10/29/2018 Department of Anesthesia, Critical Care and Pain Medicine AJH Orientation October 22, 2018 Patient Engagement, Systems Science, and the Elimination of Preventable Harm Again, welcome to the Beth Israel Deaconess Family! Agenda • Introductions • Department Overview • Faculty Development • Quality, Safety, Innovation, and Information Technology • Compliance • Billing and Coding • Key Contacts • CME/PDA • What’s coming and Questions 1
10/29/2018 Our Mission • Improve the quality of our patients’ lives by providing compassionate, state-of-the-art care. • Advance the field of perioperative medicine by – Generating new knowledge – Educating the next generation of leaders in anesthesia – Driving expansion, improvement, innovation, and integration across the system of perioperative care delivery. • Support personal and professional development and fulfillment for Department members. Beth Israel Deaconess: Today Our System Today A premier, $2+ billion academic health system including BIDMC and 3 community member hospitals 1,500 member faculty practice through Harvard Medical Faculty Physicians 6 additional affiliated hospitals 2,600 physicians in BIDCO Affiliated Physician Group Strategic partnerships with Atrius, Joslin & Hebrew SeniorLife Why BID + Lahey Health • Our missions are aligned • We share the same values • We complement one another • We will secure and strengthen our legacies • We can be transformative together 2
10/29/2018 Combined Scale: BID + Lahey + NEBH + MAH + AJH Metric / Statistic NewCo Operating Revenue $2,263 M $2,091 M $254 M $449 M $156M $5,213 M Hospitals 4 6 1 1 1 13 1,035 960 118 192 140 Beds 2,445 Physician Network Adult PCPs 519 336 N/A 85 44 984 Specialists 1,875 1,092 92 400 137 3,596 Total 2,394 1,428 92 485 181 4,580 Notes and Sources: BIDMC includes BIDMC, BID ‐ M, BID ‐ N, BID ‐ P, and APG; BIDMC 2017 budget; Lahey 2017 budget. NEBH 2017 budget; MAH 2017 budget; NEBH staffed bed count from 2016 CareGroup filing; MAH staffed bed count from 2016 CareGroup bond filing. MAH physician count from MACIPA website and physician directory. AJH physician count from AJH website – includes BIDCO numbers previously represented in the BIDMC/BIDCO column. NewCo+ revenue does not include HMFP Our Department • BIDMC – 39 ORs – Numerous remote sites – 16 Labor and Delivery suites – 41 ICU beds • BID Needham • BID Milton- OR and ICU • BID Plymouth- OR and ICU • Anna Jaques - OR • Ambulatory sites • Pain- AWPC, Spine Center, BIDN, BIDM, Chestnut Hill, Chelsea, Lexington Department Structure Chair Chair Chief Administrative Chief Administrative Executive VC Executive VC Officer Officer VC VC VC VC VC for Operative VC for Operative VC VC VC VC Divisions Divisions VC of Research VC of Research Anesthesia Anesthesia Education and Faculty Education and Faculty Perioperative Medicine Perioperative Medicine Quality Improvement Quality Improvement Faculty Development Faculty Development Development Development and Innovation and Innovation East Campus Director East Campus Director CARE CARE Residency Program Residency Program Director of PAT Director of PAT Director of Innovation Director of Innovation Director Director West Campus Director West Campus Director Director of Patient Director of Patient Fellowship Directors Fellowship Directors Safety Safety Chief Milton Chief Milton Medical Student Medical Student Director of Director of Education Education Informatics/IT Informatics/IT Chief Needham Chief Needham Internship Internship Chief Plymouth Chief Plymouth Chief AJH Chief AJH 3
10/29/2018 Department Staff 2010 2012 2014 2016 2018 Faculty 70 81 86 89 107 Research Faculty/Staff 21 23 17 24 37 CRNAs 10 15 21 37 38 Fellows 11 15 14 15 23 Residents 54 54 54 54 54 Interns 3 6 6 6 12 Nurse/PA/MA 15 17 17 24 32 Engineers/IT/Techs 18 19 19 28 29 Administrative 30 31 31 31 54 Totals 232 261 265 308 386 66% increase over 8 years Faculty Development Faculty Affairs Taneshia D. Pina Matthias Eikermann, MD Susan Kilbride Nora Mc Carthy Letisha Phillips Project Administrator Administrative Coordinator Vice Chair, Faculty Affairs Administrative Director Project Administrator Credentialing, Privileging Faculty Affairs Professor of Anaesthesia Faculty Affairs Faculty Affairs and Recruitment and Recruitment and Enrollment 4
10/29/2018 Grand rounds lectures Opportunity Grand Round lecture series • Target audience: Attending physicians, residents, CRNA, research staff. • Focus on anesthesia and perioperative medicine. • Every Wednesday Morning 7-8 AM • CME credit • Streaming to BIDMC affiliated hospitals • O t iti t t/ t Grand rounds agenda topics Opportunity Grand Round lecture series • Division specific aspects: Cardiac, vascular, thoracic, vascular, obstetrics, pain, critical care. • Important topics across Divisions: Faculty development, research, QI, management, inter-professional relations. Faculty affairs - Discussion • Professional growth • Mentorship • Lecture series - Case presentations - Guidelines - Clinical pathways 5
10/29/2018 Quality, Safety, Innovation and Information Technology Quality, Safety and Innovation World ‐ class standards & processes measurably enhance individual and organizational value Satya Krishna Ramachandran, MD Associate Professor of Anaesthesia, Harvard Medical School Vice-Chair for Quality, Safety, Innovation and Informatics Department of Anesthesia, Critical Care & Pain Medicine skrama@bidmc.harvard.edu Define & Measure Quality Structure Process Outcome How well do we perform How well do our How well does our the process of patient system allow us to patients fare during care? deliver high quality safe or after our care? care? Ext/Int standards Procedural Technical outcomes (e.g. TJC,CMS,DEA) Non-procedural Functional outcomes Compliance Outcomes that matter! 6
10/29/2018 Health Care Quality Dimensions Six Aims of Quality Six Dimensions of Seven Pillars of Quality Management Quality Donabedian 1990 IOM 2001 Bengoa 2006 Efficacy Effectiveness Effective Effective Efficiency Efficient Efficient Optimality Acceptability Patient Centered Patient Centered Legitimacy Equity Equitable Equitable Accessible Safe Safe Timely Define & Measure Quality Outcome Challenge for Quality Systems Individual Structure Process Organization What Outcomes? Outcome 7
10/29/2018 Objectives Ambition: World-class standards & processes that measurably enhance individual and organizational value • Describe the framework for implementing a network-wide Quality, Safety and Innovation (QSI) program • Discuss the critical steps involved in achieving this ambition Organizational Excellence - I 1 ‐ Year Objective: Framework for site ‐ level Q&S assessment is in place Critical Measures: 1. Priority Q&S outcomes (safety, efficiency and effectiveness) and relevant process measures are defined for each site 2. Site directors identify and discuss barriers for performance of high quality and safe care 3. The policies, guidelines and standard operating procedures are defined and accessible across all operating sites Sample Workflow for Event Review QA Concern Review Closed Confidential Discussion: QA Committee & Secured Provider & Division Head Discussion Senior Review Subcommittee 8
10/29/2018 Professional Standards Organizational responsibility: 1. Defining measures of competence – FPPE/OPPE 2. Determining SOC/reasonable care standards for AE 3. Defining domains and concepts of excellence 4. Culture of respect – supporting individual quality journeys Individual responsibility: 1. Reporting AE and close calls 2. Participate in critical site and network training 3. Commit to respect, learning environments and organizational goals 4. Present AE to group at M&M/protected forums Organizational Excellence - III 3 ‐ Year Objective: Continuous learning environment framework in place Critical Measures: 1. Established process for Q&S assurance is functional 2. The individual and departmental all ‐ payer performance improvement (PI) dashboards are active 3. Performance improvement teams are active at sites 4. Integration of patient and family perspectives in CQI Tracking Relevant Outcomes 9
10/29/2018 Project Communication Project Communication Organizational Excellence - V 5 ‐ Year Objective: Dynamic benchmarking of Perioperative Q&S measures and processes across multiple hospital systems in the network Critical Measures: 1. Daily feedback delivered to the site chiefs on interactive dashboard 10
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