The learning collaborative is a tool by which large numbers of hospitals are able to share ideas and accelerate the implementation of evidence-based practices. The Southern California Patient Safety Collaborative (SCPSC) will meet on a quarterly basis to exchange tips and strategies to overcome barriers and expedite the deployment of state-of-the-art practices. Based on experience with other learning collaboratives, participants report significant breakthroughs when they learn using this model.
After extensive input, we created 2 separate "Tracks" of interventions. We will start Track 1 in November and Track 2 will start in April to run concurrently.
Track 1: Reducing Healthcare Associated Infections
- Implement the Surgical Complication Improvement Program (SCIP)
- Reduce Ventilator Associated Pneumonia (VAP)
- Reduce Central Line related Blood Stream Infections (CLRBSI)
- Reduce mortality from Sepsis
Track 2: Reducing Medication and Other Errors
- Reduce medication errors from high-alert medications
- Improve medication reconciliation
- Reduce patient identification errors
- Reduce pressure ulcers
Yes! A number of the interventions are directly measured in CHART, CMS and JC reporting, such as the VAP process measures, components of the SCIP and reducing pressure ulcers interventions. Other interventions, like sepsis mortality reduction, will have a major impact on the ICU mortality measure reported in CHART. Still other interventions, like medication reconciliation, patient identification and high-alert medication management are components of National Patient Safety Goals required by the Joint Commission. The interventions align nicely with other state and national initiatives, and will also help reduce hospital acquired infections which is a hot topic in the California state legislature.
In addition to meeting their quality and patient safety colleagues from HASC hospitals and sharing ideas on how to improve care, participants will be able to accelerate how quickly they implement practices and improve performance. Each meeting provides dozens of ideas that other hospitals have successfully tested and implemented. Also, the Collaborative will provide direct training on proven techniques that rapidly improve implementation and can be used in other settings or other projects. In other words, we provide both practical ideas AND improve the capacity to implement them. Phrases that describe the process include "All teach, all learn" and "Steal shamelessly".
Regional learning collaboratives are successful at supporting hospitals because they utilize key components not available elsewhere:
- Participating hospitals bring a wealth of experience to groups that have previously never "cross-pollinated". A common occurrence is that substantial professional networks are created and expanded during the collaborative process.
- Since the meetings are local, the time away from the hospital is minimal and various hospital staff can attend.
- The project is financially supported by the UniHealth Foundation and Blue Shield of California Foundations; as a result program registration and materials are complementary. Hospitals may have to pay parking fees depending on the venue.
- The size of the group is limited to provide a critical mass of new ideas to test in an intimate and trusting setting where participants can speak freely and easily share ideas.
- Hospitals can learn new ways of trying to solve vexing problems from others. This also helps with implementation when a hospital can tell its staff and physicians that a similar hospital was successful using a certain approach.
- The meetings are highly interactive and focus on practical solutions, things you can try immediately in your facility. Theory and research underpin the method, but are not part of the content and discussion of the program. The focus is on information you can use immediately.
- External "experts" are used sparingly since solutions often require local modifications or they require significant translation (e.g., teaching hospital approach is different than community hospital approach).
Most hospitals will want to attend most of the quarterly in-person meetings and monthly web conference calls, but may send different representatives depending on the intervention being addressed. These sessions are highly interactive and full of practical tips, so in our experience attendance is quite high and over 90% of participants describe their experiences as very good or excellent.
Because the meetings are local and easy to attend on the same day, most hospitals will send 2-3 staff for a day 4 times a year. The monthly web conferences are 1 hour in length. Of course, the time spent testing the suggestions and ideas you learn at the meetings is up to each hospital. Still, hospitals who participate in learning collaboratives elsewhere tell how much more efficient this time is because they don't try unsuccessful strategies and short circuit major challenges. So by accelerating implementation, staff are actually freed up to address other pressing priorities.
The Collaborative is very sensitive to the multiple data demands hospitals are under and the significant manpower those demands require. We limit voluntary data requests to data hospitals are almost always already collecting (e.g., number of central line infections) and make it valuable to submit. We plan to report de-identified collaborative wide progress so hospitals can anonymously benchmark performances and observe improvement. We do not anticipate hospitals will need to develop significant new data collection methodologies to receive the value in tracking performance improvement.
In our experience, the use of specific quantifiable aims and tracking performance against them are crucial for rapid improvement. And when you can track your results anonymously against neighboring hospitals, hospitals tend to improve more quickly. Also, we found most hospitals don't mind sending simple data already collected for other purposes if they get useful information in return and can see the results of their progress. It also tells us where we need to focus to help the entire group performing at high levels.
SCPSC is a partnership of the National Health Foundation (NHF), Hospital Association of Southern California (HASC) and Convergence Health Consulting, Inc. (CHC). The work is supported by grants from the UniHealth Foundation, Blue Shield of California Foundation, and California HealthCare Foundation. NHF and HASC provide the operational and meeting infrastructure, communications and coordination with the participating hospitals. CHC provides the clinical content and meeting facilitation using nationally accepted evidence based practices.
CHC is an independent consulting firm with senior clinical leaders that has been working with learning collaboratives since 2000. CHC has successfully led similar programs for several years in Washington State and the Bay Area and is nationally recognized as an expert in quality improvement and change management. The clinical team for SCPSC includes Bruce Spurlock, M.D., Rocky Fredrickson, M.D., Pat Teske and Pat Vasko all senior clinicians who have worked at the national, regional and state level.