When the Alabama Hospital Association (AlaHA) joined forces six years ago with other state associations across the country under the umbrella of the American Hospital Association (AHA), they became recipients of a grant for hospital quality improvement, enabling them to hire a staff person to work with their member hospitals. As a result, Alabama has led the national program in reducing falls, Clostridioides difficile (C.diff) and central line-associated blood stream infections.
The national Hospital Improvement Innovation Network (HIIN) includes more than 75 percent of Alabama's hospitals. 42 are in the AlaHa HIIN, while other hospitals participate with the help of other providers. AlaHA leads the largest section for the state, but all participating hospitals work collectively on quality improvement efforts.
Rosemary Blackmon, executive vice president and chief operating officer of AlaHA said all Alabama hospitals have access to the AlaHA resources. "Because we are a state association, we share any meetings or resources we have with all our hospitals, even if they aren't in our HIIN. The vast majority of all Alabama hospitals are doing some type of coordinated or collaborative improvement work," she said.
The effort began through the Centers for Medicare and Medicaid Services (CMS). In this round of funding, their goals included a 20 percent reduction in all causes of inpatient harm and a 12 percent reduction in readmissions.
"The readmissions goal comes with its own set of difficulties," Blackmon said. "Part of the problem is that some patients don't have the resources they need to get back to the doctor or to take care of themselves. It's a tough nut to crack, but we've made some progress. The fact that CMS has set big goals has pushed hospitals to do some great work."
The AlaHA has used the grant funding to hire Margaret Borders as quality director to oversee the effort. The CMS outlines goals and areas for improvement. Those areas include reducing hospital acquired infections, sepsis, reduction of falls, pressure ulcers, adverse drug events, reducing readmissions, C. diff, ventilator conditions, and reduction of surgical site infections.
By joining forces with the AHA, Alabama has access to resources from across the country. "We've brought subject matter experts in to the state for regional meetings on various topics, and taken them to physician grand rounds," Blackmon said.
Margaret Borders also checks in with AlaHA HIIN hospitals once a month. In their monthly coaching call, she is able to review their current data for various measures and pinpoint opportunities for improvement efforts. When necessary, she has been able to arrange subject matter experts to call or visit individual hospitals to address issues specific to their concerns.
In addition to the conference calls and individual site visits, the program provides resources for regional meetings, webinars and a listserv of 1600+ hospitals nationwide. "Alabama hospitals can post a specific problem on the listserv and a hospital in Texas or Colorado or Louisiana might be able to send them the policy they are looking for," Borders said. "The HIIN has been saved CMS nine dollars for every one dollar spent on the national project in prevented harms."
The AlaHA has also used the grant money to fund two programs, a quality residency program and infection prevention boot camp.
"We see a generation of quality and IP leaders who have spent decades mastering valuable job skills, and are now ready to retire," Borders said. "With some of them serving as mentors, these programs help fill in the gaps that would be missing from a quick two-week hospital orientation. Some smaller hospitals only have one person filling these roles, so when their predecessor leaves, they don't have a lifeline for help. Our programs not only provide needed education, but also a chance to meet mentors who will continue to support them for years to come."
The quality residency program is a 10-month program that meets every other month for two days, while the IP boot camp is six in-person sessions with two webinars. "The quality residency program is a very comprehensive program with proven practices and things residents need to be reporting. A lot of these measures are tied to performance. If they don't know how to report them, it can drastically reduce their Medicare payments," Blackmon said.
Funding for the current cycle of the grant ends this month, and AlaHA is waiting to hear whether funding will be renewed, although they expect it will be. Updated data on the areas targeted for improvement will be published in April, but Borders is confident that Alabama hospitals will continue to lead in key areas and show progress in their efforts. "The success of a program like this is collaboration. Silo efforts of hospitals are in the past. Today all hospitals want to share best practices for everyone to provide the best care for our communities," she said.