The Safety Net Institute is in the midst of a strategic look at how it can best support its members – California's public hospitals and health systems. It is a time to pause and reflect -- revisiting assumptions and positing new directions.

However, ongoing SNI activities are in full throttle. Some members are engaged in our Lean learning community; some in our "Language of Caring" patient experience program. Most members are participating in our SEPSIS/CLABSI learning community and all members participate in the DSRIP program. Just like our members, our day-to-day work continues even in the midst of internal improvement initiatives!

Nancy Oswald, PhD
Interim Executive Director
California Health Care Safety Net Institute

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Thanks to matching funds from the California HealthCare Foundation (CHCF), three member hospitals (Alameda Health System, Contra Costa Regional Medical Center and San Mateo Medical Center) are wrapping up year 1 of the Embedding Lean in Public Hospitals initiative. Over the course of the year, more than 150 executives and managers were trained to use and apply Lean methodology. Improvement events (Kaizens and Value Streams) are underway in the emergency department, psychiatric inpatient and emergency services, pharmacy, adult orthopedics, ambulatory care clinical workflow, revenue cycle, operating room and new patient access, just to name a few. SNI has fostered the sharing of ideas and best practices through bi-monthly Lean Learning Community calls.

The work was bolstered by the opportunity CHCF provided for leaders from five member hospitals to attend site visits at several of the premier Lean health care institutions in the country. Twenty-five executives and leaders recently visited Denver Health, Virginia Mason and ThedaCare. Inspired by the site visits, there is a collective interest in developing leader standard work at all levels of the organization and improving business management systems. Fortunately, there will be an ongoing opportunity for member hospitals to continue their Lean work jointly as CHCF has recently released the RFP for year 2 of the Embedding Lean in Public Hospitals initiative.

Contact: Denise Gonzalez, MD

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California's public hospitals are coming to the close of the third year of the California 1115 Medicaid Waiver's Incentive Program (DSRIP). Through the DSRIP, all of California's public hospitals and health systems have taken on significant, multiple and simultaneous initiatives aimed at improving access, quality and care coordination for the patients they serve. Further, the DSRIP has fostered collaboration and shared learning among the public hospital and health systems and academic medical centers. With the first two years of the program focused on making investments to prepare staff and systems for change, laying the necessary groundwork and building a strong foundation, public hospital and health systems are demonstrating significant progress in supporting and driving needed change. This collaboration is expected to grow stronger over the remaining years of the program given the intense focus on population health and inpatient quality and safety measures in the coming years. These and other changes will well support public hospitals and health systems on the path to health reform over the coming months.

Contact: Nermeen Iskander

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Public hospitals and health systems engaged in SNI's Sepsis and CLABSI Collaborative, which is generously funded by the Blue Shield of California Foundation, have made strides to increase adherence with the central line insertion practice (CLIP) bundle and reduce the rate of central line blood stream infections (CLABSI). Many participating hospitals have implemented improvements to ensure adherence to the CLIP bundle, including the design of central line insertion kits and carts, development of electronic CLIP forms, creation of vascular access committees and dissemination of trainings and education to prevent central line infections. These improvement activities have resulted in public hospitals collectively achieving an 11.4% reduction in the unadjusted central line blood stream infection rate.

SNI will host two vascular access courses in May to continue sharing best practices and facilitating joint learning within the Collaborative. More information about the event is available on the SNI website.

Contact: Rosemary Phu

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For the past five years, SNI has collaborated with the California HealthCare Foundation (CHCF) on a major initiative to spread palliative care in California public hospitals. The results are described in the new CHCF publication In It Together: How Palliative Care Spread to All of California's Public Hospitals.

In 2008, prior to this initiative, only 22% of California public hospitals had palliative care programs, which focus on providing specialized, interdisciplinary care modalities aimed at enhancing the quality of life and relieving the pain and suffering in patients with serious illness. Today, a full 100% of public hospitals have in place a functioning palliative care service, giving care to over 4,000 patients per year. As part of the Initiative, and in response to the unique needs of many public hospital patients who are limited-English proficient, SNI is currently facilitating a Community of Practice for Interpreters in Palliative Care. The program provides a regular virtual meeting forum to the participating 22 interpreters where they can discuss common practice challenges, as well as learn and share resources and best practices in providing the language access in palliative care and end-of-life situations.

Contact: Boris Kalanj

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The goal of the CHCF Health Care Leadership Program is to improve the health of Californians by developing and sustaining a network of visionary, effective clinical leaders who will shape a more responsive and effective health care system. Since 2001, over 350 health professionals have participated in the program.

This rigorous part-time, two-year fellowship addresses essential leadership, management, as well as health practice and policy topics, including building and leading teams, forming political coalitions, using financial management tools, developing organizational strategies and goals, and investigating future trends, such as new technologies, changing demographics, and the social context of health care.

The fellowship is available to clinically trained health care professionals who live and work in California and currently serve in management or leadership roles.

The CHCF Health Care Leadership Program is sponsored by the California HealthCare Foundation, which covers most of the costs. A program fee of $2,500 per year or $5,000 over the course of the fellowship will be paid by the fellow's employer/organizational sponsor.

Full and partial fee waivers are available to qualifying representatives of safety-net and non-profit organizations, educational institutions and governmental agencies for which this fee would present a hardship. Requests for fee waivers are due at the time of application submission and will not influence the selection process.

Applications: All applications are due May 15, 2013. You can find out more information about the program and start the process by completing the online application.

Contact: Denise Gonzalez, MD

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Videos featuring program descriptions of the 2012 Quality Leaders Awards winners, San Francisco General Hospital's Quality & Leadership Academy, and Harbor-UCLA's Reducing Readmissions for a High Risk Population, are now available for viewing on the SNI website. A QLA webinar series is also featured on the website, providing an opportunity to learn more about past QLA honorees and their various programs and approaches. Congratulations to all the QLA winners. The 2013 QLA application process will kick-off this coming July, so stay tuned for more information.

Contact: Nermeen Iskander and Sasha Morduchowicz

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Following a 2-day kickoff meeting last month, a group of 15 outpatient clinics from California public hospital systems began working together to achieve outstanding results in patient experience. The clinics form the SNI-led CG-CAHPS Improvement Network, a 9-month intensive effort to increase the skills of providers and staff to communicate empathy and caring, boost the clinics' mastery of quality improvement skills relevant to patient experience, and ultimately improve Clinician and Group CAHPS survey (CG-CAHPS) scores.

The group of clinics already has a solid foundation on which to build upon. 86% of their patients currently say their providers definitely show respect for what they had to say; and their staff currently rate an average of 7 out of the maximum score of 10 their likelihood of recommending the clinic as a place of employment to their family and friends. But the clinic leaders also realize there is room for improvement, particularly around effective and reliably respectful communication both with the patients and among the staff.

Through The Language of Caring, a skills-based curriculum rolled out via internal trainers over nine months, the clinics aim to strengthen the staff communication skills to ensure their caring and compassion is more effectively and frequently felt by their patients and colleagues. As part of the program, and supporting the development of evidence-based practice, each clinic has set specific improvement aims in both patient and staff experience measures, which it will strive to achieve through the end of the program in December 2013.

Contact: Boris Kalanj

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SNI is in the final year of the Information Technology Adoption Center (ITAC) program. Funded by the Office of the National Coordinator for Health Information Technology, ITAC serves as the Local Extension Center (LEC) for the California Health Information Partnership Services Organization, or CalHIPSO (for which CAPH is a founding member). Through this grant, ITAC works with California's public hospital systems by funding technical assistance to foster the adoption of electronic health records (EHRs) in ambulatory care and the achievement of meaningful use. Examples of technical assistance that ITAC has facilitated include project management, clinical workflow redesign, and training and education. To date, over $490,000 in direct technical assistance funds have been provided to enrolled hospitals.

Contact: Sasha Morduchowicz

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CAPH/SNI's Annual Conference, Leading the Way: A New Chapter In Healthcare, will be held this year on December 4-6, 2013 at The Meritage Resort and Spa in Napa, CA.

Stay tune for more details regarding registration, speakers and the conference agenda.

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