Federal Employees Health Benefits Program

Health Partners Patient Safety Initiatives

Best practices and innovations
HealthPartners’ promise to our members and patients is clear: "You will be safe in our care."HealthPartners’ aim for our health care system is clear: "Eliminate the harm our patients and members experience." Our commitment starts at the top with an enterprise-wide patient safety plan. Executives throughout the HealthPartners family of care, which includes our owned hospital, Regions Hospital, have formed the HealthPartners Leadership Group on Safety and Errors in Medicine. They are working on developing the infrastructure we need within the organization in order to improve patient safety.

HealthPartners' promise to our members and patients is clear: "You will be safe in our care." HealthPartners' aim for our health care system is clear: "Eliminate the harm our patients and members experience." Our commitment starts at the top with an enterprise-wide patient safety plan. Executives throughout the HealthPartners family of care, which includes our owned hospital, Regions Hospital, have formed the HealthPartners Leadership Group on Safety and Errors in Medicine. They are working on developing the infrastructure we need within the organization in order to improve patient safety. The Leadership Group has developed three goals to guide our overall efforts. HealthPartners aims to reduce by 50 percent enterprise-wide the number of:

1. members reporting any medical mistake for their family in the past year
2. patients reporting any medical mistake during a recent hospital stay
3. members reporting a prescription error in their family in the past year

Engaging our patients and members
HealthPartners has many safety-related features, hotlinks to local and national safety sites and important quality and patient safety information for consumers online at healthpartners.com (search: safe). We frequently feature safety-oriented topics in our publications for members and patients. And regionshospital.com is currently developing a consumer-oriented safety site. HealthPartners also encourages the hospitals in its network to use the excellent patient brochures and videos developed by the Minnesota Alliance for Patient Safety (MAPS).

Advancing patient safety among HealthPartners' network hospitals

• HealthPartners successfully supported the 2003 legislation on Adverse Health Care Events Reporting. We expect each hospital to have policies and procedures for each "Never Event," and to track and voluntarily report any occurrences.
• HealthPartners' Pay for Performance Program, an innovative approach to measuring and rewarding superior performance, requires customized patient safety and quality goals in each hospital's contract.
• We encourage our contracted hospitals and medical groups to implement electronic prescribing systems via incentives, rewards and education.
• Through the Centers of Excellence Program, HealthPartners systematically evaluates and designates transplant programs within the network based on best care.

Advancing patient safety through our pharmacy efforts

• HealthPartners providers have access to ePocratesRX, a personal digital assistant (PDA)-based system that provides general drug information, side effects and interactions.
• HealthPartners Clinics providers use our automated medical record to order and monitor prescriptions.
• Through HealthPartners' distinctive polypharmacy program, pharmacists evaluate a patient's medication regimen for potential interactions, complications or other problems.

Advancing patient safety at Regions Hospital

• Regions Hospital has adopted a "No-Divert Policy," and set the goal of having a bed available for all medical/surgical patients who need to be admitted. Since implementing this in March 2003, the hospital has decreased the amount of time it had to divert ambulances to other hospitals by 94 percent!
• JCAHO has adopted new requirements for accreditation, leading to new patient safety procedures. To improve the accuracy of patient identification, the hospital is requiring that providers confirm that the name on the patient's armband is matched against a second ID. To improve the effectiveness of communication among caregivers, new hospital policy requires employees to repeat verbal orders back to the physician.
• Board & Executive Safety Rounds - Furthering their commitment to safe care at Regions Hospital, board members and top executives from both HealthPartners and Regions Hospital make Medical Safety Rounds each month. They ask employees and patients about their recent experiences and ideal patient safety practices. The discussions are confidential and purely for improvement. The units visited receive feedback, and suggestions are acted upon.

Leading significant change

HealthPartners actively collaborates with health care organizations, government agencies, accreditation organizations and patient safety organizations to improve the care we deliver to our members. Some examples include the Institute for Clinical Systems Improvement, Minnesota Alliance for Patient Safety and the Patient Safety Committee of the Minnesota Hospital and Healthcare Partnership. HealthPartners Government Relations department also works to encourage standardized reporting and promote state-level policy changes that enable non-punitive self-reporting.

HealthPartners is a member of Leapfrog, a national consortium of large employers concerned about the quality of care in hospitals. HealthPartners has long advocated best care practices and safety improvement measures. We are proud to be an active member of The Leapfrog Group.

Regions Hospital and HealthPartners are active participants in "Safest in America," a community-wide collaborative working toward making the Twin Cities the safest place in America in which to receive hospital care. Its goal is to reduce the harm to patients resulting from medical errors. Regions Hospital has fully implemented the group's recommendations for safe-site surgical marking and medication safety.

Safe-site surgical marking
Safest in America aims to eliminate harm in surgical patients due to incorrect surgical procedures, incorrect operating sites or misidentification of the patient. Regions Hospital adopted all four recommendations on May 1, 2003, including using a standardized process for identification of the correct surgical site, level or segment of the body part and intended procedure.

Medication safety
Safest in America also aims to eliminate all harm in participating hospitals related to dangerous medication ordering abbreviations, identified medications at risk for pediatric dosing errors and one or two selected high risk drugs. It also agreed to identify the best of the best practice recommendations currently used in participating hospitals. Safest in America developed a list of unsafe prescribing practices and abbreviations, which is common to all organizations, and implemented a common, standardized "recipe" for compounded pediatric medications.

Satisfaction surveys
HealthPartners has established a safety measurement strategy aimed at understanding its members' perception and experience with hospital, primary and specialty care. Patient surveys are conducted on an annual basis. Members are asked if they have experienced a medical mistake, and if the mistake "caused harm." Mistakes are defined as:

• Wrong diagnosis
• Wrong treatment
• Wrong prescription
• Wrong procedure or operation or one that was done incorrectly
• Any other type of medical mistake (please specify)

In 2003, an additional question "Did you feel the mistake caused you harm" was included.

Comparative results are shared with health care leadership.

HealthPartners goes high-tech to get a healing touch
On April 10, 2003, HealthPartners and Metropolitan State University opened the first ever patient-simulation center in the United States. The HealthPartners Simulation Center for Patient Safety at Metropolitan State University uses high-tech teaching tools to train caregivers of all types in near-realistic conditions.

Current teaching practices for most universities and hospitals involve residents and nursing students learning their crafts while practicing on each other or real patients. The center features human-patient simulators and a number of specific simulations, allowing health care professionals to practice almost any procedure or process over and over without putting anyone at risk.

Commitment to hospital safety
HealthPartners is committed to seeking the best quality and safest care for our members. We work with hospitals to insure that they are committed to not only providing care but doing so in a safe and high quality manner.

HealthPartners uses a committee of health care professionals, entitled Hospital Initiatives in Quality and Safety, to bring together all our hospital-related initiatives and focus our efforts on measurement and results. The committee for hospital initiatives in quality and safety focuses on the following core areas:

• Establishing the priorities for our hospital pay for performance criteria
• Administering our hospital report card
• Administering our patient satisfaction surveys
• Measurement processes that create relative comparisons between hospital providers

All of the hospitals with payment for performance criteria in their contracts with HealthPartners are required to have at least one measure related to patient safety and many have more than one. Some examples of our safety measurements are:

• correct site surgery markings
• elimination of the use of dangerous medication abbreviations
• significant reduction of patient deferrals from pediatric hospitals to nonpediatric facilities
• significant reduction in the cases of ventilator associated pneumonia
• implementation of computerized physician order entry.

Typically a hospital has two percent of their total payments at risk based on pay for performance as a whole and a significant portion of this is tied to performance on patient safety measures. While the percentage at risk is typically lower than the percentage that would be at risk for a medical group, it represents significant dollars. For example, just one hospital system may have annual revenue from HealthPartners of $100,000,000 or more. With a pay for performance percentage of two percent, $2,000,000 would be at risk.

Patient safety indicators
HealthPartners has begun working with the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (http://www.qualityindicators.ahrq.gov/) to determine if they will be helpful in improving safety for HealthPartners members. The Patient Safety Indicators (PSIs) were developed by AHRQ as an accessible and low-cost screening tool to help organizations identify potential problems in patient safety and target promising areas for in-depth review. HealthPartners has applied the AHRQ algorithms to two years of administrative data (2001 and 2002) to calculate the indicators for our population.

We have also used information from Zhan et al. (Excess length of stay, charges, & mortality: Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003 Oct 8;290(14):1868-74.) to estimate the effect of potential safety issues in our population in terms of excess length of stay, excess charges, and excess mortality.

We next plan to work with Regions Hospital to conduct chart audits of potential safety issues. This process will help us assess how accurate the claims-based algorithms are in our population. If the measures appear to provide accurate indicators of safety issues in our population, we plan to monitor the indicators at a plan level over time We also will consider setting up a notification system to share this information with hospitals so they can follow up with appropriate steps to reduce errors and potential harm to our members.

Health Plan Safety Accomplishments - 2003

Goal: Support care delivery systems by establishing standards and expectations for improvements in safety

• Held second annual E-prescribing conference for medical groups with 45 attendees from 15 different care systems
• Surveyed provider groups on progress related electronic prescribing
• Finalized provider policy on Medication Sampling; included in provider administrative manual
• Implemented Severe Drug interaction program through our pharmacy benefit manager, PharmaCare; alert sent by PharmaCare to prescribing practitioner when potential for a severe drug interaction is identified
• Sponsored a forum on strategies for preventing medication errors and the role of self-assessment and empowering patients through consultation for our pharmacy provider network with 71 attendees
• Successfully negotiated Pay for Performance in contracts for all metro hospitals (but one) and always included at least one safety measure
• Included Leapfrog reporting in hospital quality tiering methodology
• Incorporated safety language in hospital contracts
• Developed "Pay only for Appropriate" care initiative to implement changes in hospital payment based on safe and quality care of patients.
• Monitored Leapfrog website and evaluated status of contracted hospitals related to Leapfrog standards

Goal: Establish safety measures and report results to members and providers

• Included safety indicators in Hospital Report Card
• Set a new goal: 50% reduction in harm as defined by the patient
• Shared unblinded patient safety survey results with hospitals
• Analyzed safety indicators/initiatives for credibility, validity and effectiveness (Leapfrog, Mortality, AHRQ)
• Produced health plan rates for the AHRQ Patient Safety Indicators and began to explore potential use with hospitals (Regions)
• Shared non-qualified admission and facility delay data with hospital leadership

Goal: Educate plan members to perform their appropriate role regarding safety

• Offered HealthPartners DistinctionsSM Plan to HealthPartners employees which presents a tiered network based, in part, on safety
• HealthPartners NewsLink, an employee newsletter, featured enterprise-wide safety initiatives in May 2003

Goal: Work collaboratively with government and private groups to improve safety

• Joined the National Quality Forum
• Participated in the Minnesota Hospital Association Patient Safety Committee and Co-chaired the Self-Assessment Guide subgroup
• Supported successful "Never Event" Legislation (Minnesota Adverse Health Care Events Reporting statute)
• Facilitated Safest in America (SIA) collaborative
• Supported successful implementation of SIA Safe Surgical Marking and Error Reporting initiatives in ten participating hospitals
• Opened the HealthPartners Simulation Center for Patient Safety at Metropolitan State University, which uses high-tech teaching tools to train caregivers of all types in near-realistic conditions using human-patient simulators

Goal: Conducted research projects to understand and improve safety

• AHRQ-funded study of drug-drug interaction rates and lab monitoring deficiencies for medications (Medgroups)
• AHRQ-funded study of how to reduce diabetes care treatment omissions (MOVES)
• Study of patient survey responses about medical errors they have experienced
• Study of prescribing safety during pregnancy
• Centers for Education and Research on Therapeutics (CERT) study of prescribing errors in high-risk patient populations
• Ongoing major Vaccine Safety Datalink (VSD) study in collaboration with other health plans
• Study of the association of working conditions with prescribing errors