The Q Report Fall 2016

FALL 2016

Leading the way toward efficiency, effectiveness UF Health leaders and staff work together to provide the best possible care amid rising patient volumes

WORKING TOGETHER TO ENHANCE QUALITY AND OUR PATIENTS’ EXPERIENCE

Contents: 1 In the Q 2 Quality Teams 4 Cover Story 10 Innovation 12 Great Catch

The Q Report is the quarterly newsletter of the UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety. It features the latest news and initiatives related to quality and improving the patient experience at UF Health. Please email Douglas Bennett, UF Health Communications, at dougbennett@ufl.edu.

Q Report Advisory Committee: Randy Harmatz, Kim Rose, Scott Brown, Chris Cassisi, Laura Castro, Carolyn Holland, Susan Keating, Debbie Lynn, Cristin Owens, Deborah Robins, Michelle Robinson, Amy Rosenberg, Anzeela Schentrup, Douglas Bennett, Irene Alexaitis, Anna Michelle Brandt, Dave Hudson, Kevin Johnson, Diana Richardson

UF HEALTH CHIEF QUALITY OFFICER SEBASTIAN FERRERO OFFICE OF CLINICAL QUALITY AND PATIENT SAFETY

from our patients At UF Health, our patients are at the heart of everything we do. We strive to create the best possible experience for everyone who seeks our care. Feedback from patients and their families is one way we gain insight about what we’re doing well and how we can improve our service.

Here are a few comments from patients who received care at UF Health Shands. We hope these words will inspire and encourage everyone in the UF Health family. Remember, you can make a positive impact with every encounter.

All the staff, from registration through recovery, were terrific. I really appreciated their friendly, caring and patient-centered attitude.

I was very impressed with how well everything moved like a well-oiled machine. The patient

Randy Harmatz

transport staff member seemed to know everyone he

DIRECTOR, STRATEGIC COMMUNICATIONS UF HEALTH COMMUNICATIONS

each other. What really stood out was I could tell

came across and employees said hello as they passed

that everyone I met — from housekeeping, to patient

Kim Rose

transport, to intake, to nurses — really enjoyed their

EDITOR

Douglas Bennett EDITORIAL ASSISTANT

Laura Castro DESIGNER

Mary Cecelia

qreport.health.ufl.edu

jobs and the people they worked with. I was in awe of the team mentality and how well things flowed.

In the Q Randy Harmatz, M.B.A. Chief Quality Officer, UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety

Let’s not get lost in translation

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— R A N D Y H A R M AT Z

efore I moved here from Ohio, I appreciated how Florida was a tourist destination with a rich cultural heritage much different from that of the Midwest. But living here has shown me the many ways this state’s history and dependence on agriculture and tourism also impacts health care.

UF Health Shands receives patients from other hospitals, through our E.R.s, from UF Health Physicians outpatient practices and elsewhere who need our language services. We care for diverse students, faculty, staff, tourists and agricultural workers — all vital members of our state’s vibrant economic activity and our culture.

Our presence in a college town adds its own nuance to this mix of cultures and traditions.

Medical interpreters are one way we provide outstanding language access to our linguistically diverse patients. Our team of interpreters is a vital link to ensuring patient safety.

In the process of interpreting for patients and translating their documents, the medical interpreter team reports on variations in care that impact the safety

of our patients. Because we provide this vital service and have woven this team into the fabric of patient safety, we stop errors from reaching our patients.

“Our team of interpreters is a vital link to ensuring patient safety.”

Recently, our medical interpreters made us aware of common errors they noticed in after-visit summaries — which provide patients with information and instructions about their hospital stay and the care they received — that needed to be remedied before they could be safely translated. The team’s attention to detail led to chartering an improvement team for after-visit summaries. This is just one example of how their work impacts quality care.

When I reflect on the work of the medical interpreters and the other areas of our language access services program, I am reminded that Florida is unique and special. It’s not what’s lost in translation that is important, but what is found.

Call the Patient Experience department at 352.353.5084 to request interpretation services.

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G E R M

H U N T E R S

Infection control team has intense focus — FA B I A N A O T E R O

In the world of infection control, success starts with vigilant surveillance.

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hen a physician suspects that a patient has an infection, their blood, urine and other samples are sent to the laboratory to test for many infections including Clostridium difficile, a bacterium that can cause a life-threatening infection. Results are dispatched to the infection control practitioners at UF Health Shands Hospital and the investigation begins.

The team’s primary role is to prevent infections in patients but there is also an emphasis on protecting health care workers and hospital visitors, said Scott Brown, UF Health Shands Hospital Infection Control director.

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To do that, they probe and question much like a good detective: Were the positive results related to a central line or perhaps a urinary catheter? Did a cluster of patients in a unit have the same organism?

Did they share a room? Had the same workers gone through the rooms?

The infection control practitioners then help health care teams, either at the unit level or hospitalwide, determine how to wipe out the microorganism.

Quality Teams

The UF Health Shands Hospital infection control team includes (front row, from left): Nicole M. Iovine, M.D., Ph.D., hospital epi­ demiologist; and Infection Control practitioners Elizabeth Tremblay, M.P.H., C.I.C, C.P.H.; Nicole Hilliard, M.T., B.S.; Pat Nelson, R.N., B.S., and Kim Browning, R.N., B.S.N. (Back row, from left), Jonh Delano,M.P.H, Infection Control practitioner; Kartik Cherabuddi, M.D., hospital epidemiologist; Scott Brown, R.N., B.S.N., M.B.A., Infection Control director; Anthony P. Cannella, M.D., hospital epidemiologist; Deena Schuman, R.N., B.S.N., Infection Control practitioner.

In 2015, the department reviewed about 56,000 microbiology lab results, reported nearly 3,000 notifiable disease cases to health agencies and spent approximately 13,000 hours analyzing digital data.

They focus on the affected area and work with the staff, managers, Environmental Services workers and other employees to formulate a plan and make sure everyone follows protocol. The solution could be as simple as cleaning with bleach or as meticulous as screening all the patients from a unit.

Their job is highly detailed and operates on a massive scale. In 2015, the department reviewed about 56,000 microbiology lab results, reported nearly 3,000 notifiable disease cases to health agencies and spent approximately 13,000 hours analyzing digital data.

The team of three hospital epidemiologists and six infection control practitioners works with every unit in UF Health Shands Hospital as well as outpatient services. Each practitioner comes from a different specialty, such as microbiology, nursing and public health, and is assigned to his or her own group of units.

Pat Nelson, an Infection Control practitioner, addresses issues involving bone marrow transplant, orthopaedics and the UF Health Shands Burn Center.

She said,“Being able to find out an answer to something perplexing is very satisfying.”

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Cover Story

Leading the way toward efficiency, effectiveness — L AU R A C A S T RO

As UF Health’s reputation flourishes, demand for our services continues to rise. During the past six years, inpatient volumes at UF Health Shands facilities have grown by nearly 40 percent and our emergency rooms are consistently at capacity. UF Health Physicians medical practices are also treating more patients.

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coalition of more than 250 executive leaders, managers and frontline staff are working together to address key quality and patient experience measures amid the steadily increasing number of patients.

The Efficiency, Effectiveness and Patient Centeredness initiative, also known as EEPC, is directed

by David S.Guzick, M.D., Ph.D., UF senior vice president for health affairs and UF Health president, and a steering committee composed of leaders from across UF Health. Staff from core UF Health service areas comprise the committee, which oversees 14 interdisciplinary work groups and is assigned to analyze and improve factors that affect patient

experience and length of stay.

A data support group tracks the teams’ efforts in real time with a quality metrics dashboard to help them stay on track.

Like pieces in a puzzle, each group relies on the others to help advance our big-picture goal: To deliver exceptional service, value and quality to every patient at every encounter.

Here, we explore three of the groups’ activities. To learn about the other teams, see Guzick’s article “Enhancing Quality While Accommodating Growth”— UFHealth.org/on-the-samepage. Other teams will also be highlighted in upcoming editions of The Q Report.

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The Steering Committee consists of senior executive leaders.

The subcommitees consist of teams led by two chairs and one project manager.

The Data Support Group

They oversee the teams and guide them as needed.

They address factors that affect two central elements of high-quality care.

They assist subcommmitess with reporting and data tracking.

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Steering Committee

Subcommittees

Discharge Placement Discharge Appointments

PatientCenteredness at Faculty Practices

Patient Satisfaction

Length of Stay Reduction

Readmission

E.R. Internal Operations Medicine Geocentricity

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Sepsis

Blood Products Imaging

Hospice and Palliative Care

Inpatient PatientCenteredness

Intensive Care Unit Care Models Community Engagement

Data Support Group

Data Support Group

Case Management

Co-chairs: Marvin Dewar, M.D., J.D., and Laura Gruber, M.B.A., M.H.S.

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atient-centeredness is increasingly recognized as a key measure of high-quality care at health systems around the country, and it is a principal goal at UF Health. Aligning health care around patients is shown to increase both their satisfaction and clinical outcomes, while enhancing efficiency and establishing patients as active participants in their care.

Still, measuring this concept is a challenge for health systems. That’s why the Patient-Centeredness at Faculty Practices team is gathering patient feedback to assess and enhance care.

“For us, patient-centered care means that we exceeded the expectations of the person we’re here to take care of,” said Marvin Dewar, M.D., J.D., UF Health Physicians chief executive officer and UF College of Medicine senior associate dean.

“People need to feel respected and good about their provider and their interactions with our system. At the end of the day, it boils down to whether the patient is satisfied and glad that they chose to receive their care from us.”

Electronic surveys are being emailed to all patients who visit any of the 58 UF Health Physicians outpatient practices. Specific questions gauge aspects of the patient experience such as access, timeliness, hospitality and service and communication. Because patient-centeredness relies on patients’ perceptions, the answers provide crucial insight about our service.

“The questionnaire provides us with real-time data and shows trends to see if we’re getting better or worse,” said Laura Gruber, M.B.A., M.H.S., UF Health Physicians senior director of administration, strategy and education.

“We can compare ourselves internally and to national standards, then change our behaviors based on the results.”

The group is analyzing incoming data and using it to take action, Gruber said.

Early results indicate that communication across our organization needs to improve.

As more results are compiled, the team will develop and initiate plans to address opportunities.

“The surveys are showing that we do some great things, but we’re not there yet in all domains,” Dewar said. “We will use these surveys to identify what is most important to our patients and then focus on excelling at that. It’s a journey — we’re rethinking what represents quality care.”

Cover Story

Patient-Centeredness at Faculty Practices: Our patients’ perspective

Community Engagement: The tools to succeed Co-chairs: Anthony Clarizio, M.B.A., and Peter Carek, M.D.

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s the landscape of health care evolves, governmental organizations are placing a greater emphasis on the health and wellness of community populations. For the Community Engagement work group, that means proactively reaching beyond the walls of hospitals and physician practices to match community members with local health care resources and reduce unnecessary hospitalizations.

“Many of our patients lack basic needs like food, clothing, shelter and transportation, which exacerbate problems that you or I would have the resources and capacity to deal with,” said Anthony Clarizio, M.B.A., executive director of UF Health Shands HomeCare and ElderCare of Alachua County. “But these individuals end up in crisis and at the emergency room.”

In several units at UF Health Shands Hospital, the subcommittee has a pilot program to evaluate behavioral health and social indicators at the point of care. The assessment tool indicates patients’ needs and links them with case managers to help develop an effective care plan and improve patient outcomes through transitional planning and advocacy. Health coaches also work with patients for an extended amount of time to help with essentials

“Many of our patients lack basic needs like food, clothing, shelter and transportation, which exacerbate problems ...”

— Anthony Clarizio, executive director of UF Health Shands HomeCare and ElderCare of Alachua County

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Length of stay and patient satisfaction are at the center of the jigsaw puzzle, but there are many interlocking and interrelated factors impacting these two central factors. In short, we can’t improve patient satisfaction and reduce length of stay unless these other interrelated factors are addressed successfully. — David S. Guzick, M.D., Ph.D., UF senior vice president for health affairs and UF Health president

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Medicine Geocentricity: Finding the right home Co-chairs: Robert Leverence, M.D., Diana Richardson, M.B.A.

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he Medicine Geocentricity team is using geolocation and a designated observation unit to help our staff quickly and effectively serve our growing patient volumes.

Medicine geocentricity is the concept that patients who need similar health services should be located together along with their care teams. This eliminates the need for providers to move between units, which increases the efficiency and

timeliness of care. Patient satisfaction also rises, length of stay is reduced and communication between teams improves. As logical as this all sounds, it is challenging to achieve when beds are full and additional patients need immediate care.

“In an environment of limited capacity, geocentricity is a real challenge, but we feel that it’s the best choice for our patients. When staff and provider teams function together in the same space, strong relationships are formed and so care and efficiency are improved,” said Robert Leverence, M.D., UF College of Medicine department of medicine vice chair of clinical affairs and chief of the division of hospital medicine.

The subcommittee recently achieved geocentricity in two general medicine units at UF Health Shands Hospital. They also ensured that the Admission Discharge Transition Unit, a 25-room medical/surgical unit, is used as a short-stay, or observation, unit. Because many patients who come to our emergency rooms don’t require full hospitalization, the observation unit provides an alternative for patients with short anticipated hospital stays. That frees up beds for those who need traditional inpatient services.

“We’re developing ways to get the patients what they need in the shortest amount of time possible,” said Diana Richardson, M.B.A., UF Health Shands vice president of operations. “Our reports have shown that we’re doing a pretty good job of making that happen in our pilot units. Now we’re developing processes to support it long-term.”

Cover Story

such as transportation, meals and health screenings. Most importantly, they help patients enroll in local health service programs.

“Matching patients to resources is the next significant and largest step to take to ensure that social factors don’t determine their overall health,” said Peter Carek, M.D., chair of the UF College of Medicine department of community health and family medicine. “We have to keep progressing forward to make sure the connections are made and we’re changing the way our patients think about health care.”

The pilot program has been successful and partner community organizations are enthusiastic about pooling resources to implement enduring change.

“Community engagement is really what happens when we manage patients over a period of time,” Clarizio said.“Our goal is to treat the condition the patient is here for, then prepare them for what comes next.”

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‘K cards’ put focus on safety —D O U G B E N N E T T

A small, laminated card is having a big effect on patient safety at UF Health Shands Children’s Hospital.

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amishibai cards are best known for identifying errors and abnormalities in the Toyota Motor Corp.’s manufacturing processes but have since been adapted to other industries, including health care.

Amanda Bettencourt, M.S.N., R.N., a pediatric clinical nurse specialist, heard about the “K cards” at a conference and brought the idea back to work. By February, bulletin boards with K cards had been posted in the Pediatric Cardiac Intensive Care and pediatric hematology/ oncology units.

The idea is as simple as it is effective: Stimulate real-time, peer-to-peer conversations about the steps involved in safety compliance. When the program was rolled out, its initial focus was on preventing falls and central-line-associated bloodstream infections.

The K cards stimulate a spontaneous, organic discussion that drills down into the minutiae of a safety issue. Among them: When did you last do a dressing and insertion site assessment? Are all dressing, cap, tubing and medications/fluids within date?

All in for K cards (Left to right): Ozzie Hunter, M.S.N., R.N., a nurse manager in UF Health Shands Children’s Hospital’s Pediatric Hematology/Oncology Unit Unit and the Pediatric Infusion Center and Outpatient Clinic; Michele Lossius, M.D., department of pediatrics; Amanda Bettencourt, M.S.N., R.N., pediatric clinical nurse specialist; Kim Browning, R.N., B.S.N., Infection Control practitioner; Kati Harlan, M.S.N., R.N., UF Health Shands quality improvement specialist; Stephanie Oliveria, B.S.N., R.N., a nursing clinical leader in the UF Health Shands Children’s Hospital Pediatric Cardiac ICU; and Josh Campbell, B.S.N, R.N., nurse manager at UF Health Shands Children’s Hospital Pediatric Cardiac ICU. Not pictured is Tracie Kilcrease, B.S.N., R.N., clinical leader, UF Health Shands Children’s Hospital’s Pediatric Hematology/Oncology Unit and the Pediatric Infusion Center and Outpatient Clinic.

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Ozzie Hunter, M.S.N., R.N., a nurse manager in UF Health Shands Hospital’s Pediatric Hematology/Oncology Unit and the Pediatric Infusion Center and Outpatient Clinic, said almost all of the K card sessions in recent months have been done among staff members.

“What the staff likes is that it’s not management looking at them and what they’re doing. It’s them interacting with each other and discussing how we can better our practices on the floor,” he said.

Next, the K card program will be expanded throughout the hospital by September to help prevent falls, centralline infections and catheter-associated urinary tract infections.

Bettencourt said the K cards have been especially helpful in fostering candid discussions. Colleagues are more honest with each other about what they could have done better than if a manager was doing a traditional audit of a patient safety process.

Innovation

The K card for central line infection prevention contains more than a dozen items that need to be discussed and checked off. The goal is to assure that all of the infection-prevention actions listed on the card are completed at least 90 percent of the time.

“This is a tool to help measure our safety compliance and figure out what we need to do to get better. It’s a very engaging activity,” Bettencourt said.

K cards also can have an immediate effect: Getting 90 percent compliance on central-line infection prevention practices can reduce infections up to 40 percent, according to Stephanie Oliveria, B.S.N., R.N., a nursing clinical leader in the UF Health Shands Hospital Pediatric Cardiac ICU. In Oliveria’s unit, the staff of more than 80 nurses does at least 10 K cards a month. Safety compliance rose steadily from 70 percent to more than 90 percent in her unit after the K cards were implemented, she said.

“This is a tool to help measure our safety compliance and figure out what we need to do to get better. It’s a very engaging activity.”

— Amanda Bettencourt, M.S.N, R.N., pediatric clinical nurse specialist

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Each month, the UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety recognizes staff members who have made a “Great Catch” to prevent medical errors.

Nurses catch laser device’s problem

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hen Rey Reyes, R.N., an O.R. nurse at UF Health Shands Cancer Hospital, was working with a laser lithotripsy machine, part of the device overheated. Before long, he felt the device get unusually hot in his hand.

The Class 4 laser, the most powerful of its kind, is used to break down a patient’s kidney stones to make them pass more easily. Reyes and a nursing colleague, Luvenia Flowers, R.N., wanted to be certain that the problem stopped there.

During an inspection, it was discovered that the problem involved the laser fiber that carries light pulses to pulverize the stones, Flowers said. Nothing like that had ever happened before, even with the laser machine being more than 20 years old.

“It was a defective laser fiber,” Flowers said.

Flowers took that particular lot number of laser fiber off the shelf and called all the appropriate people to make sure that similar laser fibers weren’t being used elsewhere.

Although it was a rare occurrence, Flowers said she is grateful there were no significant injuries. The main concern is

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— B R I T TA N Y V A L E N C I C

always the patient’s and staff’s safety, she said. Many of the anesthetics in an O.R. are flammable and have the potential to trigger a fire.

“We are just glad everyone is OK and no one was seriously harmed from it,” Flowers said.

Their “Great Catch” prevented a possible laser fire and has renewed the emphasis on appropriate safety precautions when using such devices.

Among other things, that means always wearing eye protection and making sure windows are covered.

“Anything can happen, so you have to make sure that you follow all the steps that you need to ensure everyone is safe,” Flowers said.

Reyes and Flowers appreciate the attention but don’t think they deserve all the credit.

“We work together every day to ensure our patients’ safety. I really believe that what happened is a culmination of the training and high standard of care of our team, not just a few individuals,” Reyes said. “Anyone on the urology team could have recognized the problem and caught it before things went astray.”

and high standard of care of our team, not just a few individuals.”

— Rey Reyes, R.N. Teamwork pays off: Luvenia Flowers, R.N., (left) and Rey Reyes, R.N., (center) worked together after a part on a laser lithotripter overheated. They are shown with Kelly Nugent, R.N., B.S.N., nurse manager for the Cancer Hospital operating room.

Great Catch

“I really believe that what happened is a culmination of the training

Quality Notes SAFETY AND QUALITY CHAMPIONS

A VOICE FOR OUR PATIENTS

The road to high reliability — exceptional consistency in accomplishing safety goals and avoiding errors — is paved, in part, by safety coaches.

Safety coaches at UF Health Shands are designated clinical care staff who actively engage their peers in quality and safety initiatives — whether it’s simply reminding them to wash their hands before interacting with a patient or helping with processimprovement tools such as the online patient safety reporting system.

The program is successfully underway at UF Health Shands Psychiatric Hospital, and is now rolling out to other clinical departments at UF Health Shands.

Staff can learn more by contacting Sue Keating, clinical risk manager, at whitsu@shands.ufl.edu.

Each year, UF Health Shands provides interpretation services to thousands of patients and their families with limited English proficiency or hearing impairment.

Rising patient volumes have increased the demand for foreign-language interpretation services provided by the UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety’s Patient Experience department.

The department’s medical interpreters give our Spanish-speaking patients a voice. They interpret the information communicated between patients and their care team.

The team is available from 8 a.m. to 4:30 p.m. weekdays to assist patients and their families free of charge.

Interpreter phones can be used when medical interpreters are unavailable and for patients who speak languages other than Spanish. The 24-hour phone system provides immediate access to interpretation in 200 languages.

Call the Patient Experience department at 352-353-5084 to request an interpreter.

HUDDLING FOR HOSPITALITY At UF Health, we strive to create the best possible experience for everyone who seeks our care. Hospitality Huddles are a regular practice we use to improve the patient experience and practice positive behaviors.

They allow us to home in on the behaviors we learned during Hospitality & Service training to improve the patient experience and our workplace interactions.

We encourage all faculty and staff to continue participating in their work area’s twice-monthly briefings as they become a part of our work culture.