UPMC Center for
Quality Improvement and Innovation
UPMC believes that quality must be inherent in every aspect of care we provide to our patients.
The UPMC Center for Quality Improvement and Innovation provides quality improvement leadership, education, and support infrastructure to health care professionals across the system, in pursuit of excellence in care delivery. The Center’s core mission is to help ensure that UPMC provides the best possible patient care by increasing the pace of improvements in quality and disseminating best practices throughout the health system.
LEADERSHIP
The UPMC Center for Quality Improvement and Innovation is staffed by highly trained professionals who provide expertise and leadership to the health system in assessing, developing, implementing, and improving care delivery processes. The Center partners with hospital leadership and staff, providing tools and techniques to help identify and solve the problems inherent in today’s health care delivery environment.
The Center’s influence on care delivery throughout the UPMC can be seen in a variety of its successful quality innovations and initiatives, including:
Transforming Care at the Bedside (TCAB)
is a collaboration with the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation to improve care of hospitalized medical-surgical patients. As one of three hospitals selected by IHI/RWJ in a national pilot TCAB program, UPMC Shadyside led the development of a rapid redesign model to improve care delivery processes along a four-point framework: safe and reliable care, staff vitality and teamwork, patient-centeredness, and value-added processes. UPMC Shadyside has embraced TCAB as a care delivery improvement model, performing hundreds of “tests of change” since the inception of TCAB. Many of these changes have met with significant success and have been spread across all hospitals within the UPMC system, including Condition H (Help) and the Patient Controlled Liberalized Diet (see below). Both of these initiatives have been recognized nationally and internationally.
TCAB has been so successful as a model for care delivery redesign at UPMC Shadyside that it is being adopted in all UPMC system hospitals and within additional patient populations, such as ICUs and ambulatory service areas. All UPMC hospitals will be utilizing TCAB by January, 2008.
Condition H
is a rapid response team designed to be called by the patient or the patient’s family members when they notice a clinically significant change in the patient that is not being addressed by the care team. Condition H empowers patients and families by enabling them to focus medical attention quickly on potential problems.
Patient-Controlled Liberalized Diet puts the patient in control of food choices while in the hospital, even when on specialized diets. Giving patients both control and nutritional education empowers patients to make menu selections (thereby improving patient satisfaction) while at the same time giving caregivers the opportunity to provide individualized nutrition education in a more realistic setting.
Patient flow improvement is the goal of a system-wide effort, led by the Center in collaboration with hospital leadership, to significantly increase the efficiency and timeliness of patients’ journeys through the emergency departments, inpatient units, operating rooms, and procedural areas of UPMC on their way to transfer and/or discharge.
EDUCATION
A key function of the Center is educating staff and leadership across the system with regard to internal and external care delivery innovations and successful work redesign practices. Education is accomplished through several mechanisms:
The Quality website within UPMC Infonet provides information regarding upcoming quality-focused events, innovations from across the system, access to quality dashboards, regulatory information, resource links, and links to articles in scholarly journals by Center staff.
Learning communities launched by the Center provide system-wide educational opportunities on the topics of TCAB and patient flow. The learning communities provide a forum in which change leaders may teach new care delivery improvement approaches and skills, share innovative ideas, and foster the spread of successful work redesign processes across the health system. The two learning communities utilize periodic meetings, a website link, conference calls, and an e-mail list to share improvement ideas.
The Quality Symposium explores quality care topics through lectures by nationally known experts, learning laboratories, and poster sessions. Sponsored by the Center, the annual symposium is attended by more 400 UPMC physicians, nurse leaders, board members, executives and managers, and guests. The 2007 symposium, "The First Five Minutes," explored the actions health care providers take when patients first arrive at a health care facility and their impact on establishing appropriate patient care, promoting good clinical outcomes, and shaping favorable patient impressions.
SUPPORT
Improvement specialists from the Center partner with facility leaders to identify barriers to excellent care delivery outcomes and help redesign current processes. At any given time, the Center’s staff is involved in dozens of such partnerships at our hospitals and ambulatory care facilities. Examples of these activities include:
Acute inpatient rehabilitation enhancement focuses on UPMC’s seven locations for acute inpatient rehabilitation in the region. In order to more effectively identify patients who would benefit from inpatient rehabilitation, more quickly process their admission, and efficiently transition them from the hospital to the rehabilitation setting, several process changes were developed:
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enhancing the rehabilitation liaison role to provide earlier identification of potential patients, more efficient access to insurance authorization, and transportation to the receiving facility
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implementing a fully electronic rehabilitation referral form to standardize the information gathering function and better meet the needs of patients, receiving facilities, and regulatory agencies
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creating a centralized information repository and bed-processing function to eliminate duplicative work and more quickly find patients a rehabilitation bed
Care management redesign at UPMC Shadyside has enabled care managers to spend more time with patients, families, and physicians. The responsibilities of care managers formerly were divided into three major areas: care coordination, discharge planning, and utilization review (or insurance work). With insurance guidelines becoming more complex, the amount of the care managers’ days spent completing utilization review functions increased, reducing the time they could spend with patients, families, physicians, and caregivers. Separating the utilization review work from the care coordination and discharge planning has resulted in a 144 percent increase in time spent with patients and families, a 200 percent increase in time spent with physicians, and a 48 percent reduction in time spent on documentation.
The UPMC Center for Quality Improvement and Innovation has received generous support from the Jewish Healthcare Foundation, the Robert Wood Johnson Foundation, and the Shadyside Hospital Foundation.