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Patient Safety First
In the first part of this two-part series, ABILITY Magazine examined a unique collaboration among Anthem Blue Cross, California’s hospital associations, and the National Health Foundation (NHF). This alliance, called the Patient Safety First partnership, involves a three-year effort in the following areas:

1. Perinatal Care: Reduction of elective deliveries prior to 39 weeks

2. Sepsis: Reduction of incidence and morbidity

3. Hospital-Acquired Infections in the Intensive Care Unit (ICU): Reduction of instances of ventilator-associated pneumonia (VAP), central line bloodstream infections (CLBSI), and catheter-associated urinary tract infections (CAUTI).

Our first article focused on Anthem Blue Cross, its role in forming this unique partnership, and its commitment to saving lives while reducing health care costs for Californians.

In part two, ABILITY’s Lauren Becker interviews the other integral players in this collaboration: Art Sponseller, President and CEO of the Hospital Council of Northern and Central California; Gene Grigsby, President of NHF; Leslie Kowalewski, Associate State Director, California Chapter and Director, Big 5 State Prematurity Initiatives for March of Dimes (MOD); and Joanna Horsfall, an independent consultant tasked by Anthem with providing direction, oversight and coordination to the effort.

This article examines the contributions of each of these individuals in forwarding the goals of the initiative. It also investigates the coordination of efforts toward the project’s success and its implications on the future.

The California Hospital Associations: Putting Patients First

California’s hospital associations include the Hospital Council of Northern and Central California, the Hospital Association of San Diego and Imperial Counties, and the Hospital Association of Southern California. The not-for-profit regional trade associations represent 95% of all hospitals in the state. Their mission is to serve the political, economic, informational and educational needs of their member hospitals, and to improve the quality and accessibility of health care services in an effort to create healthier communities.

The Hospital Council of Northern and Central California is the lead organization for the initiative’s three regional associations. In the following interview, Art Sponseller, President and CEO of the Council, describes the initiative from the perspective of hospital associations, and discusses their roles and expectations.

Lauren Becker: What prompted this collaboration?

Art Sponseller: In 2005, the Hospital Council, with funding from the Gordon and Betty Moore Foundation, and clinical leadership from Dr. Bruce Spurlock of Convergence Health Consulting, established the first large scale, hospital-based patient safety collaborative in the San Francisco Bay Area. Our initial focus was on the 100,000 Lives Campaign, a nationwide initiative to significantly reduce morbidity and mortality in American health care. Subsequently, a similar effort was established in Southern California. From day one, we had a vision that every hospital in California could participate in this initiative, and our real challenge was a matter of funding.

In 2008, we began discussions with Anthem Blue Cross about a partnership in which they would provide funding and public outreach to expand our collaborative activities so that our vision of all California hospitals participating could be achieved. That vision was realized in Patient Safety First…a California Partnership for Health, which was launched in January of 2010. Blue Cross envisioned that the state’s largest health insurer and the hospitals of California could come together in a unique and unprecedented way to save lives, and this led to the creation of the collaborative.

Becker: Why did the hospital associations decide to collaborate with these particular partners?

Sponseller: I know some of your readers are asking this question with skepticism. Hospitals and health plans are strange bedfellows, sure, but they really don’t need to be that way. In essence, we share a common hope and vision: we both want to save lives. So, realistically, this is a natural fit. Getting this initiative started under this collaborative model is the right thing at the right time.

Our partnership builds upon established peer-to-peer learning networks like the Bay Area Patient Safety Collaborative (BEACON) and the Southern California Patient Safety Collaborative. It also compliments the work of the March of Dimes, zeroing in on the area of perinatal care, and on issues of prematurity and education about why the last weeks of pregnancy can be critical to the health of the mother and baby.

Becker: Why did you feel this union presented a good opportunity for the hospitals?

Sponseller: We have found great success in the collaborative model. Our BEACON Collaborative in the Bay Area has had great results, with tremendous participation and enthusiasm. BEACON has accelerated the adoption of evidence-based and innovative practices, and has created a learning network among organizations who share a commitment to building healthier communities. The collaborative has also educated organizations about the importance of the initiative’s work.

Through quarter four of 2009, an estimated 1,593 lives have been saved: 375 from ventilator-associated pneumonia (VAP), 219 from central line blood stream infections (CLBSI), and 999 from sepsis. There have been 2,388 fewer hospital acquired infections: 941 from VAP and 1222 from CLBSI, and 463 fewer patients acquired pressure ulcers while hospitalized. What we’re doing is important work that ultimately translates to people being able to be up and walking around, people who three years ago would have died.

A number of hospitals in inland counties within our membership had previously expressed interest in creating similar collaborations in their areas. This project was a natural vehicle to use to facilitate this important work.

Becker: What is the role of the hospital associations in the partnership?

Sponseller: Our role as a member association is to convene our hospitals to discuss ways of improving patient safety in the areas defined by this initiative. We bring together hospitals in regions throughout Northern California to share best practices and to focus on measures that will assure improvements in areas targeted by the initiative. We provide a neutral ground on which hospitals can discuss their concerns and questions openly, without divulging proprietary details of their operations. The best practices highlighted by member hospitals can then be used by other hospitals. Our motto in these collaboratives is, “steal shamelessly.” It really works!

Becker: Did you seek approval from your membership prior to engaging in the collaboration? What was the general feeling toward the effort?

Sponseller: We always brief our hospital leadership teams about initiatives such as this one to get their counsel and support. Nearly all of our hospitals have patient safety measures underway to minimize errors. We were somewhat concerned about introducing another patient safety initiative because hospitals were already engaged in their own processes. The hospitals were particularly interested in this opportunity because the participation of the largest health plan in California created a stronger partnership that was focused on just three main initiatives.

Becker: Did you experience any pushback from the hospitals?

Sponseller: There was some concern that this initiative would simply create extra work for hospitals. However, it turned out that most of the hospitals were already engaged in patient safety efforts in the three areas of focus in the initiative. Pulling this effort together with other hospitals in various regions provided opportunities to see greater results with unilateral focus.

Becker: What is the relationship between the hospital associations and Anthem Blue Cross?

Sponseller: We’re committed to a collaborative working relationship to benefit the citizens and patients of California. This has brought us together in a productive relationship in which we share a common mission, goals, and objective, and has led to the development of a very exciting partnership.

Becker: Another partner in the initiative is the NHF. How do you interact with them?

Sponseller: The National Health Foundation helps us to independently document our progress. We are very fortunate to have their expertise in data collection and their experience in evaluating large-scale projects.

Becker: Is there any one entity that is taking the lead on coordinating these overall efforts?

Sponseller: A leadership council, made up of the president and senior executives of all five organizations, meets on a regular basis to ensure that we are fulfilling our mission and meeting strategic goals. We decided from the beginning of this effort that we needed to bring the principal elements of this collaborative together through detailed planning and communication. There have been numerous in-person meetings, conference calls and emails sharing the evolution of the product. Regular updates are also provided to participating hospitals.

Becker: Tell me about the areas of focus for the initiative. Why are these the priorities of the hospitals that the associations represent?

Sponseller: As you know, the initial focus for Patient Safety First…A California Partnership for Health comes down to three primary areas: perinatal care, sepsis, and hospital-acquired infections in the ICU. We wanted to focus on issues on which hospitals were already working—we wanted to help them accelerate change and learn stronger reliability strategies.

In addition, these three issues have had huge impacts on the lives of our patients in our communities. Hospital-acquired infections must be reported to the California Department of Public Health, and have high visibility. If we can help more of our hospitals get to the “zero zone”, eliminating these infections, it makes sense to focus there. The perinatal initiative makes sense, too, as there are multiple entities focused on it today, including the Joint Commission (TJC), the Institute for Healthcare Improvement (IHI), and the California Hospital Assessment and Reporting Taskforce (CHART).

The maternal mortality rate in California is higher than the national average, and many practices, such as elective deliveries prior to 39 weeks gestational age, are based on convenience and on changes in societal demands, rather than on evidence-based practice. In fact, elective delivery, whether by induction or by C-section, should be undertaken only after 39 weeks of gestation. The American College of Obstetricians and Gynecologists, the California Maternal Quality Care Collaborative, and the March of Dimes have been working together on a toolkit that will help spur this change.

Becker: What models are you using for this project?

Sponseller: Models for this project have a different presentation in each regional association. In San Diego, the hospitals have a long history of working on projects directed towards standardization of policies and processes, so they are taking a topic-by-topic approach to determining strategies to reach their objectives.

The Southern California Region has two regional collaboratives with a stable hospital population that are adding and refining the initiatives to include in their current programming. In the Hospital Council Region, we are soliciting and encouraging hospitals to participate. We are engaging hospitals that have not previously had this level of engagement offered to them. The idea here is to replicate the BEACON Bay Area collaborative, which involves in-person meetings, as well as web-based education and presentations during the intervening months.

Becker: What are the expected outcomes for the hospitals?

Sponseller: We hope to reduce mortality from sepsis by 25% statewide over three years. We also want to eliminate hospital-acquired infections, with a target of zero for central line blood stream infections, ventilator-associated pneumonia, and catheter-associated
urinary tract infections.

Becker: Have you encountered any challenges with this effort? If so, how have you addressed them?

Sponseller: In the council region, the biggest challenge is the recruitment process. This is not new, as we experienced it previously with the BEACON project. There are many competing priorities in hospitals, as well as numerous opportunities to engage in quality and patient safety efforts through entities including physicians’ professional associations, the IHI, and others. With this effort, we are trying to emphasize the importance of regional collaboration and its positive impact on accelerating change.

Becker: What is most exciting to you about the initiative?

Sponseller: With health care reform having arrived on the scene over these past months, we see this initiative as a prime opportunity to try a different approach to solving challenging problems in patient safety. We’ve joined in this new partnership with the aim of saving lives and improving quality of care in a cost-effective manner. These are goals our partners share, and this mutual alignment creates a unique opportunity to positively impact the lives of the patients we all serve. “Patient Safety First” means just that. They are our customers and we have found a better way to safeguard them while they are in our care.

Becker: Where do you foresee this effort moving in the future?

Our hope is that the first three initiatives will ignite a firestorm that will burn for a long time among the partnership. We share common goals. Zero tolerance for error has been achieved by other industries, so why can’t health care be held to the same standard? With the strength, dedication, and focus of this new partnership, we can do better and sustain this improvement our over time. The success of these initiatives will naturally lead us to other areas of focus that need attention.

The National Health Foundation: Keeping an Eye on the Dashboard

A Los Angeles-based non-profit organization, the National Health Foundation (NHF) is dedicated to improving and enhancing the health care of the underserved by developing and supporting innovative programs that may become independently viable, provide systemic solutions to gaps in health care access and delivery, and hold the potential to be replicated nation-wide. As its president, Gene Grigsby represents the NHF in its partnership efforts.

Lauren Becker: What is the role of the NHF within this project? .... continued in ABILITY Magazine

Articles in the Daryl "Chill" Mitchell Issue; Humor — Laziness is the Key to; Ashley’s Column — ESPY Time!; Timothy & Anthony Shriver — Eunice’s Legacy; ABILITY Facebook Contest — “This is How We Roll”; Augie Nieto — Excerpt from Reciprocity, Incorporated; Dr. Ericha Scott — The Fine Art of Addiction Therapy; Alicia Rojas — Portrait of an Artist as a Young Woman; Daryl “Chill” Mitchell — Cool, Calm and Collected; Spinal Cord Injury — Stem Cell Research Gaining Ground; Medicare — Competitive Bidding and Cost Reduction; Anthem Blue Cross — The Patient Safety First Project; It’s Our Story — A New Chapter in Disability Representation; ABILITY's Crossword Puzzle; Events and Conferences... subscribe

Aug/Sept 2010

Excerpts from the Daryl “Chill” Mitchell Issue:

Daryl "Chill" Mitchell — Interview

Alicia Rojas — Portrait of an Artist as a Young Woman

Timothy & Anthony Shriver — Eunice’s Legacy

Anthem Blue Cross — The Patient Safety First Project

Spinal Cord Injury — Stem Cell Research Gaining Ground

Itís Our Story — A New Chapter in Disability Representation

Humor — Laziness is the Key to

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