HIIN builds on success

By Julius Karash

Faced with ongoing improvement work and beckoning opportunities, more than 4,000 hospitals around the country have joined together to improve care and increase collaboration through the Hospital Improvement Innovation Network.

HIIN was launched in September 2016 by the Centers for Medicare & Medicaid Services and was designed to build upon and accelerate improvements achieved by the Hospital Engagement Network program that ran from 2011 to 2016.

Contracts were awarded to 16 HIINs with the goal of achieving a 20 percent reduction in overall inpatient harm and a 12 percent reduction in 30-day readmissions by the end of 2019. The HIIN managed by the American Hospital Association’s Health Research & Educational Trust is the largest such network, with close to 1,700 hospitals participating. Along with the individual hospitals and health systems, 32 state hospital associations and six Quality Improvement Organizations/Quality Improvement Networks have partnered with the HRET HIIN. The HIIN contract allows HRET to provide education, technical and data assistance to the hospitals participating in the HIIN. HRET also facilitates the collection and development of best practices along with peer-to-peer networking opportunities for its participating hospitals.

“We are grateful for the opportunity to participate as a HIIN and are eager to assist our hospitals to better align, amplify and accelerate the improvements FEA_HIIN_Bhattalready made during HEN,” says Jay Bhatt, D.O., chief medical officer of the AHA and president and CEO of the HRET. 

The HRET’s HIIN participants are “looking to harness the innovations taking place in the field. The HRET is fostering an environment that encourages sharing and allowing innovative practices and evidence-based practices to flourish,” says Bhatt.

The HIIN program consists of a 24-month base period and a 12-month option year. Participants will focus on making improvements in a number of clinical areas, including reducing central line-associated blood stream infections, injury from falls, and catheter-associated urinary tract infections.

Building on the successes of HEN

The AHA/HRET HEN had a significant impact on reducing adverse patient incidents. Over its five-year time frame, the HRET HEN and HEN 2.0 prevented an estimated 127,000 patient-safety incidents and saved more than $1 billion. Contributing factors to HEN's achievements include improvements in the collection and use of data.

“When we first started the AHA/HRET HEN project in 2011, one of the major concerns hospitals had was about data and the ability to get needed data out of their electronic medical records,” says Charisse Coulombe, vice president of clinical quality for HRET. “We encouraged hospitals to send us any data they were collecting. Since then, we've internally improved our data collection and analysis, and hospitals have also evolved in their data collection. Today we are much more sophisticated when it comes to the data we are collecting and reporting.”

Mary Cooper, M.D., senior vice president of clinical services for the Connecticut Hospital Association, says Connecticut hospitals joined the HRET’s HEN and HIIN programs because their state has a “commitment to decrease preventable harm to zero. We are excited to have evidence-based practices that can be applied to our work.” 

Specifically, Cooper says, the AHA/HRET HEN program helped Connecticut hospitals to make improvements in such areas as reducing central line-associated bloodstream infections, catheter-associated urinary tract infections and incidences of infection with the bacterium Clostridium difficile. “We have instance after instance of improvements that we can trace directly to the implementation of HEN,” Cooper says.

Kendra Tinsley, executive director of the Kansas Healthcare Collaborative, says: “We're a very rural state. We're a fairly under-resourced state. Our hospitals are grateful for the educational resources that being part of the HRET HEN and now HIIN brings.” 

FEA_HIIN_TinsleyTinsley points to a specific example in Satanta District Hospital in southwest Kansas, where participation in the AHA/HRET HEN and now HIIN programs is helping to improve sepsis control in its long-term care unit.  

Ken Alexander, vice president of member services and quality improvement for the Louisiana Hospital Association, says, “The tools, the resources, the collaboration and the networking give hospitals the ability to improve the care they deliver.”

Alexander says participating in the HEN has helped to foster better communication among hospitals and other providers, resulting in reduced emergency department readmission rates. Hospitals in Lafayette and the surrounding region are now working together. “They have a guide they can go to, find out who delivers what service, who they should talk to at that home health agency or hospice or nursing home,” he says. “The end game and the major success is it's keeping the patients in the appropriate care setting.”

Opportunities

Alison Hong, M.D., senior director of quality and patient safety with the CHA, says participation in the HIIN can help hospitals to overcome the lack of resources available to accelerate improvements. “They're not re-creating the wheel, they go right to the evidence,” Hong says. “They can implement the best practices. They can tap into the resources of the HIIN that are available through the HRET and CMS, and through peer-to-peer networking.”

Cooper says HRET’s HIIN can help hospitals work around the difficulties they face when they try to make improvements on their own. “The HRET HIIN provides support from others across the state and across the country.

“Introducing innovation can be a barrier in itself. People are resistant to change. The power of many hospitals across the country making changes at the same time makes it easier for change to occur,” she says.

Bhatt notes that the HRET’s HIIN is focused on expanding the accomplishments of the HEN. “We plan to share evidence-based practices, create new best practices, shine a light through storytelling and inspire a new normal for hospitals, patients and their families,” he says.

Tinsley says it has been a “blessing to our state to be able to partner with the AHA and HRET. Frankly, I don't know what we'd do without them.”  

A plethora of programs

The HRET’s Coulombe highlighted two fellowship programs as important educational offerings unique to the HIIN. “Hospitals in our HIIN are able to identify staff to receive additional training with one of our partners, including the Institute for Healthcare Improvement. When the project is over, these fellows will have been trained by subject-matter experts to understand how to run effective quality improvement teams.”

Bhatt says HIIN principles, such as patient and family engagement, physician involvement and eliminating disparities, align with the broader work and mission of the HRET. “Patients and families are key members of any care team,” he says. “Their perspective and voice will enhance the care, mitigate adverse events, and help us to be the best we can in caring for patients, families and their community.”

Beyond the specific metric goals set by CMS, Bhatt says that one of his personal goals is to ensure the success of the HRET HIIN’s new Safety Networks to Accelerate Performance, or SNAP. “These are voluntary learning networks that will address emerging best practices related to HIIN topics. Early adopter hospitals will set forth bold aims and test new practices, using our improvement infrastructure to then evaluate the intervention so we can disseminate it to the field,” he says.

Bhatt also shared that the HRET HIIN also includes innovative programs, such as the UP campaign. UP is designed to simplify safe care and streamline interventions, reduce multiple types of adverse incidents with simple, easy-to-accomplish activities and consolidate basic interventions that cut across several topics to decrease adverse incidents. The campaign is made up of three components:

• Wake up: Reduce unnecessary sleepiness and sedation.

• Get up: Mobilize patients to return to function more quickly.

• Soap up: Implement appropriate hand hygiene to reduce the spread of infection.

“Our goal is to begin seeing these interventions firsthand in the field,” Bhatt says. “We want to see people using interventions that we know work to advance care and high reliability. And we want to be a go-to source for quality improvement and help to facilitate sustained improvements.”

Sharing good work

The HRET HIIN infrastructure encourages the sharing of good work in a variety of ways. Alexander points to the continuity of improvements in the continued Lean Six Sigma Green Belt certification training being offered to Louisiana hospital personnel. The training focuses on preventing falls and venous thromboembolism, and has led to significant improvements at Willis-Knighton Health System in Shreveport. “Data show significant reduction in harm in those two areas as a direct result of that training,” Alexander says.

Coulombe says HRET will use several platforms to tell the HIIN story and demonstrate the commitment of hospitals to continuous quality improvement, including the website www.hret-hiin.org, a Twitter feed using the hashtag #WhyImHIIN and best-practice videos on YouTube.

“We are doing interviews and spotlighting the HIIN successes across the country,” Coulombe says. “We have seen evidence that when hospitals share their best practices and lessons learned with one another, it makes a difference, spreading successful interventions to other facilities.” For instance, 20 HIIN hospitals attended the AHA’s Rural Health Care Leadership Conference for education and networking.

Coulombe added that she is excited that HRET’s participating hospitals are committed to accelerating improvements in patient safety. “The focus these hospitals have on keeping patients safe continues to drive my passion for the work we're doing.”

Not too late to participate

Coulombe says hospitals not yet involved are still welcome to join the HRET HIIN. "We welcome the opportunity for new hospitals to join our improvement network.

“With our large network comes much opportunity for peer-to-peer networking, learning from hospitals that are similar,” she says. “We collect data that afford opportunities to benchmark, not only with hospitals in their state, but also with similar hospitals across the country. We offer as many resources and tools as possible, and engage with hospitals at a pace that works for them to make change possible. We're a one-stop shop for hospitals to get up-to-the minute, evidence-based information.”

The HRET also provides site visits to hospitals that participate in its HIIN program, Coulombe says. “It's important for our hospitals to understand that we want to help. We want to come to their facilities and learn about their organizations, culture and best practices, and learn what's worked well and what hasn't worked well, so that everybody can benefit from the conversation.”

Hospitals that wish to join the HRET HIIN may do so here.

The HRET HIIN Projects for Improvement

  • Adverse drug events.
  • Central line-associated blood stream infections.
  • Catheter-associated urinary tract infections.
  • Clostridium difficile infection.
  • Injury from falls and immobility.
  • Hospital-acquired pressure ulcers.
  • Readmissions.
  • Sepsis and septic shock.
  • Surgical-site infections.
  • Venous thromboembolism.
  • Ventilator-associated events.