CQO Corner: Dr. Robert Schwab, Texas Health Allen and Denton
CQO Corner: Dr. Robert Schwab, Texas Health Allen and Denton
Video Credit: Rachel Raya
The Texas Health Resources Medication Safety Forum is a multidisciplinary medical committee designed to provide integrated, system-level input into medication safety efforts across the Texas Health system.
Formed in January 2011, the forum is comprised of physicians, nurses, pharmacists, quality and safety leaders, and IT experts. It is co-chaired by Dr. Robert Schwab, vice president and chief quality officer for Texas Health's Denton and Allen hospitals, and Marcie Williams, vice president of patient safety and risk management for the Texas Health system.
"This forum brings every group with 'skin in the game' around the same table to discuss important medication safety issues," Williams said.
In the past, medication safety issues have been addressed in Clinical & Operational Improvement Councils — or COPICs — which pull together system leaders in each discipline, such as nursing, pharmacy, or quality.
The Medication Safety Forum now takes key leaders from each COPIC that is involved in medication safety and combines them into one group, Dr. Schwab said.
"Medication management is immensely complicated," he said. "When you give a medication, the number of steps it takes from the order to the patient taking the medication is pretty mind boggling, and in that process, all those different disciplines are involved, so it makes sense to have them involved in trying to sort out how we're going to try to make those processes work better."
"Our role will be to reach consensus on issues and say, 'Based on the evidence, here's what makes the most sense to us,'" Schwab said.
Quick Facts About Dr. Schwab
Title: Robert Schwab, MD
Medical Education: University of Virginia School of Medicine
Residency: Emergency Medicine, Truman Medical Center, Kansas City, Mo.
Former titles held:
Patient Safety/Risk Management, St. Luke's Hospital, Kansas City, Mo.
Hobbies: Fiction and poetry writing, songwriting, guitar, golf
According to Williams, the functions of the forum will be to:
Advise system leadership on medication safety initiatives;
Assist in prioritization of initiatives to existing teams;
Investigate critical medication events and recommend improvement processes;
Coordinate efforts among existing teams;
Ensure multidisciplinary input for system medication management initiatives; and
Integrate information technology, clinical, and administrative input.
Topics for the forum will include various aspects of medication management, including how medications are managed with the electronic health record and how Texas Health will use medication bar coding, which is currently being piloted at five Texas Health hospitals and is expected to be fully deployed by year's end.
Schwab said he thinks the collaboration between multidisciplinary groups will prove to be invaluable in informing these important issues.
"When you sit around the table and get to know people, no longer are they the physician who won't play or the pharmacist who doesn't know what you know; they're people," he said. "And even if you're arguing, argumentation ought to be collaborative. You ought to be arguing to try to come to a conclusion. That's what we're trying to do. Not everybody is going to agree, but we'll end up with consensus. Because in the end, everybody is working for the best of the patient."
Journey to Base Camp 2: Building on dramatic and sustained quality improvements
The Patient Safety Bundle contains key patient safety activities that are independently measured year round.
Texas Health hospitals have made marked improvements in quality and patient safety since beginning its 10-year strategic focus in 2006, achieving top quartile performance in appropriate care and producing double-digit improvements in patient safety bundle scores.
These improvements — seen across Texas Health's 13 hospitals — are the direct result of an ambitious, 10-year plan to transform how health care is delivered and make our healthcare system the benchmark by which other systems across the nation measure themselves.
"We have reached our first checkpoint — or Base Camp, as we call it — a place where we pause along this 10-year journey to assess our progress and make adjustments as needed," said Chief Clinical and Quality Officer Dr. Michael Deegan. "The strides we have made since beginning this journey are dramatic indeed and represent concentrated efforts across our healthcare system to not only improve, but bring about fundamental changes in our culture. We made a conscious decision to be dissatisfied with the status quo and to put all of our collective efforts into making leaps — not just steps — toward improvement."
Appropriate Care Scores Between 2007 and 2010, Texas Health hospitals dramatically improved appropriate care scores, achieving top-quartile performance in heart attack, heart failure, pneumonia, and surgical care improvement.
That's quite a significant improvement," said Linda Gerbig, Texas Health's vice president for performance improvement. "Those scores are very hard to move, because getting everything done right on every patient, every time requires that these evidence based measures be top of mind. There is little or no margin for error."
QUEST During the same period, Texas Health hospitals dramatically improved their performance in the QUEST collaborative. QUEST is a voluntary, three-year quality improvement collaborative overseen by Premier Inc.
"In QUEST, we compare ourselves against a subset of very high performing hospitals," Gerbig said, "so the bar is set higher."
One tactic Texas Health hospitals used to drive improvement of QUEST scores was to integrate core measures into Care Connect, the system's electronic health record, Deegan said.
"This has enabled us to 'hardwire' quality improvement processes into the care for each patient," he said.
We also identified a best practice at Texas Health Cleburne of monitoring the evidence based measures throughout a patient's hospital stay and spread this best practice to each and every Texas Health hospital. Monitoring and addressing opportunities throughout the patient's hospital stay helps us bring our compliance with evidence-based processes to a new level.
"If we see that there is a measure that hasn't been done yet, our quality staff can call the nurse or the doctor and tell them it looks like an evidence based measure is due and facilitate the order or discuss why the measure wouldn't be the best care for the patient," Gerbig said. "This allows the clinician to address the measure and meet the requirement."
Patient Safety Bundles Patient safety bundle scores have also significantly improved. The Patient Safety Bundle contains key patient safety activities that are independently measured year round in all wholly owned Texas Health facilities. The measures contained in the patient safety bundles are:
Hand Hygiene - cleaning hands before and after patient contact and after contact with the patient care environment.
Patient Identification - asking the patient his or her name and date of birth and then comparing and confirming that information to an order, requisition or medication administration record.
Time Out - a briefing process done before surgery or an invasive procedure. The process involves completing a Time Out Check List and covering all of the elements on the list each time. The Time Out validates that the right patient is having the right procedure on the right body part, all documentation is complete, all pre-procedure tasks have been done and everything that is needed is in the room and ready.
Since 2006, compliance with the hand hygiene, patient identification and time out bundles have increased from below 75 percent in 2007 to above the 85 percent starting in 2009.
"Patient Safety Bundles are about striving to do the right thing every time, to help keep our patients safe," said Marcie Williams, Texas Health's vice president of patient safety and risk management.
In order to measure compliance with the bundles, Texas Health employs an observation methodology for independently assessing performance learned from the nuclear power industry. This methodology allows independent observers to "fade into the background" of a work area and over time to be able to observe true staff practices.
"Every year the observation process is expanded, and as it has expanded, the scores have gotten better," Williams said.
Looking ahead to Base Camp 2 March 2011 begins Texas Health's ascent toward the second Base Camp along its journey, with an expected arrival in 2013. During the next two years, Texas Health hospitals will focus intently on continuing to strengthen its culture, engaging physicians, driving clinical integration, advancing quality and patient safety, and improving operating performance.
Dr. Garner Newton, chairman of orthopedic surgery at Texas Health Dallas, performs a knee surgery. U.S. News & World Report recognized Texas Health Dallas for orthopedics and three other specialties.
Texas Health hospitals in Dallas, Fort Worth, Plano, Arlington and Southwest Fort Worth were named among the area's best in the first-ever metro-area Best Hospitals rankings, published by U.S. News & World Report.
"This recognition speaks to the quality care we deliver and represents the hard work and dedication of physicians, nurses and hospital leadership across our health care system," said Douglas D. Hawthorne, FACHE, CEO of Texas Health Resources. "We're honored to be recognized and proud to deliver each day on our mission of improving the health of the people in the communities we serve."
Texas Health hospitals ranked in the U.S. News listing were:
Texas Health Harris Methodist Hospital Fort Worth, listed as high-performing in these specialties: diabetes and endocrinology, gastroenterology, gynecology, kidney disorders, orthopedics and pulmonology;
Texas Health Presbyterian Hospital Dallas, listed as high-performing in these specialties: gastroenterology, gynecology, neurology and neurosurgery, and orthopedics;
Texas Health Arlington Memorial Hospital, listed as high-performing in these specialties: gastroenterology, kidney disorders, and neurology and neurosurgery;
Texas Health Presbyterian Hospital Plano, listed as high-performing in these specialties: gastroenterology and orthopedics; and
Texas Health Harris Methodist Hospital Southwest Fort Worth, listed as high-performing in ear, nose and throat.
These five Texas Health hospitals were among 19 in the Dallas-Fort Worth area to appear in the metro-area rankings, based on reputation, clinical excellence and a mix of care-related factors such as nursing and patient services. Data from the American Hospital Association and surveys of the nation's top physicians are also used to determine the rankings.
Texas Health Resources, Texas Health Physicians Group and MedicalEdge leaders celebrate the integration of MedicalEdge with Texas Health Physicians Group. Pictured (from left): Mike Stoltz, M.D., Texas Health Physicians Group; Carl Soderstrom, Texas Health Physicians Group; Steve Hanson, Texas Health Resources; Doug Hawthorne, Texas Health Resources; Clay Heighten, M.D., Texas Health Physicians Group; and Tom Ziesmann, Texas Health Physicians Group.
Engaging with physicians and becoming an integrated provider and coordinator of care are two of the key goals outlined in Texas Health Resources' 10-year strategic focus, which began in 2006.
Texas Health took a large step toward accomplishing these goals in January with the Texas Health Physicians Group acquisition of MedicalEdge Healthcare Group P.A., one of the largest independent physician practice groups in North Texas.
With the addition of Medical Edge's 250 facilities in Collin, Dallas, Denton, Grayson, Johnson, Parker and Tarrant counties, Texas Health physicians are now positioned closer to where patients live and work and have the ability to serve patients throughout the lifetime of their changing medical needs.
"Our vision is for Texas Health to become a 'medical home' for thousands of North Texas patients," said Douglas D. Hawthorne, FACHE, CEO of Texas Health Resources. "Immediately, more than 420 physicians, physician assistants and nurse practitioners become part of our established and well-respected Texas Health Physicians Group, and the patients of MedicalEdge providers will have easy access to a health system dedicated to both quality and accountable medical treatment."
In addition, MedicalEdge brings several ancillary services to Texas Health, including sleep lab services, infusion services, diagnostic imaging and chiropractic services.
"We have built Texas Health to be a 'house with many rooms' to align with all types of physicians," Hawthorne said. "Our ultimate goal is to improve quality and outcomes through better coordination of care from prevention and wellness programs, to acute care, to long term and hospice care. This is the most significant step Texas Health has taken in our strategy to become an integrated provider and coordinator of care and transform the delivery of health care in North Texas."
Acquisition of MedicalEdge and PhyServe adds more than 2,300 people to the Texas Health family. The Texas Health Board of Trustees approved the acquisition Nov. 16, and the transaction closed Dec. 31.