Monday, November 2, 2015

Leapfrog and UMMC

Published in VC's Notes on November 02, 2015

Leapfrog and UMMC

Good morning.

I'm sending out a VC Notes on a Monday, in addition to the usual Friday edition, to respond to a news story that appeared this weekend. 

On Saturday, the Clarion-Ledger carried an article about our hospital's safety scores as published by The Leapfrog Group.  We think the article was essentially accurate, but it painted an incomplete picture of patient safety at UMMC.

The Leapfrog Group has contributed to putting patient safety on the map by publishing safety scores for hospitals during the last three years.  It produces numeric scores for hospitals based on two sources of information.  First, it uses publicly available quality data for all hospitals, and second, it invites hospitals to take a lengthy, self-reported survey. 

About half of the country's hospitals actively participate in the survey, and this is the first year that UMMC has submitted data to Leapfrog, in hopes of gaining additional insight toward our ongoing efforts to improve clinical quality.  To our knowledge, UMMC is the only metro-area hospital that voluntarily submits data to Leapfrog.

There are 28 safety measures in all, covering such areas as avoidance of pressure ulcers, practicing good hand hygiene and preventing death from serious treatable complications.  Leapfrog reduces these numeric scores to a report card-style rating system using A through F grades that one would commonly see in a school setting.  This report card is the primary means by which it communicates hospital quality to the public.  

And there lies the problem.  

UMMC received an “F” in the Leapfrog report.  But, as we all know, we are not an "F" hospital.

When you receive a grade of F in school, that means you failed the test or the course.  UMMC and the other hospitals receiving an F did not fail anything.  We simply scored marginally lower than other hospitals. 

And we didn't even score that much lower.  The differences in the higher-scoring hospitals and the lower-scoring hospitals for any of the metrics are not that large.   In fact, we exceeded the national average in 11 of the 28 metrics Leapfrog uses.

The point here is not to criticize Leapfrog, which we consider a partner helping us to achieve the very highest clinical quality, or the newspaper, which is just passing on information we believe the public deserves to have.  The point is that clinical quality is a complex, multi-faceted subject that, we believe, can't be adequately or fairly reduced to a grade in a school report card format.  To represent this as a “failure” to the public on such a sensitive issue is inflammatory and does not serve patients as they make decisions about their health care. 

UMMC is a safe hospital.  Patients can and do come to us with confidence that we are on top of our game and that they will receive superb care.

Are we perfect?  No.  Despite our very best efforts, we do occasionally make errors or oversights that could potentially expose patients to harm, as do all hospitals.  But if you look at the Leapfrog data you will see that those instances are extremely rare.

One thing the data may not fully reflect is that we are a major trauma and referral center.  We are constantly caring for the state's most critically ill and injured patients.  We embrace this responsibility, but the challenges associated with it may not be completely captured in a particular survey's risk adjustment calculations. 

You should also bear in mind that most of the data on which the scores are based are more than two years old.  In those two years, we have made major strides in our clinical quality program.

Here are a few of the major things we've done: 

  • Recruited Dr. Michael Henderson from the Cleveland Clinic as chief medical officer.  A proven national leader in clinical quality improvement and patient safety, Mike is leading the charge to our becoming a high-reliability organization.
  • Identified clinical quality as our Number 1 priority for strategic investment
  • Required every employee to participate in error-prevention training
  • Begun a hand-hygiene initiative that we feel confident will dramatically improve our compliance
  • Begun monthly “Leadership Rounds” to promote engagement of UMMC's 150 top leaders with our clinical quality efforts
  • Achieved outcomes in complex transplant and congenital heart surgeries that are among the best in the country
  • Shifted to an electronic health record that is ensuring our performance data isn't undermined by poor coding.  More importantly, our Epic EHR allows us to use data analytics to better identify and correct behaviors that result in errors.    
  • Standardized best practices in surgery, such as “time outs” for the whole team to do final checks that the right things get done and everyone knows and agrees with the surgical plan

Leapfrog and its peers set the quality bar high, and it should be high.  Our goals are zero preventable harm and progressive, measurable improvement in quality outcomes. 

We also welcome the transparency that Leapfrog and other measurement groups provide.  Transparency can be uncomfortable, but it will help us drive continued improvement.  

In the final analysis, each of us owns our performance, and we own this Leapfrog report.  Patients are at the center of what we do every day and the commitment to this improvement is the responsibility of every person who works in the hospital every day.  

I know and appreciate that you have embraced this responsibility and are working very hard on behalf of our patients.  I'm confident that in time, our “grade” will reflect it.  And knowing that is all the motivation we need to keep moving onward toward A Healthier Mississippi.



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