meeting—to participate in March’s Cardiovas- Lawrence M. Wagner, The Hillman Company cular Work Group. The group is poised to develop Sunil Wadhwani, IGate Capital Corporation standard data on many of the elements needed to un- John Ryan III, Mine Safety Appliances Co. derstand and reduce mortality and atrial fibrillation Maxwell King, The Heinz Endowments following coronary bypass. Participating hospitals will James S. Broadhurst, Eat’n’Park submit the data to an independent data registry for Alain J. P. Belda, Alcoa analysis and identification of the processes of care that David S. Shapira, achieve optimal results. Information will be shared James E. Rohr, PNC three times a year at a Cardiac Forum. The purpose of Thomas J. Usher, USX George E. Miles, WQED this initiative is simple and unambiguous: to share im- Sean McDonald, McKesson HBOC provement information with an eye toward perfecting William S. Dietrich II, Dietrich Industries the care of patients with heart disease in Southwestern Roy Haley, Wesco Pennsylvania. Dr. John E. Murray, Jr., Duquesne University • Leaders of the Clinical Advisory Committee are de- Daniel J. Sullivan, FedEx Ground signing ways to engage the energy of the group in insti- Murry S. Gerber, Equitable Resources tutional improvements, like the cardiac project de- Thomas W. Golonski, National City scribed above, through reporting and support. Vickie Milton A. Washington, AHRCO Ellsworth Brown, Carnegie Museums of Pittsburgh Pisowicz of the Center for Shared Learning will be in- Fred Ishii, Sony Electronics volved in this design to use TPS principles in the devel- Esther L. Barrazzone, Chatham College opment of learning lines that touch the selected clinical Mark A. Nordenberg, University of Pittsburgh areas. Michael Watson, Foundation Stephen C. Hansen, Lenora M. Vesio, AT&T Other contact information

Karen Wolk Feinstein, PRHI Chair 412.594-2555 PRHI Executive Summary is a monthly bulletin highlighting the Leadership Obligation Group Chair [email protected] Initiative’s most recent activities. Direct inquiries to: Ken Segel, PRHI Director 412.594-2558 Naida Grunden, PRHI Communications Director, [email protected] 412.594-2572, [email protected]. PAGE 4 PRHI EXECUTIVE SUMMARY MARCH 2001 Progress Report

Each edition of PRHI Executive Summary will feature a snapshot of our progress on a single initiative. More detailed versions of this track- ing scorecard are available to PRHI partners by e-mailing Tony Kelly, [email protected]

National Noso- Blood Stream Next category Adopt BSI Adopt best Reporting Nosocomial Nosocomial comial Infec- Infection infection imple- best practices, perform- Advisory Infection work tions Surveil- (BSI) imple- mentation practices next ance, tar- Committee group particip lance System mentation category get 100% (NNIS) training

PRHI Partners Feb 01 April 01 Sept 01 May 01 Oct 01 Quarterly May 1 Ongoing

Butler Memorial Hospital Children’s Hospital of Pittsburgh Heritage Valley Health Systems, Inc. Latrobe Area Hospital

Monongahela Valley Hospital, Inc. Ohio Valley General Hospital Pittsburgh Mercy Health System South Hills Health System St. Clair Memorial Hospital St. Francis Health System UPMC Health System

West Penn Allegheny Health System Westmoreland Health System Leadership Obligation Group

Chair • Karen Wolk Feinstein, Ph.D.

Committee Co-chairs Patient Safety • Mark Laskow, CEO, Greycourt & Co. Inc. • James McHugh, President, Saint-Gobain Advanced Ceramics

Clinical Advisory Committee • Marlene Garone, M.D., V.P., Operations, Western Pennsylvania Hospital • Carl Sirio, M.D., Associate Professor, University of Pittsburgh Medical Center

Buying Healthcare Value • Cliff Shannon, President, SMC Business Councils