Henry Ford Health System
Detroit, MI
2306 staffed beds
Henry Ford Health System, a Detroit-based integrated, not-for-profit hospital system based in Detroit with seven acute care hospitals whose services include a Level I trauma center.
STEEEP
Efficient - Successful pilot projects at individual hospitals are adapted for use throughout the system.
Patient Centered - All Henry Ford patients now receive detailed instructions at discharge on their medication regimens, future treatments along with contact information for follow-up questions.
Safe - The No Harm Campaign has helped Henry Ford Health System lower its inpatient harm rate by 20 percent in two years.
Team Members
Beth Anctil, RN
Principal Management Engineer
Edward Callaghan
Chair, Board of Trustees Quality Committee
William Conway, MD
Chief Quality Officer
Jack Jordan
Director of Quality
Eliminating Harm in a Large, Integrated System
The Problem
According to the Centers for Disease Control, health care-acquired infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. In 2007, the board of trustees of Henry Ford Health System leaders identified eliminating all harm as the organization’s top priority. The board of trustees subsequently set a goal of reducing preventable harm throughout the system by 50 percent between March 2008 and December 2010.
The Solution
Henry Ford Health System leaders began by analyzing the major causes of harm within the organization, beginning by dividing harm into four categories: infection-related harm, procedure-related harm, medication-related harm and other preventable harm.
In 2008, the system launched two major collaborative efforts targeted at reducing readmissions and improving perinatal care. System leaders also recruited clinicians with expertise in harm reduction to lead smaller pilot projects in individual units. Over time, successful pilot projects have been adapted for use throughout the system, and the board and executive leadership team has continued to identify new areas of focus for harm reduction.
The Results
Henry Ford Health System’s aggregate inpatient harm rate has been reduced roughly 20 percent since the No Harm campaign began in March 2008.
The system now reports a rate of .5 percent for hospital-acquired infections, which includes a reduction of Clostrodium difficile (C. diff.) infections to 3 per 10,000 patient days in December 2009, compared to the national benchmark of 7 per 10,000 patient days.
Other improvements include a drop in the system-wide pressure ulcer rate from 8 cases per 1,000 discharges in January 2008 to approximately three cases per 1,000 discharges by November 2009.
Background
Since the No Harm Campaign began in 2007, Henry Ford Health System’s board of trustees has targeted quality improvement as its primary fiduciary responsibility, according to board member Edward Callaghan, who chairs the board’s quality committee. The quality committee meets monthly to monitor harm prevention activities and discuss strategies for adapting successful projects in individual hospitals throughout the system, Callaghan says.
“We need to take advantage of successes, and learn from our failures as well,” Callaghan says.
The quality committee’s targets have been executed by an executive leadership team that has carefully researched the major causes of harm and stayed abreast of trends in quality improvement. Starting in 2008, system leaders launched two organization-wide efforts to reduce harm, with efforts to reduce readmissions and improve perinatal care.
The readmissions effort required each individual hospital to develop ways for patients to contact the hospital following discharge. That focus led to the creation of a one page document known as DAMSELS—Diagnosis, Appointments, Medications, Signs and Symptoms, Emergency numbers, Limitations and Services—that every patient throughout the system now receives at discharge. The system also attempts to identify patients at high risk for readmission and refer them for home health care services within 48 hours of discharge. Going forward, the next phase of the project includes improving transitions between the system and skilled nursing facilities, and participation in the including the Michigan State Action for Avoidable Rehospitalizations (MI STAAR) initiative.
The perinatal care project began with an emphasis on creating a comprehensive bundle in 2009, and continues this year with participation in the Keystone Collaborative’s Comprehensive Unit-Based Safety Program (CUSP).
Both projects were the result of early analysis of quality trends by the board and the executive leadership team, according to William Conway, M.D., the system’s chief quality officer.
“It was pretty clear three or four years ago that CMS was going to go after readmission rates, so we latched onto that pretty early,” Conway recalls. “It was evident three years ago that perinatal care was going to get a lot of attention, so we were one of the first systems to join a perinatal effort.”
Principles of Performance Excellence
Creation of a high-reliability culture
In addition to organization-wide collaborative projects, Henry Ford Health System leaders have also relied on smaller, grassroots projects led by individual clinicians. Those projects have included a pharmacist-direct anti-coagulation services initiative to fight coagulation in high-risk patients and a comprehensive effort to improve nurse rounding to reduce patient falls and pressure ulcers.
After board members and system leaders identify areas for harm reduction, executive leaders work to connect board-level and administrative targets with the frontline nurses and doctors with the skill sets and experiences to carry out specific projects, according to Jack Jordan, director of quality for Henry Ford Health System.
“We have to lead with passion or desire,” Jordan says. “We might look for nurse managers or nurses who are working on their masters’ degree in a specific area that might help pick the topic. We haven’t been highly prescriptive as far as everyone doing the same thing.”
Beth Anctil, R.N., the system’s principal management engineer, works carefully with project leaders and chief medical officers to provide assistance with quality measurement and other needed resources.
“We provide support to folks,” Anctil says. “Our goal is to have a culture where improvement work is part of every manager’s goal.”
Managing organizational variability
If pilot projects prove successful, Jordan and other system leaders carefully explore methods for spreading their use to other Henry Ford hospitals. For instance, Henry Ford Hospital in Detroit joined the National Surgical Quality Improvement Program (NISQIP) in mid-2006, and was joined by three other system hospitals in late 2007. Henry Ford Hospital’s involvement in the NISQIP project have led to reduced mortality and length of stay, while data for the other three participating hospitals will be released later this year. Starting this year, the best practices of the four hospitals currently participating in the NISQIP collaborative will be adapted throughout the system, with improvement efforts focusing on tangible reductions in surgical site infections, blood clots and pneumonia, while improving preoperative patient education.
“With NISQIP, we’ve been involved since 2006,” Jordan says. “We’ve had good results at the main campus, and now we’re working to spread it to get consistent progress.”
Continual improvement
This year, the system will be participating in the Michigan Hospital Association Keystone ER Collaborative. That effort will focus on improving the culture of safety in hospital EDs, improving handovers of care, identifying and treating sepsis in a timely manner and using Lean methodology to improve the process of patient flow.
In the long-term, Callaghan says he wants to see Henry Ford Health System emerge as a national model for quality improvement.
“I’d like to come up with a Henry Ford scorecard or dashboard that’s a benchmark, just like the Institute for Healthcare Improvement or National Quality Forum data,” Callaghan says.
