Issue link: https://beckershealthcare.uberflip.com/i/1446606
35 QUALITY IMPROVEMENT & MEASUREMENT Q: When did the hospital begin implementing this frame- work of thinking? SE: We started, actually, during the pandemic. So we started it in the summer of 2020. We had a little bit of bandwidth, and because we had a lull in cases. Our intention actually was to do this much earlier in the year, but of course we had to contend with the acute surge in the New York metro area. But we knew that despite the pandemic, we had to get ahead of this because we saw our hospital-acquired infections go up significantly, you know, during that time, during those very difficult months, March through May of 2020. And so we had a baseline when I got there this summer before, that wasn't where we wanted to be, and it got even worse. So we knew we had to take quick action. And we did, and I think we're seeing the results now. Q: How would you say the pandemic has affected quality improvement work? SE: The pandemic highlighted the importance of solving these problems, because so many of them got worse. But it also made us a stronger team. The fact that we had to band together — it was a life or death situation for so many patients, and unfortu- nately, for so many staff because we did have employees die as well, from the disease. That, you know, we've essentially set aside our differences internally and became a very, very strong team during the pandemic — one of the few silver linings, I would argue. That really enabled and motivated us to make progress here because I knew that if we didn't initiate this, we would have people with significant morbidity or even mortality from these hospital acquired conditions. And so you know, people under- stood that this hospital was responsible for so many lives saved. But we're reminded that if hospitals don't focus on these issues, we can actually be the cause of problems, and so I think that motivated so many of us to engage. Q: What are your top priorities for patient safety and quali- ty improvement at the hospital in 2022? SE: Our top priority this year is around two things. e first is continuing our progress with CLABSI. We have room for improve- ment there even though we've made substantial reductions. But then also looking at patient experience. Patient experience suffered during the pandemic period for obvious reasons. We couldn't do the normal scope of things that we do because the system was so stressed to make sure the patient experience was optimal. So we've launched something called our AIDET initiative, which is an acronym that essentially makes sure that whenever people com- municate with patients, they do so in a scripted way that allows for everything from an introduction to acknowledgement of the pa- tient and their condition to explaining the duration of what they're going to expect in terms of next steps in their care. It makes sure you don't miss anything when you're talking to patients and that communication is enhanced. We did an A3 analysis on why our HCAHP scores were not where we wanted them to be, and found that communication across the board, from clinicians to patients, was the major issue. We are also focused on health equity as a major piece of our quality improvement efforts. It's not just understanding how many prevent- able infections you have. ere's also the task of stratifying that by race, ethnicity and gender to understand how much implicit bias is factoring in and how much structural issues around equity can impact quality as well. And so we're in the beginning of that journey, but very informative and important to do that as well. Q: What advice do you have for other healthcare leaders looking to reinvigorate quality improvement efforts after the pandemic? SE: I've heard a lot of leaders say that, you know, because of issues around staffing and morale, that it's hard to focus as much on quality improvement and lean transformations like the ones we've insti- tuted. And I think we have a counterexample here in our hospital where, by virtue of engaging people through our quality improve- ment efforts, we are actually improving morale, because people feel like they have agency, they feel like they're a more central part of the mission. And so it's not just the imperative to improve quality and safety, which is the most important reason to do it for our patients. But it can be a tool to better engage your employees and improve morale in and of itself. n US to bolster maternal outcomes initiatives By Erica Carbajal A s part of a comprehensive plan to reduce maternal mortality and morbidity in the U.S., the White House is urging all states to provide postpartum coverage for one year through their Medicaid programs. The plan, released by President Joe Biden and Vice President Kamala Harris' administration Dec. 7, is a "nationwide call to action to both the public and private sectors to help improve health outcomes for parents and infants," according to a White House statement. The administration is encouraging all states to expand postpartum coverage from 60 days to 12 months as part of the effort, and CMS will release new guidance to support states in doing so in April. The statement also highlight- ed a new HHS report that estimated about 720,000 more people would get a full year of postpartum coverage if all states adopted the expansion. As part of the nationwide effort to improve maternal health outcomes and reduce pregnancy and childbirth complications, CMS is also planning to create a "Birthing-Friendly" hospital designation, which would mark the first-ever HHS quality designation dedicated to maternity care. Hospitals participating in a federal collaborative program to improve maternal out- comes would receive the designation. Additionally, the White House said it will invest $3 billion in maternal health as part of the proposed Build Back Better Act. n