The Anderson Center “Getting to Scale” Symposium
In March, 2013, the Anderson Center held its first ever external symposium, “Getting to Scale”. We invited world-class thinkers from a variety of sectors to address the challenges of scaling; spreading our innovations and interventions to large populations to exponentially increase their impact. The program featured prominent experts on scale from both healthcare and non-healthcare industries presenting brief, “thought bomb” case-studies based upon their experiences as well as highly interactive sessions with leaders from across healthcare. The speakers included Nana Twum-Danso (Fives Alive), Bob Jesse (Veterans Health Administration), Claudia Kotchka (P&G), Louise Liang (Kaiser), and Bonny Simi (JetBlue). Joe McCannon (100,000 Lives Initiative) and Bob Sutton (an author and highly innovative thinker on the theories of scale at Stanford) moderated the event and shared their expertise on scale as well. Using OCHSPS as a case study, international thought leaders assessed the challenges and tradeoffs of going to scale. Participants walked away with practical applications of lessons learned across many industries that they could apply to their individual business situations.
Under the leadership of Dr. Steve Muething, we identified multi-factorial causes of the deterioration in safety culture and process reliability, and are partnering with senior leadership to design and begin work on Operational Excellence so that Safety is not a separate initiative, but a focus of everyone as part of their jobs every day. We are also working to spread this high reliability culture to other Children’s Hospitals nationwide. The Ohio Children’s Hospital Solutions for Patient Safety (OCHSPS) has seen a 50% reduction in the Serious Safety Event rate and serious harm index in Ohio, beginning reductions in serious harm for 33 hospitals in Phase I and expansion to 76 hospitals with 43 hospitals joining in Phase II. OCHSPS has been nationally recognized as a leading hospital engagement network.
Chronic and Complex Disease
Chronic and complex disease represents a formidable challenge, but is arguably the most important work we do with the most significant and far-reaching impact not only on the health of children, but on the healthcare system as a whole. Under the leadership of Dr. Jennifer Lail, and in partnership with Patient Services, the Care Coordination and Outcomes Initiative has worked with innovative clinical areas to change the way we deliver chronic care to a more holistic and coordinated approach. Thirteen conditions developed registry and outcomes measures, deployed needs stratification and care support, as well as self-management and pre-visit planning. As a result, this collaboration achieved 20% improvement in outcomes for six conditions; double our projections for FY2013. We look forward to improving outcomes with additional condition-based teams as part of Wave 2 in FY2014.
In partnership with various community agencies, Dr. Robert Kahn led initiatives to reduce unintentional injuries, infant mortality, asthma ED visits, and address childhood obesity. As a result of their diligence, there was a 70% reduction in unintentional injuries in the Norwood intervention homes, and improved QI capacity in the community with six school and health center teams participating in RCIC. Additionally, in partnership with PI and ECS, we were awarded $3.2M in grant funding from Bethesda, Inc. to drive breakthrough results in infant mortality for our region.
Dr. Fred Ryckman accomplished significant results in Productivity and Flow this year, with the achievement of 80% discharged when Physically Ready, the validation of bed models, and the maintenance of system delay rates even with a record high census. His area also led early work on the development of GARDIANS (Global Automated Risk Detection Interface and Network System) for Operational Excellence. GARDIANS serves as a front-line tool that comprehensively and efficiently presents information to enable front-line leaders to identify and mitigate risk for flow failures, patient and family experience failures, and safety events. Most importantly, Peri-Op completed 940 days without a serious safety event.
Under the leadership of Dr. Carole Lannon and Dr. Peter Margolis, significant accomplishments were realized in our learning networks, including the development of Learning Networks Core infrastructure which enabled the extension of support by the five existing networks to 170 sites in 41 states and two countries. Dr. Lannon has led the continued collaboration with ABP, including a national invitational meeting focused on promoting and sustaining the network model in June 2013, and a grant with ABP to highlight networks as part of the maintenance of certification program.
Significant improvements in outcomes among the national networks such as the Improve Care Now (ICN) and Chronic Care Collaborative (C3N) networks and the demonstration of a robust network infrastructure for research, e.g. the ability to replicate important trials using data collected by these networks, has garnered national recognition by funding agencies interested in proliferating this success. As a result, Dr. Margolis has led the collaboration regarding C3N with the Patient Centered Outcomes Research Institute pertaining to PCORI funding strategies.
Health Services Research
This year, Dr. Peter Margolis led efforts to strengthen and integrate health services teaching and knowledge throughout the organization. In support of this, the Anderson Center hosted 12 speakers and two community learning events, as well as established a research mentoring program.
Evidence and Measurement
Under the leadership of Dr. Evie Alessandrini, significant strides were made in health care awards. Reporting to US News and World Report was improved, including closer links to improvement priorities with a concomitant 48% rate of gap closures, and resulting in a #3 overall ranking, and a #1 ranking in cancer care. The survey strategy and coordination with clinical areas resulted in a Parents’ Magazine rank of #3 (#4 in 2009), with all six subspecialties ranked in top three (all 7-9 in 2009). Additionally, Cincinnati Children’s was one of only two hospitals nationally to win the LeapFrog/URAC web transparency.
The Leadership Academy
The Leadership Academy also made significant strides in both internal and external capability and capacity building. The external I2S2 course was launched with nine external candidates in current classes, with a course of external participants only (19 confirmed) scheduled for October. We increased the overall project total and early testing of PDSA's in both I2S2 and RCIC resulting in improved project results, as well as increased the percentage of teams achieving improvement (five or above) in RCIC from 60 to 88%.