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June 2018

True North Newsletter

Welcome to our True North e-newsletter, which is designed to provide our physicians and AHPs a better vehicle to share information about UCSF Health improvement activities, upcoming events, and perhaps other objectives based on your continued feedback .

What is “True North” and why is it important?

True North  pillars represent our long-term objectives –  what we need to accomplish to achieve our vision -  because they serve as a constant guide for aligning and prioritizing our work. The UCSF Health True North pillars should not surprise you. In fact, we hope the areas of patient experience, quality and safety, our people, financial strength, strategic growth and learning health system reflect active improvement efforts you’ve participated in or have observed in your practice settings. The True North pillars are also important since they serve as a communication vehicle and common language to link our daily work to what's important in allowing us to continually become better versions of ourselves.

How are we doing with our True North metrics?

Please review our  current   True North scorecard that continues to serve as one lens into our organizational priorities and performance. This month's communication focuses on our O/E metrics and Harm Events.

Why do we use O/E (Observed to Expected) indices for performance metrics?  Given our focus on O/E metrics, it's important to understand their value and limitations. The "observed" is the actual number of patients reflected in a specific time frame (e.g., deaths in a given month). The "expected" is the average number of events based on diagnosed conditions, age, gender and/or other variables that comprise different risk model adjustments. Therefore, when we report on O/E indices (lower or <1.0 is better), we're trying to both identify improvement opportunities at the service-level, while also using benchmarks that are relevant (e.g., other academic medical centers). For instance, our most recent sepsis mortality O/E is markedly improved, partly reflecting the passing of our unusual influenza season (the "observed") and targeted documentation improvement interventions (the "expected”) -- both play critical roles in assuring the external world's evaluation of our outcomes are accurately captured. A recent JAMA viewpoint nicely discusses the role of risk adjustment in interpreting quality measures.

What highlights should we take from the past month of Harm Events? First, we should give an organizational "shout out" to our teams at BCH-SF who for the second time in three months achieved ZERO CLABSIs, CAUTIs, VAPs, SSIs, HAPUs, falls with serious injury and serious safety events. It's a remarkable accomplishment. Overall, we should also acknowledge the continued trends that are demonstrating significant reductions in our C. difficile infection   rates (~18% over past 2 years) and CAUTI (~20% projected for this year). The primary harm event that continues to challenge both our adult and children's populations is CLABSI; there are many interventions underway to both better understand and ultimately reduce their occurrence with teams sharing lessons learned across facilities, sites, and units.

3rd Annual UCSF Health Improvement Symposium Recap

Symposium Festivities We were thrilled to showcase nearly 160 improvement initiatives across the organization, which we organized into an e-program booklet . We encourage you to peruse the program booklet to appreciate the incredibly diverse work that touched on all of our True North pillars; there was also a notable presence of projects from our medical students, residents and fellows. The several hundred attendees enjoyed socializing with old (and new) friends, learning about the amazing work of their colleagues, and playing QI BINGO for raffle prizes. Adrienne Green, Josh Adler, Talmadge King and Mark Laret even took time to toss t-shirts off stage in trying to simulate Oracle Arena for a Warriors game. We will look forward to next year's event as our biggest problem will be space to accommodate the growing number of improvement projects!

Highlighting the Most Impactful Improvement Initiatives During the symposium, we invited groups of leaders to conduct "Poster Leader Rounds"--an opportunity to both recognize the enthusiastic presenters for their work, while also learning about their improvement initiatives in intimate fashion. Each rounding team was asked to select the top initiatives that were the most innovative, impactful and ready for spread to other areas. We've organized the "Highest Rated Improvement Initiatives" in this summary that we hope you'll enjoy reviewing; please congratulate your colleagues for their work and adopt (or adapt) their ideas to your own clinical setting.

Other News & Announcements

New CURES Mandate from the California Medical Board As many of you likely read, the Controlled Substance Utilization Review and Evaluation System (CURES) was certified for statewide use by the Department of Justice (DOJ) on April 2, 2018. Therefore, the mandate to consult CURES prior to prescribing, ordering, administering, or furnishing a Schedule II–IV controlled substance becomes effective on October 2, 2018. UCSF Health was already working on a system-wide solution within APeX to direct prescribing providers to the CURES website as part of our Opioid Stewardship Initiative ; now, we need to thoughtfully build the workflows around the mandated requirements as well. More to come but please see the Medical Board's flyer for additional information.

2018 Annual Meeting of the Medical Staff Please join this year's annual medical staff meeting on Tuesday, June 26th from 12-1:30p in the Milberry Union Conference Center. In addition to updates and announcements, the keynote speaker will be Atul Butte . It will also serve as the formal transition between our outgoing President of the Medical Staff,  Bob Kerlan  from Interventional Radiology, to our new President,  Errol Lobo   from Anesthesia.

Caring for the Caregiver & Peer Support UCSF Health continues to invest in supporting our providers who may suffer from the second victim effect in caring for patients. In the past year, we have trained more than 100 peer supporters to allow for providers to benefit from this critical and timely resource when they need it most, and by colleagues closest to their work itself (e.g., same clinical division or department). The Caring for the Caregiver team is offering another training on June 8th ( see flyer ) and will be offering additional ones in the future.