moving health forward

TENET HEALTHCARE CLINICAL OPERATIONS
2014 ANNUAL REPORT
moving
health
forward
contents
3
Message from the
Chief Clinical Officer
5
Supporting Our Patients
& Caregivers
4
Mission & Priorities
9
Highlights & Trends
17
Key Initiatives
21
The Year Ahead
Table of Contents | 1
2 | 2014 Clinical Operations Annual Report
Welcome
I am pleased to share Tenet Healthcare’s first Clinical Operations Annual Report. In the pages that follow, you will
see evidence of our accomplishments in key priority areas of clinical care. These priorities reflect the areas that
will play a key role in advancing Tenet’s mission of helping people live happier, healthier lives. I thank you for your
dedication to Tenet and to the priorities we have set together. I hope that this annual report serves as a reminder of
what we have accomplished, while also clearly identifying the opportunities for improvement that remain.
Kelvin A. Baggett, MD
SVP, Clinical Operations &
Chief Clinical Officer
At the center of Clinical
So what do we see as we look ahead? For one thing, there is an
Operations is a commitment
increasing expectation that value is created in each encounter
to improve the safety, quality,
within the healthcare system. Simply put, value is outcome
service and outcomes of the
relative to the cost required to achieve it. Part of the value
care that we provide in every
equation includes consideration of the outcome desired by the
Tenet environment, whether at
patient, which is part of our commitment to offering a better care
one of our acute-care hospitals
experience. In an environment of new entrants and increasing
or ambulatory care locations.
consumer and patient expectations, it is imperative that we
Our portfolio has become
continue to differentiate ourselves with an outstanding experience
more diverse in the last several
for our patients. It’s a challenge we all must address.
years, with a growing number
of outpatient facilities and new
acute-care hospital operations.
That makes it more critical than ever that we understand the
nuances that exist within various care settings, while also
adhering to the expectations and standards of operational
excellence that have been set. We know that our patients, partners
and colleagues expect nothing less for themselves or for those for
For 2015, we will place even greater emphasis on making Tenet
a leader in the journey to precision medicine. This includes our
commitment to reducing harm through high reliability practices,
eliminating waste through lean operating principles and
advancing appropriate standards. Two specific areas we will be
focusing on are improving our safety huddles, as a core forum to
identify and address potential harm, and reducing the incidence
whom we have the privilege to care.
and progression of sepsis and septic shock in our patients. In the
In 2014, we made significant strides to advance the safety, quality
you to become not only better informed, but also more involved.
service and outcomes in our care. We improved in three of the
four areas of focus on the Quality and Service pillars of the
Balanced Scorecard — value-based purchasing, readmissions and
physician satisfaction. We didn’t make the desired progress on
the patient satisfaction score, and we should all take this to heart
and refocus our efforts to ensure our patients are receiving the
excellent service they expect and deserve.
As we look ahead, we’ll continue to focus on our core activities
while recognizing that being a leader in healthcare requires us to
coming year you’ll hear much more about these areas, and I expect
In closing, I want to repeat a phrase that I say quite often.
With regard to our accomplishments in 2014, I am “pleased,
but not satisfied.” Our commitment to quality, our patients,
our communities and each other is what drives us to improve
everything we do. I thank you for all that you’ve contributed in
the last year and for your dedication to continued success and
improvement in 2015.
Sincerely,
always have our eye on the horizon. With that in mind, I believe
the priorities you will see in the latter section of this report ref lect
our commitment to creating the value we believe is necessary to
perform in the present and succeed in the future. I am confident
we can achieve our goals, and that confidence is justified by our
past successes.
Introduction | 3
Clinical Operations Mission
Be the Safest Provider of Care
Lead in Care Quality
Eliminate Unnecessary Waste and Variability
Exceed Expectations in Every Interaction
Drive Innovation and Transparency
CLINICAL OPERATIONS STRATEGIC PRIORITIES
Safety
Outcomes and Value
We will become the safest provider of care.
We will become more predictable in care
delivery, adopting and pursing standards
that advance evidence-based practice
while lowering the cost of care.
• Accreditation and certification
• ZERO tolerance for serious safety events, hospital
acquired conditions/ healthcare associated infections
(HACs/HAIs), venous thromboembolism (VTE)
• Blood product utilization
• Imaging utilization
• Mothers and babies — perinatal safety
measures and obstetrics care performance
• Preventable/avoidable readmissions
Quality Processes
• Pharmacy utilization
We will promote our accomplishments in quality
processes and support transparency to
distinguish our organization and inform
our stakeholders.
• Leapfrog Safety Scores and Top Hospitals
• CMS hospital compare/other public websites
• National Committee for Quality Assurance
Healthcare Effectiveness Data and Information
Set (HEDIS) and quality measures
4 | Mission & Priorities
• Service line advancement – critical care, palliative
care, emergency care, hospitalists’ care, OB care
• Sepsis care improvement
• Quality standards across the care continuum
SERVICE
We will understand, serve and engage our
customers better than our competitors.
• Patient experience/patient satisfaction
• Employee engagement
• Physician satisfaction
Supporting Our patients
& caregivers
Physician
and nursing
development
& reductions
in Harm
Supporting Our Patients & Caregivers | 5
Supporting Our Patients & Caregivers
Message from the Chief Medical Officer & the Chief Nurse Officer
Critical to our success is the ability to deliver high-quality
care to our patients while providing ongoing support and
resources to our caregivers. In collaboration with our
physicians, nurses and other healthcare team members, as
the company’s chief medical officer and chief nurse officer,
we strive to align operational and clinical strategies to
improve system efficiencies and outcomes.
Throughout Clinical Operations, key strategies for 2014
were to develop and expand the regional leadership teams
to allow for dyads between medical practice and patient
care. We are proud to share with you that strong regional
dyad teams are now in place, consisting of regional chief
medical officers and regional chief nurse executives whose
focus is on execution of clinical programs, quality process
improvement and operational efficiencies.
Chief Medical Officer
Chief Nurse Executive
California
Dr. Ron Kaufman
Dr. Michael Basinger
Central
Dr. Karen Webb &
Dr. David Schwartz
Dr. Rusty McNew
Detroit
Dr. Suzanne White
Shawn Levitt
Florida
Dr. David Katzin
Dr. Julie Hilsinbeck
Northeast
Dr. Octavio Diaz
Ruth Walton
Phoenix
Dr. William Ellert
Tyna Williams
Southern
Dr. Phil Perry
Pat LeCroy
Texas
Dr. David Siegel
Dr. Tommye Austin &
Dr. Rusty McNew
Dr. Mark Montoney serves as the chief
medical officer for Tenet Healthcare, with
responsibility for systemwide patient safety,
quality improvement and advancement of
evidence-based clinical standards.
He joined Tenet from Vanguard Health
Systems, where he served as executive
vice president and chief medical officer.
Dr. Montoney is a former Malcolm Baldrige
Mark Montoney, MD
National Quality Award examiner, past
Chief Medical Officer
board chairman of the Ohio Partnership for
Excellence and previously served on the Tennessee Center for
Performance Excellence Board of Directors. He also chairs the
Quality Committee for the Federation of American Hospitals.
6 | Supporting Our Patients & Caregivers
Reducing variation in care and improving overall patient
throughput and clinical outcomes were key areas of focus
for our regional clinical leadership in 2014.
In 2015, as we continue to concentrate on clinical outcomes,
we will also be focused on physician and nursing leadership
development across the organization. While the Tenet Leadership
Academy has provided a cohort of our leaders with additional
skill set development, in 2015 we will launch the Tenet Physician
Executive Institute, focusing on our hospital chief medical
officers. Physician leaders play an important role in forging
alignment with our medical staffs, and their impact will continue
to grow as we advance the value-based healthcare model.
We are also launching a systemwide nursing strategic
plan beginning in 2015 that focuses on commitment to
three priorities:
• To our patients, families and communities: quality, safety
and exceptional care experience
• To our people: exemplary nursing practice, professional
growth, development and succession planning
• To our organization: strategic patient growth in all patient
care settings
We encourage you to reach out to your local and regional
clinical operations leaders or us to learn more about our
quality, safety and clinical outcomes resources and our
professional programs and development pathways. We are
honored to support you and the work you do every day to
care for our patients and their families.
Dr. Anna J. Kiger serves as Tenet’s chief nurse
officer with responsibility for systemwide nursing
leadership clinical practice, measurement of patient
and physician satisfaction, and guidance on obtaining
center of excellence designations, including Magnet and
Pathways to Excellence.
Dr. Kiger joined Tenet in 1999 as a regional director
of clinical process improvement in the New Orleans
market. Prior to that, she held nursing leadership
Anna J. Kiger, DNP
positions in academic and investor-owned hospitals.
Chief Nurse Officer &
VP, Patient Care Services She is an adjunct faculty member for Drexel University,
where she teaches biostatistics for graduate-level
allied health students. She serves on the editorial board for the Journal of
Nursing Administration (JONA) and on the American Society for Health Care
Risk Management’s Journal of Health Care Risk Management.
Supporting Our Patients & Caregivers
Improving Patient Safety
Keeping our patients safe is the most important thing we do
as a healthcare provider. At Tenet, we have major programs
underway across the company to improve the safety of the
patients we’re privileged to care for. We made significant
progress with four of these initiatives in 2014.
• Overall, these 47 hospitals reduced the number of retained
sponges by 50% in 2014 . And 42 of the 47 hospitals have
had no retained sponges for more than a year.
Reduction in retained surgical items
• Each Tenet hospital has some type of electronic safety
and risk management system (eSRM). These systems
allow the company to aggregate trends around adverse
events, develop best practices using high-reliability
principles and rapidly disseminate information and
education across the company.
• Tenet hospitals have programs to reduce retained surgical
items (RSIs), which typically are sponges left in patients
after various surgical procedures. Tenet’s RSI program
was designed in collaboration with Dr. Verna Gibbs, a
nationally recognized expert in reducing RSIs. It’s built
around recognizing and eliminating the mistakes and
practices (the “human factors”) that can lead to retained
surgical items. The program also includes onsite training,
auditing and monitoring, and monthly best-practice calls.
• These enhanced strategies have been implemented at
47 Tenet hospitals and will continue to be rolled-out
to other facilities.
Expansion of our electronic safety and risk
management system
• Last year, enhancements were made to the eSRM
at many Tenet hospitals to make point-of-care
reporting easier and to optimize reporting and data
collection capabilities.
• In particular, data and information from Tenet’s eSRMs are
driving major initiatives aimed at reducing patient falls and
central line-associated bloodstream infections (CLABSIs).
Supporting Our Patients & Caregivers | 7
Supporting Our Patients & Caregivers
Rollout of comprehensive unit-based
safety programs
• In 2014, Tenet rolled out comprehensive unit-based
safety programs (CUSPs) at 76 hospitals. CUSPs — a
nationally recognized best practice — are five-step
programs designed to change a unit’s workplace
safety culture.
• CUSPs are based on the concept that those who deliver
patient care are best positioned to identify and correct
defects in care that can result in patient harm. Staff
members are empowered to assume responsibility for
safety in their environment. This is achieved through
education, awareness, access to organizational resources
and a toolkit of interventions.
• Last year, Tenet’s CUSPs were focused on reducing
central line-associated bloodstream infections
(CLABSIs) in ICUs. Overall, the rate of CLABSIs in
Tenet’s ICUs dropped 23 percent in 2014. In addition,
27 ICUs have been free of CLABSIs for more than a year.
• Tenet plans to roll out CUSPs to all acute-care units
in the coming year. A major focus will be on reducing
catheter-associated urinary tract infections (CAUTIs).
Reduction in medication errors
• The severity level of medication events decreased overall
in 2014. As more Tenet facilities implemented Cerner’s
electronic health record system last year, the number
of severe medication events decreased across Tenet’s
system, while the number of near misses increased. This
is almost certainly due to the fact that bedside barcode
scanning provides the ability to identify an error before
it impacts the patient, which in turn prevents a more
serious medication event.
• Another success last year involved expanding the use
of “guardrails” on our Alaris pumps, which deliver IV
medication, to 60% of our hospitals. These guardrails
are extra protections built into the pumps that ensure a
patient is getting the right medication at the right dose
(or rate of infusion). Last year, use of these guardrails,
where the target for use is 80%, jumped to 77% from
50% the year before, greatly reducing the chances for
medication errors.
8 | Supporting Our Patients & Caregivers
• Looking ahead, an adverse drug event (ADE) reporting
tool has been created and will be used to survey all
medication orders in Cerner to identify “triggers” for
patients that have had an adverse drug event. This tool
will launch in 2015 and will represent a move away from
self-reporting to observation reporting, improving the
accuracy of the rate of ADEs and allowing investigation
into ADE trends that are identified.
• Additional medication safety initiatives will focus on
appropriate medication selection based on clinical
evidence. The lack of evidence demonstrating clinical
superiority of several medications has led to the
development of strategies to decrease the use of these
medications in 2015.
2014
Year in
Review
Summary
Highlights & Trends
Highlights & Trends | 9
Responding to a Global He alth Thre at
Meeting the Challenge of Ebola
In the fall of 2014, the United States healthcare system witnessed the
unprecedented unfolding of the West African Ebola epidemic. Healthcare providers
quickly discovered that this epidemic could have major ramifications for
public health in ways that no other modern infectious disease had before.
In July 2014, Tenet became aware of the threat of Ebola
reaching the U.S., and began efforts to ensure the preparedness
of our facilities. Immediately following the first diagnosis
of Ebola in the U.S., on September 30, 2014, we assembled a
team of facility and Home Office leaders focused on providing
critical guidance, resources and training materials to our
facilities. This cross-functional team was available 24/7 as
part of the Ebola Incident Command Center (EICC). Its
purpose was to support Tenet hospitals, outpatient centers and
physician practices in protecting the safety and well-being of
our colleagues, patients, visitors and communities.
The EICC closely monitored new information being
released by the Centers for Disease Control and Prevention
(CDC), designed educational materials to support CDC
recommendations and communicated regularly with facilities
and patient care leadership teams across our entire network.
“The expertise and quality of resources provided by Tenet’s
Ebola Incident Command Center, combined with our local
hospital Ebola teams’ efforts, were crucial to the Northeast
Region’s ability to adequately prepare for this epidemic,” said
Erik Wexler, CEO of the Northeast Region.
In the first crucial days, our experts identified five key areas
of focus for the care teams:
Rapidly identify a potential Ebola patient

Isolate a person under investigation for Ebola

Properly don and doff personal protective

equipment (PPE)
Limit contact with persons under investigation for

Ebola by using dedicated Ebola Care Teams (ECTs)
Notify state and local health agencies and

Understanding that the entire healthcare system would
be in need of personal protective equipment (PPE) and
supplies would quickly become hard to obtain, the Home
Office supplies and logistics team immediately assessed each
hospital’s PPE stock. The team verified that each facility
had an adequate short-term supply of CDC-recommended
PPE and arranged for placement of additional supplies in
locations allowing for quick deployment to any facility where
needed. More than 100,000 units of critical PPE supplies
were distributed to more than 75 facilities, and 25,000 items
(1,900 kits) were sent to physicians’ offices across the country.
While much progress has been made to strengthen the U.S.
healthcare system’s ability to provide treatment for Ebola
patients, there is still much to be done to address this disease. We
remain vigilant in our efforts to support our hospitals, outpatient
centers and physician practices as they stand prepared to identify
and care for potential patients with the Ebola virus.
Did You Know...
As part of our Ebola Virus Disease
preparedness training, Tenet
Home Office when caring for a suspected Ebola patient
colleagues completed over 200,000
To assist with training and education for frontline caregivers,
the EICC deployed training materials and resources,
including videos, drill scenarios and enhanced .edu courses.
online training sessions in addition
10 | Highlights & Trends
to drills and readiness activities in
each facility.
LEAPFROG HOSPITAL SAFET Y SCORE PERFORMANCE
Leaping Forward in 2014
Of the many ways hospitals are judged on patient safety, Leapfrog Hospital Safety Scores
are among the most prominent and visible. That’s great for Tenet, whose Leapfrog
scores are well above the national average, having risen significantly over the last
several years thanks to substantial work and focus across the company.
Leapfrog, a non-profit organization, scores more than 2,500
hospitals around the country twice each year on 28 measures
of patient safety. It tracks a broad range of process and
structural measures – whether a hospital uses a computerized
entry system for physician orders, for instance, or how often
patients are given antibiotics prior to surgery. Leapfrog
also tracks outcome measures, such as the rates of falls and
urinary tract infections. Based on how they perform on these
28 safety measures, hospitals are given a numerical score,
which is then converted into a letter grade – A is the best,
followed by B, C, D or F.
Did You Know...
If Tenet were ranked as a
state, it would rank third in the
nation with the most hospitals
earning an “A”, falling just
behind Maine (with 67 percent)
and Massachusetts (with
63 percent).
In the most recent Leapfrog survey, last October, Tenet did
exceptionally well: 61% of Tenet’s hospitals scored an A –
almost double the 31% of all hospitals nationally that earned
an A. Tenet’s performance is also up significantly from two
years ago, when 41% of Tenet’s hospitals were given A scores by
Leapfrog – still a strong showing.
Framed another way, in the most recent survey, Tenet’s
hospitals collectively earned a 3.48 GPA, compared with
a 2.82 GPA for all hospitals nationally. That’s also risen
substantially from two years ago, when Tenet’s GPA was 3.05.
(For all hospitals nationwide, the GPA has declined slightly in
that same time, down from 2.84.)
“Our strong Leapfrog scores aren’t simply an overnight
success,” said Cathy Munoz, vice president, patient safety &
clinical risk management. “Many of the key elements that
Leapfrog measures are patient safety indicators we’ve been
very focused on as a company for several years now.”
A key focus for Tenet, Munoz said, has been on the process
and structural components of the Leapfrog survey. Some are
organizational processes and protocols that promote safe
patient care, such as culture, teamwork and leadership. Others
are more clinically focused: implementing computerized
physician order entry systems, for instance, or ensuring
Tenet Results by Letter Grade % in October 2014
1%
A
10%
B
28%
61%
C
D
timely administration of antibiotics.
Highlights & Trends | 11
LEAPFROG HOSPITAL SAFET Y SCORE PERFORMANCE
“This was truly a team effort. We had the full support of regional
leadership and our colleagues at Tenet’s Home Office. And at the
hospital, every leader and department was fully engaged in the effort
to improve patient care and safety and to raise our score.
I’m extremely proud of what the team accomplished.”
— Jay Krishnaswamy, CEO, Doctors Hospital at White Rock Lake
“When you focus hard on the process and structural
elements — the basics, if you will — it also helps you do well
on the outcomes side of the survey,” Munoz said. “Process
and structure drive outcomes.”
at Tenet’s Home Office. And at the hospital, every leader
and department was fully engaged in the effort to improve
patient care and safety and to raise our score. I’m extremely
proud of what the team accomplished.”
One of the biggest Leapfrog success stories within Tenet
has been Doctors Hospital at White Rock Lake in Dallas —
which in November 2012 received a D grade from Leapfrog,
and in the last scoring earned an A grade. Munoz credits
the efforts of hospital CEO Jay Krishnaswamy and Central
Region CEO Tim Adams for the hospital’s extraordinary
improvement in the Leapfrog survey.
While its performance in the Leapfrog survey has been
extremely strong, Doctors Hospital is one of many across
Tenet that has made great improvement in recent years.
As a company, our hospitals have made big strides in the
Leapfrog Hospital Safety score, improving by 30% from June
2012 to October 2014.
“That was really driven by the leadership and engagement of
Jay and Tim,” Munoz said. “They were determined to improve
the hospital’s performance in virtually every key area.”
“This was truly a team effort,” said Krishnaswamy. “We
had the full support of Tim Adams and our colleagues
12 | Highlights & Trends
“This is really recognition of the hard work our clinicians
and leadership teams have been doing to provide a
safe environment for our patients,” said Munoz. “The
commitment of our senior leadership at Tenet has been the
great enabler of our progress and success in the Leapfrog
survey. There’s been hard work in every part of the company.”
Physician le adership and engagement
Strengthening Our Physician Partnerships
At Tenet and throughout our hospitals, outpatient centers and physician clinics,
it’s the partnership of our affiliated and employed physicians that enables us
to provide high-quality care to the communities we serve. That’s why we continually
strive to ensure the engagement and satisfaction of our physicians.
One avenue of ensuring physicians
We also have the great fortune of
are heard is through physician
having highly regarded physicians
satisfaction surveys. These brief
with expertise in every clinical area,
anonymous surveys allow both
and this year we made significant
Home Office and hospital leadership
progress in establishing our
to connect with our physician
National Clinical Councils and
partners and listen to what’s working
Collaboratives, which bring together
and what’s not while actively
subject-matter expertise from across
engaging in finding solutions – both to share great feedback
the system to address national healthcare issues and provide
across the organization and to address concerns. Participation
guidance to our organization on best practices in evidence-
rates are key to ensuring we’re fully engaging our physicians,
based medicine. Some key work done by the councils
and this year’s annual survey yielded the highest physician
this year includes furthering our efforts in blood product
response rate in five years. In 2014, our physician satisfaction
utilization and targeting strategies to address sepsis, a major
rating significantly improved from 2013 by listening to and
initiative in 2015. Councils are the backbone for creating
engaging our physician partners in hospital decisions and
clinical standards for our hospitals and affiliated facilities
including them in critical clinical process decisions.
to follow. These standards provide hospitals and physicians
an opportunity to engage in best practices that are shared
“Physician leadership and engagement is crucial for any
systemwide, which help ensure we are providing the best
organization to succeed and prevail in the ever-changing
possible care to our patients. Physicians from many of our
healthcare landscape,” said Dr. Scott Anders, chief medical
hospitals have a seat on these councils and workgroups.
officer for Tenet Physician Resources. “Tenet is committed to
soliciting, analyzing and acting on feedback with input and
guidance from our physicians.”
But it is not just the surveys that give our physician partners
“Physicians are critical to the success of our
organization, and we are committed to ensuring
their satisfaction. I’m pleased by the avenues
a voice; Physician Leadership Groups were also expanded
we either established or expanded in 2014
systemwide this year. These groups meet locally on an on-
to give physicians greater voice in decision-
going basis to address operational, tactical and strategic
issues that arise throughout the year, giving physicians a
venue in which to engage with hospital A-teams.
making and in ensuring the highest quality
of care for our patients.”
— Mark Montoney, MD, Chief Medical Officer
Highlights & Trends | 13
What others ARE saying about our care
Recognition in 2014
Tenet received more than 750 recognitions in 2014 for our efforts in quality,
safety and excellence in care delivery. Some highlights of the year include:
Leapfrog, a non-profit
organization, scores more than
2,500 hospitals around the country twice
each year on 28 measures of patient safety.
It tracks a broad range of process and
structural measures. See the article in
this section of the report for more
information on our excellent performance
in Leapfrog measures.
Tenet received 173 recognitions
from the American Heart
Association for compliance
with its Get with the Guidelines
programs in heart failure,
resuscitation and stroke and
the ACTION registry.
61% of Tenet Hospitals
Received the Highest Rating of
“A” from the Leapfrog Group
173 Recognitions by the
American Heart Association
The Joint Commission’s
Disease-Specific Care (DSC)
certification program is designed to
evaluate clinical programs across the
continuum of care. Achieving certification
makes a strong statement to the
community about an organization’s efforts
to provide the highest quality services.
The Accreditation for
Cardiovascular Excellence granted
Palm Beach Gardens Medical Center
full accreditation for carotid artery
stenting and for diagnostic cardiac
catheterization and percutaneous coronary
intervention (Cath/PCI), making the
hospital one of only four in the country
with this dual accreditation
80 Disease-Specific
Care Certifications
1 of Only 4 Hospitals in the
Country with Cardiovascular
Excellence Accreditation
14 | Highlights & Trends
What others ARE saying about our care
Hospitals Receiving Healthgrades Awards in 2014
Every year, Healthgrades analyzes three years of Medicare Provider Analysis and Review
(MedPAR) data to produce a detailed report on mortality and complication rates in America’s hospitals.
Healthgrades findings empower consumers to evaluate and compare hospital performance.
2014 Awards
Healthgrades America’s 50 Best Award™
Delray Medical Center
Healthgrades Distinguished Hospital Award-Clinical Excellence™
Delray Medical Center, Huron Valley-Sinai Hospital, MetroWest Medical Center-Framingham,
Saint Vincent Hospital-Worchester, Valley Baptist Medical Center-Harlingen
Healthgrades Patient Safety Excellence Award™
Arrowhead Hospital, Coral Gables Hospital, Frye Regional Medical Center, MetroWest Medical Center-Framingham
Healthgrades Outstanding Patient Experience Award™
East Cooper Medical Center
2015 Awards (Received in 2014)
Healthgrades America’s 100 Best Hospitals for Cardiac Care™
Saint Vincent Hospital-Worchester, Valley Baptist Medical Center-Harlingen
Healthgrades America’s 100 Best Hospitals for Coronary Intervention™
Phoenix Baptist Hospital, Fountain Valley Regional Medical Center, Valley Baptist Medical Center-Harlingen
Healthgrades America’s 100 Best Hospitals for Pulmonary Care™
Saint Vincent Hospital-Worchester
Healthgrades America’s 100 Best Hospitals for Orthopedic Surgery™
Delray Medical Center
Healthgrades America’s 100 Best Hospitals for Joint Replacement™
Valley Baptist Medical Center-Harlingen
Healthgrades America’s 100 Best Hospitals for Stroke Care™
Delray Medical Center
Healthgrades America’s 100 Best Hospitals for Gastrointestinal Care™
MetroWest Medical Center-Framingham
Healthgrades America’s 100 Best Hospitals for Critical Care™
Saint Vincent Hospital-Worchester
Highlights & Trends | 15
What others ARE saying about our care
31 Tenet Hospitals Named
The Joint Commission’s Top Performers in 2014
The Joint Commission’s Top Performer on Key Quality Measures®
program recognizes accredited hospitals that attain excellence on
accountability measure performance. Thirty-one out of 64 eligible Tenet hospitals received the recognition
this year, five more than last year. Eleven hospitals received the
recognition for the first time this year.
Coral Gables Hospital
MetroWest Medical Center
Delray Medical Center
Palm Beach Gardens Medical Center
DMC Children’s Hospital of Michigan
Palmetto General Hospital
DMC Detroit Receiving Hospital
Paradise Valley Hospital
DMC Harper University Hospital
Phoenix Baptist Hospital
DMC Huron Valley-Sinai Hospital
Placentia-Linda Hospital
DMC Sinai-Grace Hospital
Providence Memorial Hospital
Doctors Hospital at White Rock Lake
San Ramon Regional Medical Center
Doctors Medical Center of Modesto
Sierra Medical Center
Good Samaritan Medical Center
Spalding Regional Medical Center
Hahnemann University Hospital
St. Christopher’s Hospital for Children
Houston Northwest Medical Center
St. Mary’s Medical Center
Lake Pointe Medical Center
Saint Vincent Hospital
Los Alamitos Medical Center
Twin Cities Community Hospital
Louis A. Weiss Memorial Hospital
West Boca Medical Center
Maryvale Hospital
Three hospitals have received the recognition for four years in a row:
Coral Gables Hospital, Delray Medical Center, Lake Pointe Medical Center
16 | Highlights & Trends
2014
Year in
Review
Summary
Key INITIATIVEs
Key Initiatives | 17
Successes in 2014
Blood Product Utilization
Blood transfusions are essentially
liquid organ transplants. While
they often provide life-sustaining
treatment, each transfusion
carries unique risks that can lead
to prolonged hospital stays and
long-term health complications
for patients.
The literature continues to evolve regarding the risks
involved with the transfusion of blood products — risks
that extend well beyond the infectious exposure risks we’ve
focused on in the past. A whole host of other complications
are now more fully appreciated, including increased
hospital-acquired infections, greater risk for re-bleeding,
longer hospital stays and higher mortality, among others. As
a result, many patient populations have now been shown to
do better on a more restrictive transfusion approach.
In addition, we know that the complications associated
with blood transfusions are dose-dependent; as the number
of red blood cell units transfused increases, patient risk of
harm also increases. The old adage “more is better” is not
true when it comes to blood transfusions. The best available
evidence for transfusion therapy indicates that giving only
as much blood as a patient needs improves outcomes and
saves lives.
To support our ongoing blood utilization efforts, Tenet
convened a group of systemwide experts to review the
latest literature and develop a clinical standard for blood
utilization, which includes the most current evidencebased practice in this area, including guidance on when
to transfuse, what products to transfuse and in what
quantities, as well as recommended best practices in
utilization management.
18 | Key Initiatives
Why give 2,
when 1 will do?
• Blood transfusion is
a liquid transplant.
• The risk is dose
dependent.
• When it comes
to transfusions,
less is more!
Clinical research shows that a conservative
approach to blood transfusions saves blood,
improves patient outcomes and saves lives.
Reducing the number of blood transfusions is
first and foremost a patient safety issue.
In addition to our evidence-based standards development,
Tenet has launched a comprehensive campaign to
educate physicians, nurses and other clinical staff on the
importance of administering blood product transfusions
appropriately. Since 2011, this initiative has saved about
$24 million. Our November 2014 year-to-date cost savings
alone is $5.2 million. These results demonstrate our
clinicians’ ability to drive change consistent with evolving
best clinical practices.
Successes in 2014
Stroke Therapy
Stroke awareness and treatment
have received significant focus
over the past few years, and
rightfully so — stroke is the fourth
leading cause of death overall, and
third for women. Tenet treats over
13,500 stroke patients annually.
Patients whose strokes are caused by a blood vessel blockage
have the best chance of survival and preventing disability
when they rapidly receive a clot-busting drug, tissue plasminogen activator (tPA), to restore blood f low to the brain.
Research shows that early tPA administration is associated
with improved outcomes, including lower
in-hospital mortality and fewer complications.
Stroke Recognitions
49 Tenet Facilities were certified as
Advanced Primary Stroke Centers by
The Joint Commission in 2014
Did You Know...
Tenet has 60 hospitals recognized
by the American Heart Association
for participation in the Get With
the Guidelines stroke program.
Thirty hospitals have received the
highest level of recognition, the
Target Stroke Honor Roll.
Through the Tenet Stroke Collaborative, we launched a
Door-to-Needle Challenge at most Tenet hospitals over the
past 18 months to reduce the amount of time for patients
to receive that therapy. As a result of our clinicians’ hard
work during 2013 and 2014, we were able to increase the
number of stroke patients receiving this rapid treatment by
20 percent. Today, more than 70 percent of stroke patients
at those hospitals are able to have the intravenous drug
delivered within one hour of arrival, exceeding the national
rate of 30 percent.
Our hospitals will continue to carry out processes to
improve stroke awareness and treatment by partnering with
emergency medical services and community organizations
to educate the public regarding stroke symptoms. The
Stroke Collaborative Group will continue to assist our
hospitals with education, developing resources and
providing expertise to meet our goals. We are looking
forward to Phase 2 of the Door-to-Needle Challenge and
continued progress for all stroke measures.
Key Initiatives | 19
Successes in 2014
Healthier Babies
Providing the highest level of
perinatal care to our expectant
mothers and their unborn babies
has been a primary goal of our
Women and Children’s service
line hospitals.
Research has shown that early elective delivery (before 39
weeks) without medical or obstetrical indication is linked to
higher complication rates, including newborn death. “We have
focused on providing physician, nursing and patient education
to ensure that babies are allowed to grow in the uterus until at
least 39 weeks. We want to provide every opportunity for all
babies born in our hospitals to start their lives healthy,” says
Dr. Anna J. Kiger, Tenet’s chief nurse officer.
Targeting this important risk factor by educating our
colleagues and moms-to-be has been a focus for Tenet since
2012, and we are proud to share that our performance is now
significantly better than the national average. We established
a target in 2012 of 4%, and outperformed this goal in both 2013
and 2014. In 2014 we achieved a reduction of 0.08% from 3.79%
in 2013 to 3.71% in 2014, where the national average is 4.6% of
deliveries being elective prior to 39 weeks.
“Since the beginning of the program we have really focused
on promoting safe and effective induction of labor through
defined parameters established by the American Congress
of Obstetricians and Gynecologists (ACOG), Association of
Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
and the American Academy of Pediatrics (AAP),” said Tenet’s
director of perinatal services, Alana McGolrick.
Through the use of toolkits and webinars, we’ve been able
to achieve a tremendous success rate, and we will be able to
continue to improve thanks to the systemwide program put in
place to collect data that is now paying results . We can better
see where there may be common barriers that still exist and can
target those areas.
20 | Key Initiatives
Did You Know...
There were over 102,000 babies
born in Tenet hospitals in 2014?
That’s enough babies to fill every
seat in Rose Bowl Stadium!
The Year Ahead
moving
health
forward
The Year Ahead | 21
New OR E xpanded Are as of Focus for 2015
Reducing Clinical Variation & Improving the Value of Care
Care Variability Leaders
As we move into 2015, we are increasing crossfunctional initiatives to identify and reduce
non-value-added variability in care delivery to
produce better outcomes consistently for our
patients, increase efficiency and reduce waste. We
are fortunate to have strong internal partnerships
Kristy Waters
SVP, Performance Management and Innovation
with our colleagues in Performance Management
and Innovation and Applied Clinical Informatics to
support a rapid-cycle improvement system to target
areas for improvement:
 Identification of potential opportunities to
address non-value-added care variation
Liz Johnson, RN
VP, Applied Clinical Informatics
 Analysis of the variation and the impact to the
organization and our patients
 Develop evidence-based practice
improvement strategies supported by
national clinical councils or steering committees
 Drive operational implementation,
hardwiring, and technology support and
reinforcement
Huiling Zhang, MD
VP, Strategic Analytics & Solutions
 Assess the effectiveness of our improvement
strategies and refine our approach
The following pages highlight new or expanded areas
of focus in 2015 that are examples of this collaboration
across the organization to improve the value of the
care delivered to our patients.
Christine Hale, MD
National Director, Clinical Performance Excellence
22 | The Year Ahead
New OR E xpanded Are as of Focus for 2015
Pharmacy Utilization
What we’re focused on
Spotlight on our Pharmacy Utilization
The use of high-dollar medications
Champion, Dr. Traci Holton
continues to increase across Tenet.
Many times these medications offer no
superiority to the medications we have
Traci Holton, PharmD serves as
the senior director of pharmacy
and medication safety for Tenet,
responsible for all aspects of the
medication use process. Primarily
she focuses on operational
improvements, evidence-based clinical advancement,
management of the pharmaceutical supply chain and
safe use of medications within the organization.
used in the past that come at a lower cost
Prior to joining Tenet, Dr. Holton worked as a
consultant to the company, where she was responsible
for the development and implementation of the
medication use management program and clinical
cost savings initiatives for eight years. She is a
residency-trained clinical pharmacist and practiced
as a clinical pharmacist and director of pharmacy.
She is a past president of the Texas Society of Health
System Pharmacists (TSHP). Currently she serves on
the board of directors for the TSHP Research and
Education Foundation.
hospital leadership on medications falling
(standard of care). With medication where
evidence and internal data show no clinical
advantage to the standard of care, the
medication should either not be added
to the formulary or be removed from
the formulary. In 2015 Tenet will provide
education, guidance and comprehensive
toolkits to our physicians, pharmacists and
into these categories.
Why it matters
All medications that are on the formulary
within our facilities should demonstrate
effectiveness and where appropriate
demonstrate clinical advantage over
the standard of care. The use of
medications with no data on superiority
to the standard of care increases cost of
care to our patients and our facilities.
The Year Ahead | 23
New OR E xpanded Are as of Focus for 2015
Palliative Care Program
What we’re focused on
Palliative care is specialized care
provided to patients with serious
Spotlight on our Palliative Care Champion,
Dr. Robert Zalenski
illness by an interdisciplinary team
of professional caregivers. The team
provides support throughout a patient’s
journey with serious illness and works
to relieve the suffering that comes with
such conditions, such as cancer, heart
failure or emphysema. For 2015 we will
be focused on launching programs in
several facilities and piloting advanced
directives tools.
Why it matters
Palliative care increases the value of
health care for patients. It improves
Rob Zalenski, MD serves as the
director of palliative medicine
for Tenet. He is board certified in
emergency medicine and in hospice
and palliative medicine. In 2003, he
was a faculty scholar in the Program
in Palliative Care Education and Practice at Harvard
Medical School. From 2011-2013, he served as medical
director of palliative care for Vanguard Health System.
His recent work in palliative care at Vanguard Health
has been presented nationally and internationally and
published in the British Medical Journal’s Supportive
and Palliative Care in 2014.
quality due to symptom control,
following patient preferences and
improving communication and
Spotlight on our Palliative Care Champion,
satisfaction for professional and family
Dr. Stacey Bumgardner
caregivers. Daily cost of care and
length of stay are also reduced via
better symptom management and
elimination of unwanted interventions.
24 | The Year Ahead
Stacey Bumgardner, DNP is a board
certified family nurse practitioner.
She has a passion for patient advocacy
and listening to patients and their
families. Dr. Bumgardner is the
nursing co-chair of the Tenet National
Palliative Care Council and co-chair for the Carolinas
Collaborative Committee and the Pain and Symptom
Management Workgroup; is a trainer for ELNEC (End
of Life Nursing Education Consortium); and is a teacher
at Piedmont Medical Center, where she is the director of
medical surgical services.
New OR E xpanded Are as of Focus for 2015
Critical Care Standards
of Excellence
What we’re focused on
The Critical Care Standards of
Excellence initiative will improve quality
while reducing variations in care and
Spotlight on our Critical Care Champion,
ensuring appropriate screening of
Dr. David Kaufman
ICU admissions. The National Critical
Care Council has been focused on
David Kaufman, MD, Tenet’s
national director for clinical program
management, is responsible for
the systemwide development and
implementation of clinical standards
across multiple specialties and areas
of practice.
An intensivist, he was formerly vice president for
critical care services at Vanguard Health Systems,
where he developed new innovations for advancing
and measuring the implementation of evidence-based,
standardized approaches to care. Prior to joining
Vanguard, he spent 22 years in clinical practice as chief
of critical care medicine at Saint Vincent Hospital in
Worcester, Massachusetts. He is an associate professor
of clinical medicine, surgery and anesthesiology at The
University of Massachusetts Medical School, a fellow
of the American College of Critical Care Medicine and
past president of the New England Society of Critical
Care Medicine.
areas of improvement for our ICUs
and currently has 18 workgroups
of clinicians targeting evidencebased practices in the ICU, including
ambulation, preventing pressure
ulcers and nutrition support, among
many others. The concentration for
the ICU programs this year will be on
making sure we have the right triage
processes in place for patients coming
to the ICU, as well as improving other
areas of ICU operations.
Why it matters
Most hospital deaths occur in ICUs,
and one-third of hospital costs are
from ICUs. As many as 25% of
patients in ICUs may be better suited
for other care environments, such as
telemetry, medical-surgical units or
hospice.
The Year Ahead | 25
New OR E xpanded Are as of Focus for 2015
Behavioral Health Patients
in the ED
What we’re focused on
Our Emergency Department National
Spotlight on our Behavioral Health in the
Clinical Council and the National
ED Champion, Dr. Octavio J. Diaz
Behavioral Health Advisory created
a joint workgroup to bring together
subject matter experts across the
organization to address the complex
needs of behavioral health patients
in our emergency departments. The
group will focus on four key areas of
the emergency room process for these
patients–intake, safety, psychiatric care
and disposition –and leverage best
practices in these areas from across
the system to create a comprehensive
toolkit for our emergency departments.
Why it matters
According to the Agency for Healthcare
Octavio Diaz, MD serves as the chief
medical officer of the Northeast
Region of Tenet and is the council
sponsor for Tenet’s National
Emergency Medicine Clinical
Council. Dr. Diaz’s career with Tenet
Healthcare began in 2004 as the
chief of emergency medicine at Saint Vincent Hospital
in Worcester. He attended the inaugural class of the
Vanguard Leadership Academy, is a diplomate of the
American Board of Emergency Medicine and holds
an active medical license in the Commonwealth of
Massachusetts.
Spotlight on our Behavioral Health in the
ED Champion, Scott Morey
Research and Quality, mental disorders and/
or substance abuse are related to one of
every eight emergency department cases in
the U.S. In addition, a marked decline in the
number of inpatient psychiatry beds across
the country means behavioral health patients
may need to be cared for in the emergency
department for extended periods while
awaiting placement. Tenet is committed to
supporting our emergency department teams
in the proper identification and management of
the unique needs of these patients to ensure
the safety and security of all parties involved
in the emergency department visit.
26 | The Year Ahead
Scott Morey is the chief operating
officer/chief nursing officer at
Maryvale Hospital in Phoenix and
is the co-chair of Tenet’s National
Emergency Medicine Clinical
Council. Scott began his career with
Tenet Healthcare as a staff nurse in
critical care in 2005 and was later promoted to director
of telemetry/emergency services at Phoenix Memorial
Hospital. He then served as director of emergency
services at Phoenix Baptist Hospital. In 2011, Scott was
selected to attend the Vanguard Leadership Academy
and was the first of this class in Phoenix to be promoted
to an executive leadership role as a direct result of his
participation in this program.
New OR E xpanded Are as of Focus for 2015
Blood Product Utilization
Spotlight on our Blood Product
Utilization Champion, Dr. Emily Volk
Emily Ellen Volk, MD is boardcertified in anatomic pathology and
clinical pathology, with subspecialty
certification in cytopathology. Dr.
Volk received a medical degree from
the University of Missouri-Kansas
City and a master’s degree in business
administration from the University of Massachusetts,
Amherst. Dr. Volk currently practices with Clinical
Pathology Associates at the Baptist Health System in
San Antonio, Texas, where she serves as the regional
medical director of the department of laboratory
medicine and pathology and where she is an integral
part of the team that integrated evidence-based blood
utilization. Currently, she serves as vice-chief of staff at
Mission Trail Baptist Hospital.
What we’re focused on
As discussed in the blood product
utilization article featured in the
Initiative Successes section, Tenet
has been working for the past several
years on ensuring the appropriateness
of blood transfusions. This year the
program will continue and will add
extra focus on platelet transfusions
and anemia management, in addition
to continuing our work on red blood
cell transfusions.
Why it matters
While blood transfusions often
provide life-sustaining treatment, each
transfusion carries unique risks that
Spotlight on our Blood Product
can lead to prolonged hospital stays
Utilization Champion, Suellen Smith
and long-term health complications
for patients. Many complications
Suellen Smith is Tenet’s senior director
for performance management and
began working on blood utilization
when she served as COO for Twin
Cities Community Hospital. Under
PMI and Dr. Steve Newman, the
challenge was given to hospitals to
review blood management against current evidencedbased practices to improve safety and cost. Over the
years, Suellen and her team of PMI account managers and
analysts have worked with hospitals to provide utilization
data, standard reports, literature and best practices to
support hospitals to educate and drive results.
can arise from blood transfusions,
including infections, risk for rebleeding and greater mortality.
The Year Ahead | 27
New OR E xpanded Are as of Focus for 2015
Physician Resources
What we’re focused on
Across the nation, physician and nonphysician providers are increasingly
seeking employment as an alternative
to independent practice. In 2015, we
will focus on improving our candidate
Spotlight on our Physician Resource Champion,
selection process, ensuring our
Dr. Scott Anders
physician and non-physician employees
meet rigorous quality and care
standards, align with Tenet’s values and
mesh with our culture. We will enhance
communication, build relationships and
foster feelings of community through
national and local physician leadership
councils and development of physician
leaders. 2015 will see quality of care
become an integral part of provider
performance discussions. We will
ensure that patient and employee
safety are the foundation for a safe
environment to provide the right care
through education, risk mitigation
and mediation.
Why it matters
Our employees, including physicians
and non-physician providers, are our
greatest assets. Our goal is to provide the
right care, at the right time, in the right
manner in a way that supports patient
and community needs while maintaining
prudent financial stewardship.
28 | The Year Ahead
Scott Anders, MD joined
Tenet as chief medical officer for
Tenet Physician Resources in June
2014. His major focus is working
with Tenet’s chief clinical officer
to enhance our national leadership
position as a provider of wholeperson, high-value care encompassing all aspects of a
patient’s care needs. He supports physician recruitment
and retention, company and market growth, clinical and
quality strategies, technology integration and improving
the patient experience.
Dr. Anders is board certified in family medicine
and is a licensed specialist in hypertension certified
by the American Society of Hypertension. He has
patient practice experience in many settings, including
emergency medicine, intensive care
and ambulatory care.
New OR E xpanded Are as of Focus for 2015
Targeting Sepsis
Sepsis is a diagnosis indicating
that a patient has acquired a
life-threatening infection that
can lead to organ failure and
eventually death.
The incidence and mortality associated with sepsis has
increased in recent decades. It’s the leading cause of death
in critically ill patients in the United States, killing more
than 500,000 people each year, with a mortality rate
between 30% and 50%. In addition to being deadly, sepsis
is also costly: lengths of stay for patients with severe sepsis
are more than twice those of other patients. Moreover,
sepsis is expected to worsen in the coming years, as
invasive procedures become more common and the aging
population becomes more susceptible to infection.
Within Tenet’s acute care hospitals, sepsis is the most
common secondary diagnosis. In 2015 our acute-care
hospitals will undertake an aggressive, systemwide
campaign to ensure early identification of potential sepsis
patients and initiate evidence-based interventions that
lead to lower mortality associated with sepsis. In addition
to following national best practices, we will also leverage
our electronic medical record to keep our healthcare
team informed of changes in the patient’s condition and
response to medical and nursing interventions. Overall, we
aim to reduce our sepsis-associated mortality by 5% and
achieve systemwide Medicare sepsis excess days of 29% –
resulting in 600 lives saved.
Thanks to major initiatives targeting sepsis, Tenet
hospitals in Chicago and San Antonio have had great
success in reducing the mortality rate from the illness in
recent years.
At West Suburban Medical Center in Illinois, for example,
the mortality rate for severe sepsis and septic shock has
plunged since 2006. Tenet’s Baptist Health system in San
Antonio has seen striking results as well.
“The key to success has been aggressive and comprehensive
screening of patients for sepsis – and then rapid
intervention once severe sepsis is identified,” said Patty
Cormack, RN, critical care clinical educator and sepsis
coordinator at West Suburban. “This is evidence-based
care, and it works.”
At West Suburban, all ED patients with suspected
infection are screened for severe sepsis, as are all patients
being admitted to acute-care areas. Screening is then
done again during each shift assessment and also done if a
patient’s condition worsens.
At the Baptist hospitals in San Antonio, screening is done
in the ED and the ICU, as well as on rapid response and
“code sepsis” calls. Once severe sepsis is identified in a
patient, treatment is laid out in a comprehensive timeline,
with certain interventions – called “bundles”– completed
at 3 hours and 6 hours after diagnosis.
“We can’t take our eye off the ball for a second,” said Amy
Olseth, ICU operations director for Baptist Health. “This
program takes work, but success means we are saving lives.
It’s that important.”
The Year Ahead | 29
New OR E xpanded Are as of Focus for 2015
“Sepsis provides many challenges with the provision of healthcare services.
Sepsis is resource-intensive, continues to increase in frequency and presents an
excellent opportunity to improve the health of the communities we serve. We are
engaging our entire clinical team to improve all aspects of sepsis care as
one of our top systemwide initiatives in 2015.”
— Kristy Waters, Senior Vice President, Performance Management & Innovation
Other key elements of the sepsis campaigns include:
• Monitoring of compliance with the screening protocol
• Formation of a multi-disciplinary sepsis team at each
facility, with a designated leader of the program
The bottom line, said Dr. Anna J. Kiger, Tenet’s chief nurse
officer, is that progression to septic shock in acute care is
absolutely preventable. “We know what works, based on what
we’ve seen in San Antonio and Chicago,” she said. “We’re
going to take that learning and knowledge and roll it out
across our system in 2015. This is one of the most critical
issues we face as a healthcare provider.”
• Development of a severe sepsis screening tool and
severe sepsis protocol (the treatment timeline and
bundles noted above)
• Comprehensive and ongoing education of physicians
and nursing staff regarding sepsis screening and severe
sepsis progression
30 | The Year Ahead
2014 Clinical Operations Annual Report | 31