QUALITY SAFETY VALUE SERVICE

SAFETY
QUALITY
Helping People Live
Happier, Healthier Lives.
SERVICE
VALUE
Clinical Operations
2015 Annual Report
Clinical Operations
2015 Annual Report
SAFETY
QUALITY
4
Message
from the Chief
Clinical Officer
CONTENTS
5
Introducing
Dian Adams
VALUE
SERVICE
6
10
14
Mission
and Priorities
2015 Recognition
and Achievements
Keeping
Patients Safe
20
24
26
Sepsis Update
Tenet’s Vision
for Nursing
Improving
the Patient
Care Experience
34
36
40
46
Tenet
Physician Resources
Standardization
Value-Based
Care Environment
Call to Action
WELCOME
each other accountable. We must recognize our colleagues
for good catches or stopping the line to prevent a medical
error. As we move toward a more patient-centered care
environment, all of us must commit to creating meaningful
change. In this report, we share the story of how Sierra Vista
transformed aspects of its culture and the results of that
transformation. It’s just one example of how our colleagues
are making a difference.
Dear Colleagues,
Strive for continuous improvement
This is the second year for our Clinical Operations Annual
Report. In addition to sharing our accomplishments from the
previous year, we’re giving you an inside look at what we
want to accomplish in 2016 and beyond. I personally want
to thank you for everything that you do, day in and day out,
to care for those patients that trust us with their health.
Our dedication to providing high-quality care means that
we must leverage best practices and strive for continuous
improvement each day. One of the ways we can do this is
through the introduction of more standardized practices
and processes throughout our organization. It’s a delicate
balance. We understand the need to preserve the uniqueness
of each of the environments that comprise Tenet. However,
standardized, evidence-based practices have proven
beneficial for us in many areas, including the reduction of
healthcare-associated conditions (HACs), stroke outcomes
and readmission rates. Customized care does have an
important place, especially when it comes to delivering a
unique patient care experience, but we need to reinforce and
use evidence-based practices where sound evidence exists.
Looking back at our achievements and highlights over the
past year, it is clear we are committed to our patients. We
performed well in a number of areas, but I know that we can
do even better. This year, I’m calling on all of us to renew
our commitment to providing the very best in quality care as
we carry out our mission of helping people to live happier,
healthier lives.
As you read through this report, you’ll notice a return to
the basics. We focus heavily on safety, quality, service and
value so that we can deliver the best patient care possible.
Every interaction with the patient counts, from the moment
they walk through our doors through the follow up care they
receive after their visit to one of our facilities. We need to
ask ourselves what we can do to ensure we are meeting
the needs of our patients and supporting each other.
It starts with keeping patients safe
We will be the safest provider of care. Our goal is to have
ZERO harm to our patients. I know this sounds ambitious,
but I believe we can achieve this – but only if we are all
dedicated to providing quality care and superior outcomes
within a culture of patient safety. All of us must be on board
and agree to take ownership of the care we deliver and hold
4 | Clinical Operations Annual Report
“We focus heavily on safety, quality,
service and value so that we can deliver
the best patient care possible. ”
We still have significant room for improvement when it comes
to the patient care experience. Surveys such as the Center
for Medicare and Medicaid Services’ (CMS) HCAHPS Star
ratings show that patients think we can do a much better
job. A patient’s perception of care, while mainly subjective,
is important. Patients often equate the quality of care they
receive with how they feel about their experience as a
patient. Were they treated well? Were their needs met in
a timely fashion? Were we caring and compassionate? All
of those items matter greatly to patients. Ensuring we deliver
care in patient-centered environments will enable us to create exceptional experiences for our patients and their families.
Evidence now also demonstrates that a better patient experience produces better patient outcomes. Additionally, with more
payers incorporating patient satisfaction into their reimbursement, it also makes good business sense. I challenge all of us
to deliver a better patient care experience and a better work experience for each other.
Throughout each section of this report, you’ll see quotes and stories from colleagues who believe that their role within Tenet
allows them to make a difference in the lives of people each day. We end this report with a call to action for each of us to do
all that we can do to fulfill our mission of helping people to live happier, healthier lives.
Introducing Dian Adams
Last October, Dian Adams joined Tenet as our vice president of patient care services
and chief nursing officer (CNO). I’m very excited to have Dian on board to provide
leadership for our nursing teams in their efforts to advance the delivery of high-quality
healthcare throughout all of our Tenet facilities.
Dian brings a wealth of experience to our team, along with a fresh perspective on how
we can continue to build a patient-centered culture at our hospitals. She previously
worked for Hospital Corporation of America (HCA) as the assistant vice president of
nursing leadership. She also served as a nursing resource for leadership development,
process improvement, advancement of practice and value-based purchasing.
With more than 20 years of progressive experience in nursing leadership, Dian has led
teams in building strong nursing organizations at the facility, region and corporate level.
She believes in raising the bar for the nursing profession and looks forward to working
closely with our nursing colleagues, as well as with physicians and operational team
partners to do so.
When speaking with Dian about her nursing philosophy, it is clear that she takes a
patient-centric approach to care. Each patient is unique, and what is meaningful to one
patient may not be meaningful to another. She believes it is important to understand the
needs and expectations of our patients. In 2016, we’ll see Dian’s philosophy in action.
As our CNO, she will help our teams to develop a more patient-centric culture so that
we consistently deliver an exceptional service and care experience for our patients. She
is dedicated to providing our nurses with the support and tools they need to succeed as
leaders at the bedside and in other roles.
Dian Adams, VP of Patient Care Services
and Chief Nursing Officer, Tenet Healthcare
“She believes it
is important to
understand the needs
and expectations of
our patients.”
Please join me in welcoming Dian.
Sincerely,
Kelvin A. Baggett, MD
SVP, Clinical Operations & Chief Clinical Officer
Clinical Operations Annual Report | 5
Role of Clinical Operations
The role of Clinical Operations at Tenet is to serve and support our colleagues in the fulfillment of Tenet’s mission to
help people live happier, healthier lives. Our role is accomplished by providing and promoting appropriate clinical care
safeguards and standards that:
• Eliminate Harm
• Support the Agenda for
Growth and Cost Reduction
• Improve Quality
• Enhance the Service Experience
• Enable the Ability to Manage
Health Populations
Motivating a Career While Helping a Community
“I fell in love with the hospital because I could relate to the
people. It’s about being able to serve the community I love.”
– Dr. Luis Gutierrez-Galatas, Emergency Director, Coral Gables Hospital, Coral Gables, FL.
Dr. Luis Gutierrez-Galatas serves as the medical director of the emergency department (ED)
at Coral Gables Hospital. He enjoys getting to know his patients and their families. Because
of his Cuban heritage, he feels a common bond with many of the people who visit the ED.
Helping people live happier, healthier lives through…
Safety
Quality
Service
Value
Safety
We will be the safest
provider of care.
Quality
Voices from the Front Lines of Care
Throughout this report, you’ll see quotes from our Clinical Operations colleagues throughout Tenet.
They give us some insight on how they help people live happier, healthier lives.
Improving Medical Care for Patients
Provides a Sense of Accomplishment
“The most rewarding part of being in the healthcare field is
that patients give you the privilege of taking care of them
during their most vulnerable times and put complete trust
in you…You can truly make a difference in their lives.”
– Joy Dilley, RN, Abrazo Central Campus in the Abrazo Community Health Network,
Phoenix, AZ.
Joy Dilley is naturally inclined to care for patients. As a nurse and director of stroke
coordination at Abrazo Central Campus, the opportunity to care for patients is meaningful.
6 | Clinical Operations Annual Report
We will be reliable in care delivery
and the advancement of evidencebased practice standards.
Service
We will understand, serve and
engage our patients, their
families and our colleagues.
Value
We will deliver quality care that
meets expectations for care
appropriateness, effectiveness
and efficiency.
Clinical Operations Annual Report | 7
2015 Balanced Scorecard
The success of our organization is dependent upon our ability to provide top-quality care, exemplary service and a safe
environment for our patients and colleagues. This year, we prioritized eight quality measures on our Balanced Scorecard,
and improved upon seven of them. We have room for improvement, but our success in certain areas shows that we are
capable of providing great care. In 2016, we will focus even more heavily on quality and service so that we can deliver a
superior patient care experience.
Sepsis Excess Days
Blood Utilization
(Single Unit Orders)
Improvement:
1% over 2014
Improvement:
50% over 2014
30.6%
VTE
97.4%
Improvement:
4% over 2014
CLABSI
.863
52.3%
BSC
Balanced Scorecard
Quality Pillar
Readmission Rate
13.6%
YTD
Improvement:
8% over 2014
Pharmacy Utilization
(Experel)
3.1
Improvement:
21% over 2014
Stroke 4
95.8%
Improvement:
12% over 2014
Falls with Injury
.030
Improvement:
21% over 2014
Caring and Passionate Approach
to Patient Care.
“Being a good caregiver comes naturally to me. I
like listening to patients and hearing their stories.”
–Sue Joyce, RN, Hahnemann University Hospital, Philadelphia, PA.
On the oncology unit where Sue works, patients are often hospitalized for
extended periods of time. Sue takes the opportunity to get to know the
patients, and they often share life stories. She often creates blankets for
the patients that reflect their interests and personality traits, as well as
superhero blankets for organ donors.
8 | Clinical Operations Annual Report
Clinical Operations Annual Report | 9
Achievements/Recognition in 2015
The Leapfrog Group, 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.
44 Tenet hospitals received the highest rating of “A” from Leapfrog in the
October 2015 report.
8
9.75
Tenet hospitals –
percent – have received straight “A”s since
Leapfrog began its program in 2012. Only 133 – or 5 percent – of all
hospitals measured by Leapfrog have achieved this distinction.
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.
Tenet hospitals had
129
Tenet received
recognitions from the
American Heart Association
for compliance with its
Get with the Guidelines
programs in heart failure,
resuscitation and stroke
and the ACTION Network.
Tenet Hospitals Named
to the List of The Joint Commission’s
Top Performers in 2015
The Joint Commission’s Top Performer on Key Quality Measures program
recognizes accredited hospitals that attain excellence on accountability
measure performance.
Delray Medical Center*
DMC Children’s Hospital of Michigan
DMC Huron Valley-Sinai Hospital
89 Disease-Specific Care Certifications in 2015.
DMC Sinai-Grace Hospital
Fountain Valley Regional Hospital
Good Samaritan Medical Center
Hahnemann University Hospital
Healthgrades analyzes three years of Medicare Provider
Houston Northwest Medical Center
Review 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.
160 Healthgrades Five Star Awards
for specific hospitals. 37 hospitals were named among the
MacNeal Hospital
Palm Beach Gardens Medical Center
Palmetto General Hospital
Princeton Baptist Medical Center
Tenet hospitals received
Top 10 Percent in the nation for certain specialties.
.
10 | Clinical Operations Annual Report
St. Christopher’s Hospital for Children
Healthgrades Distinguished
Hospitals for Clinical Excellence
Saint Francis Hospital – Memphis
Delray Medical Center
Shelby Baptist Medical Center
MetroWest Medical Center – Leonard Morse
Texas Regional Medical Center
MetroWest Medical Center – Framingham Union
Twin Cities Community Hospital
Saint Vincent Hospital
Walker Baptist Medical Center
Valley Baptist Medical Center – Harlingen
* Special congratulations to Delray Medical Center for receiving
this recognition for five consecutive years.
Saint Vincent Hospital
Clinical Operations Annual Report | 11
SAFETY
QUALITY
SAFETY
SERVICE
VALUE
Recognizing Patient
Safety Heroes
As part of our efforts to create
a culture of patient safety,
we’re reinvigorating our Patient
Safety Heroes campaign in
2016. This program is one way
to recognize our colleagues
for stopping the line, or
preventing medical errors.
A Patient Safety Hero is
someone who goes above and
beyond to ensure the safety
of our patients by initiating
their facilities “Stop the
Line” process. This is a peer
recognition program, and we
encourage you to nominate your
colleagues for the actions they
take to keep our patients safe.
To nominate a colleague, email
Jeffrey Klenklen, senior director
of Patient Safety, at Jeffrey.
[email protected].
We’ll keep an archive of
Patient Safety Heroes on our
Clinical Operations SharePoint
site so you can see the good
work our colleagues are doing
throughout Tenet.
Creating a Culture of Patient Safety
Our Clinical Operations team plays an integral role in
the lives of our patients during a time when they are
most vulnerable.
Change is never simple, but it is necessary in every organization. As we move toward a more patient-centered
environment, we’re asking you to help us create meaningful change within our organization. No matter your role,
you can make a difference in reducing harm:
When patients choose our hospitals for their care, they place their trust in us and expect
that we will help them achieve the best possible health outcome in a safe environment.
Why is a culture of patient safety necessary?
Patient safety culture is defined as a
holistic snapshot of enacted norms,
policies and procedures that guide the
behaviors and attitudes of healthcare
providers. In a culture of patient safety,
team members are accountable to patients
and to each other. They take action to
eliminate harm whenever necessary and
safety efforts are supported at every
level. Employees do not fear reprisal for
reporting near misses because they see
it as an opportunity to learn.
Identify and use best practices in patient safety
1
Direct Our
Actions
E nsure safety huddles and team meetings include a consistent
focus on error prevention and reducing harm to patients
Establish specific goals for:
a. Reducing serious safety events
Implementing a culture of patient
safety can lead to:
b. Reducing healthcare-associated conditions (HACs)
c. Eliminating never events
•Better outcomes for patients
•Reduction in adverse events
•Higher level of satisfaction for
patients and colleagues
•A non-punitive environment that
encourages team members to
report errors and near misses
2
Motivate
Each Other
Make safety stories and great catches a consistent discussion item
in all meetings, and publicly recognize individuals for their efforts
E stablish weekly goals to advance the culture of safety by addressing
specific patient safety concerns
E mpower colleagues to practice safe patient care through peer
checking and peer coaching
•Zero tolerance for unsafe behaviors
•More transparent and
effective communication
How do we create a culture of
patient safety?
Creating a culture of patient safety amongst
our colleagues at all of our hospitals and
facilities is only possible when we’re all on
board. It starts with our leaders, but each of
us play a role in keeping patients safe. We are
accountable to each other. Our dedication to
patient safety is paramount to our mission of
helping people live happier, healthier lives.
14 | Clinical Operations Annual Report
Our commitment to safety is more than words.
3
Shape
the Path
Use standardized checklists in all appropriate clinical situations
Reinforce safe staff practice behavior through leader feedback
Reinforce patient safety as the primary focus on every unit, every
day, through leadership rounding
We’ll provide you with the resources you need to successfully create a strong culture of safety, in which
quality and service are valued in an effort to produce positive outcomes. We also encourage you to read the
sections of this report about our Call to Action in 2016 and about improving the patient care experience. All of
these elements are part of our commitment to patients.
Clinical Operations Annual Report | 15
Qualities of a culture of safety:
Teamwork
We work together and recognize that we’re all on the same
team with a goal to cause zero harm to our patients.
are valued is essential. Should an adverse event occur,
we focus on what went wrong rather than who should
be blamed.
Patient-Centered Care
Non-Punitive Environment
Each of us has the right to speak up. A culture of safety
cannot coexist within a culture of blame. A non-punitive
environment where accountability, excellence and honesty
We consider the key role we play in our patients’ lives.
Making sure they understand every aspect of their care and
encouraging them to speak up when they have questions or
concerns helps to ensure a safe, quality care environment.
Safety & Quality in 2015
We saw progress with many of our patient safety efforts:
21
%
13.6
%
HOSPITALS HAVE
SEEN A 21 PERCENT
IMPROVEMENT FOR
PATIENT FALLS
WITH INJURY
READMISSION
RATES ARE AT
13.6 PERCENT
70
%
RETAINED SURGICAL
SPONGE INCIDENTS
HAVE BEEN REDUCED
70 PERCENT
AN ESTIMATED 779
LIVES WERE SAVED
AS A RESULT OF THE
SEE SEPSIS CAMPAIGN
Meet One of Our
Patient Safety Heroes
“If you find something you think could be a potential
safety error, let your patient safety officer know.”
–Mary Skroko, RN, PCU nurse at Hilton Head Hospital, Hilton Head, SC.
•Comprehensive unit-based safety programs (CUSPs)
have been rolled out at all Tenet hospitals for acute
and intensive care units.
•The rate of catheter-associated urinary tract infections
(CAUTIs) decreased by 37.5 percent in 2015; 15
hospitals had zero incidences of CAUTI.
16 | Clinical Operations Annual Report
•As of July 2015, all hospitals within our system have
been trained on the retained surgical instrument (RSI)
program. Hospitals new to the Tenet system will be
trained in 2016.
“Prevention is always better than having to deal with the aftermath of a medical
error.” Mary was recognized as a Patient Safety Hero when she stopped the
line at Hilton Head by using the proper Five Rights of Medication Administration
procedure. She realized that pre-packaged morphine syringes contained the
incorrect dosage of medicine. After alerting the pharmacy, it was discovered
that multiple syringes had been packaged incorrectly. Had Mary not stopped
the line by alerting others to the issue, patients could have received improper
dosages of morphine. “Something as simple as speaking up can make a world of
difference,” Mary said. “The whole point is to make sure you are doing the best
you possibly can for our patients.”
Clinical Operations Annual Report | 17
Strong Employee
Engagement Leads to a
Strong Culture of Patient
Safety at Sierra Vista
Regional Medical Center
With everyone on board, Sierra
Vista has seen remarkable
improvements in quality and
safety in 2015.
0 incidences of CLABSI in 2015; down
from 3 incidences in 2014.
0 incidences of CAUTI in 2015; down
from 2 incidences in 2014.
0 falls with injury for two years.
Top 10 Tenet Performer in Medicare Excess
Days for Sepsis
Sierra Vista had the lowest readmission rates
for heart attack, heart failure and pneumonia
in 2015.
The hospital’s internal patient satisfaction
score (PSMS) is 74.7; and their performance
on the new patient satisfaction measure of Care
Transition is in the Top 10 at Tenet.
Culture of Patient Safety Survey:
Teamwork within units improved to 77 percent
favorable in 2015; up from 73 percent in 2014.
Teamwork across units improved to 62 percent
favorable in 2015, up from 56 percent in 2014.
Management Support for Patient Safety
improved to 67 percent favorable in 2015,
up from 63 percent in 2014.
Overall patient safety grade increased to 64
percent in 2015, up from 59 percent in 2014.
18 | Clinical Operations Annual Report
HOW IT WORKS
With the emphasis on patient safety, Joe said he often
asks his team to stop and think about patient safety.
He encourages them to regularly ask themselves these
two questions.
•Am I doing everything possible to keep my patient safe?
•Am I reporting adverse events and/or near misses?
Sierra Vista thrives when it comes
to providing a safe environment for
patient care.
Leaders Engage Employees to Support Patient Safety
For this to work, Joe knew it was important that everyone understand why quality
and safety initiatives are so important. Joe, along with Kim Brown Sims, chief nursing
officer at Sierra Vista, began educating the entire team on why quality scores were
meaningful. They used lean daily management (LDM) as a tool to set processes in
place and ensure no steps were missed when it came to providing safe, quality care.
“We work within a true culture of patient safety,” said
Sierra Vista CEO Joe DeSchryver. “Everyone knows it isn’t just
another initiative of the month. It’s just what we do here.”
Two years ago, Sierra Vista began the process of transforming
into a culture of patient safety. Two factors led to the success
of this initiative: employee engagement and leadership support.
“We believe in employee engagement. Our aim is to have
happy and engaged employees because we know it will
translate into excellent care for our patients,” Joe said. “A
strong culture of safety can’t exist unless employees are
engaged and committed.”
(from left to right) Carrie Sayeski-Reid, Interim
Director Women and Children’s Services; Kristina
Stokes, Clinical Informatics Liaison; and Lorene
Campbell, Infection Prevention Manager, discuss
important patient safety issues during the
morning team huddle.
The culture shift didn’t happen overnight. The change was
deliberate, and required the involvement and commitment of
the entire team, starting with its leaders.
“We put a strong system into place so that the culture
of patient safety will continue – but it will always require
strong leadership,” Joe said.
Driving patient safety through employee engagement has
benefited Sierra Vista in many ways. “We built it on a culture
that promotes transparent communication, staff involvement
in decision-making, optimal outcomes and exceptional patient
service. In 2015, we had a year-over-year improvement of
8 percent for employee engagement – which was the most
improved of any Tenet hospital,” Joe said.
Stacy Walker, RN, BSN, Step Down
Unit, goes over items posted to the
patient safety “Gemba Board.”
“Sierra Vista was the first Tenet hospital in California to implement LDM, which
empowers employees at all levels of the hospital to recognize and address problems
in a sustainable way. It refocused everyone on delivering safe, high-quality, efficient
patient care in what became known as ‘The Sierra Vista Way,’” Joe said. At first,
some were skeptical. They did not understand how it could help them build the culture
they sought to achieve. Hospital leaders showed them just how it could work, and
now most everyone is on board. “Some who were our biggest naysayers are now our
biggest champions of the Sierra Vista Way,” Joe said.
Each morning, charge nurses
gather for daily safety huddles
with hospital leadership.
The leaders at Sierra Vista
know not to schedule any
other meetings from 8:30
to 10 a.m. – the time of the
safety huddles. Joe said this
reinforces the message that
the hospital is committed to
patient safety, and that the
time is used wisely.
During the huddle, the team talks about potential issues and
shares how past issues were addressed. “It’s important for our
staff to know they are being heard. By talking about solutions,
we can close the loop on their concerns. Our team is able
to see how their actions make a difference,” said Kim. Every
week, the leadership team picks a topic of focus, pulling out
policies for discussion when necessary. The charge nurses
then take information back to share in shift huddles with
their teams.
Before the meeting ends, colleagues are asked if they have
any new safety concerns that need to be addressed. From
there, hospital leaders pair up to walk one of four routes and
speak with staff on those units directly. Since hospital leaders
are briefed each morning prior to the safety huddles, they can
talk to front-line staff about specific actions that have been
taken on their units. Throughout the day, metrics and issues
are discussed during all team safety huddles and meetings for
each shift.
“It’s really allowed for our colleagues on the front lines to
develop a closer relationship with the leadership team,” Kim
said. “It’s phenomenal. Every morning they are out there
walking the units, talking to staff and listening for items to
present in our daily huddles.”
Clinical Operations Annual Report | 19
Sepsis, a life-threatening illness that can lead to organ failure, is the leading cause of death for critically ill patients, with a
mortality rate of up to 50 percent. Time is of the essence for patients with a sepsis infection. For every hour that passes
without treatment, the risk of death increases by 7 percent.
We recognized the severity of sepsis and did something about it. Last year, we began a comprehensive campaign called “See
Sepsis” to educate our colleagues and raise awareness of sepsis. When we See Sepsis, we save lives. Since the launch of the
campaign in March 2015, we’ve experienced significant staff response and engagement.
Here is a look at what we’ve accomplished so far:
• Multi-disciplinary sepsis teams were formed at each facility, each with a designated leader
• A severe sepsis screening tool and protocol were developed with detailed information on treatment timeline and bundles
Saving an estimated 779
lives in 2015
• See Sepsis webinars targeting hospital leaders, physicians, nurses, unlicensed staff and sepsis campaign leads were
held with participation of more than 1,500 in attendance
• Developed a See Sepsis dashboard to easily provide hospitals with metrics on outcome data
• 5.3 percent reduction in sepsis mortality
• An estimated 779 lives were saved in 2015
• $292,982 projected savings through avoidance of Medicare Excess Days
In 2016, we will continue our See Sepsis awareness efforts. We will provide additional educational opportunities for our staff
and again participate in September Sepsis Awareness Month in conjunction with The Sepsis Alliance.
20 | Clinical Operations Annual Report
Clinical Operations Annual Report | 21
SAFETY
QUALITY
SERVICE
SERVICE
VALUE
Nursing is at the Heart of Patient Care
As the new chief nursing officer for Tenet, I’m often asked about my nursing philosophy. It’s really quite
simple. I believe that nursing practice and nursing leadership have the responsibility to make a difference in
each of the lives we touch.
Tenet CNO Dian Adams meets with Kristian Poitier, director of patient safety
and clinical risk management.
Over the past few months, I’ve had the opportunity to meet
and speak with many nurses throughout our organization. No
matter which region or hospital a nurse is from, one theme
is clear: we all chose to work in healthcare because we care
about people. Patient care is at the heart of what we do
every day; whether we’re working at the bedside, or in an
administrative role, nurses are leaders in patient care.
It makes sense, then, that we are committed to providing
a patient-centered culture in which we actively engage our
patients throughout the care delivery process. Service quality
as measured by the Centers for Medicaid and Medicare
Services (CMS) on the HCAHPS ratings system continues to
be a challenge for a number of our hospitals. This is because
HCAHPS responses are based on how a patient perceives his
or her care from the moment they step into a hospital until
after they are discharged home. A holistic culture of patientcentered care can positively impact a patient’s perception of
care in our hospitals and through the transition of care.
Since nurses interact regularly with patients, they have an
opportunity to impact patients’ overall care experience.
Simply listening to patients’ concerns, responding to requests
and encouraging them to ask questions about their treatment
plans can go a long way in how patients perceive the quality
of their care because the patients feel more involved in their
care plans.
24 | Clinical Operations Annual Report
As CNO, my overarching goal is to ensure that our regional
and hospital chief nursing executives are positioned to
support nurses at every level with the tools and training
they need to provide patient-centered care in our hospitals.
We continually look for ways to innovate and improve our
clinical care processes and outcomes while driving quality
of care, patient safety and the advancement of the nursing
practice. We’ll also be partnering closely with physicians
and other members of our operational and care teams
to ensure synergy as we achieve our safety, quality and
operational goals.
“No matter which region or hospital a nurse
is from, one theme is clear: we all chose
to work in healthcare because we care
about people.”
This year, we also seek to create a culture in which our
nurses are engaged in owning the advancement of their
practice. Our nurses at the bedside are our experts. As
leaders, it is our responsibility to create the right environment
in which they choose to stay and practice nursing at Tenet.
This goal is intended to identify what it means to be a nurse
at Tenet. We are also working with our partners in Human
Resources to develop our ability to recruit and retain highly
qualified nurses.
I’m encouraged by the passion I see among the nurses
I’ve met in our facilities in the regions where I’ve had the
opportunity to visit. I see the good work, high level of practice
and commitment our nurses bring to caring for patients.
One of the most exciting things I look forward to in 2016 is
meeting and learning from more of our Tenet nurses.
Dian Adams
CNO, Tenet Healthcare
Put Your Patients –
and Their Parents – First.
“I really get to know the babies – when they’re
feeling good and when they’re not. I also know
how important communication is for parents’
peace of mind. I involve them in their babies’
care as much as possible. Parents are always
thankful for what we do – and that feeling
is awesome!”
– Kristol Veach, RN, The Hospitals of Providence, El Paso, TX.
Clinical Operations Annual Report | 25
Taking Steps to Improve the
Patient Care Experience
The patient care experience is a
critical component of our mission
to help people live happier,
healthier lives.
According to our patients, it’s also an area in
which we have great opportunity for improvement
at many of our hospitals. We invest heavily in
safety and quality efforts, as we should, to
ensure the best outcomes for our patients.
What sometimes gets lost in the shuffle are the
individual needs and expectations of each unique
patient. Now, it’s time to bring all elements of
the patient experience together – quality, safety and
service – to anticipate the needs of our patients and exceed
their expectations.
In 2015, this was a challenge for Tenet hospitals. The first
HCAHPS Star Ratings were released and our results were
inconsistent with our mission. We began efforts to improve
the care experience for our patients and their families, and
we’ve made some progress. We need to make more. It’s time
to take a different approach as we move forward.
Why is improving the patient care experience important?
“We should place a high priority on the patient experience,
first and foremost, because it’s the right thing to do,”
said Tim Adams, senior vice president of operations and
integration. “We are fortunate to have millions of people each
year who place their trust in us while in their most vulnerable
state. We have a responsibility to treat them with the greatest
of care and compassion.”
All hospitals within our organization should challenge
themselves to become known for great patient experiences.
We must all get on board as one team to provide
experiences that meet the needs and expectations
of those we serve.
“Providing the most positive experience is not just good
business. It’s about creating an environment that allows our
patients to get to their healthiest self,” said Dian Adams, vice
president of patient care services and chief nursing officer.
“What sometimes gets lost in the shuffle are the individual needs
and expectations of each unique patient.”
Tim notes that while there are numerous organizational
implications associated with how we provide care, we must
remember that healthcare is becoming more and more of a
consumer-driven industry.
Each time we engage with a patient, we must keep in mind
patients’ individual needs and expectations. Are we treating
the patient with respect and dignity? Did we carefully explain
the treatment plan and allow opportunities for the patient and
his or her family members to ask clarifying questions?
While patient satisfaction is important to the overall patient
experience, service itself is not the only element. We must
remember that patient safety and quality outcomes are
part of it. If a patient experiences a medication error and
has a longer stay as a result, the experience will likely be
considered a negative one. Improving patient safety and
outcomes leads to better quality care, and more satisfied
patients. However, the converse is true.
We could provide our patients with the best quality care, but
if they do not feel they were treated well, they might consider
their overall experience to be negative.
continued on next page
“Not providing a great care experience can have material
negative implications. First, it will no doubt be a barrier to
growth, thus negatively impacting our financial performance
and ability to reinvest in our facilities and our staff,” Tim
said. “Second, the Affordable Care Act (ACA) introduced
something known as Value-Based Purchasing (VBP), which
can both reward and penalize hospitals based on the quality
of care they provide to patients.”
What is the patient care experience?
The patient care experience can be defined as the sum of all
interactions, shaped by an organization’s culture, that influence
patient perceptions across the continuum of care. Put even
more simply, it is how the patient perceives the quality of his or
her care. It can be likened in many ways to customer service
for other types of businesses.
“A patient’s experience is subjective,” said Mark Montoney, M.D.,
Tenet’s chief medical officer. “Patients don’t typically judge us
by the same metrics as we judge ourselves for quality. In most
cases, they equate quality of care with their overall experience
at the hospital. It’s more about how they feel they were treated.”
26 | Clinical Operations Annual Report
Ensuring we have patient-centered environments will allow
us to create exceptional experiences for patients, their families
and all who come into contact with our facilities. Every
encounter with a patient or family member counts – we can
enhance or diminish their perception of the care we provide
each time we come into contact with them. What matters
most to patients should matter to us.
“I always ask myself how I would like to be treated; or how
I would like my family to be treated,” said Dr. Montoney. “A
caring attitude, eye contact, simply sitting with a patient and
listening can make a huge difference in how the patient feels
about the experience.”
Dian agrees. “Engaging our patients and families in the
continuity of their care empowers them to partner with us so
that we can deliver the best possible experience,” Dian said.
Dr. Montoney points out that unless someone is in the
hospital to have a baby, most people are not happy to be
patients. “The hospital can be a scary, anxiety producing
place. Patients and their families may not understand
everything that is going on around them. We need to take
the time to explain everything in terms that they can
understand and reduce the anxiety of the unknown.”
Clinical Operations Annual Report | 27
How we measure the
Patient Experience
1. The externally-conducted
Centers for Medicare
and Medicaid Services
(CMS) hospital consumer
assessment program,
HCAHPS, which collects
data from several months
prior. In April 2015, the
HCAHPS program converted its
patient satisfaction scores into
simple star ratings from 1 star
(poor) to 5 stars (excellent).
Patients rate us on 11 different
elements of care, including
communication with doctors and
nurses, pain management, staff
responsiveness, communication
about medicines, cleanliness and
quietness of hospitals. Ultimately,
patients are asked whether they
would recommend the hospital
to their family and friends. The
HCAHPS Star Rating is the
average of these responses.
In April 2016, CMS adds Quality
Star ratings to its Hospital
Compare website. A significant
component of the Quality Star
ratings is patient experience.
CMS uses HCAHPS scores for
this measure of the program,
which underscores our need to
focus on the patient experience,
as it will affect how patients view
quality when choosing hospitals
for their care needs.
2. Our internally-conducted
Patient Satisfaction
Measurement System
(PSMS), which provides more
recent patient satisfaction
survey data.
28 | Clinical Operations Annual Report
“We’ve seen a proliferation of publicly available ‘scorecards’ developed in recent
years, such as the CMS HCAHPS Survey, LeapFrog Group Hospital Safety Score
and Consumer Reports, to name a few. These reports are designed to help the
consumer/patient make the right choice when deciding where to receive care.
Providing great care creates a tremendous opportunity to distinguish ourselves
from other area providers,” Tim said.
CMS’ definition of quality of care in relation to VBP is comprised of several
elements. Overall, 25 percent of those measurements are tied to patient
satisfaction/experience. “That equates to millions of dollars in reward or penalties
for our organization each year. I think we can all appreciate how tough this industry
is right now,” he said. “We can’t afford to lose any reimbursement for the services
we provide.”
“We support our colleagues to make the
difference for our patients, and to hold one
another accountable to ensure that patients
have an experience where safety is a given
and the ‘wow factor’ is a must.”
– Dian Adams, CNO, Tenet Healthcare
Creating an Atmosphere of Warmth
“We educate every staff member so that our patient
experience ratings match the quality of care we provide.
We want people to come to the hospital and experience
something different – a warm and friendly environment,”
–Judy Zavatsky, Director of Imaging, Delray Medical Center, Delray Beach, FL.
When Judy Zavatsky was 14 years old, she had an X-ray for scoliosis and found
herself fascinated. She also found a career. Judy is now the director of imaging
services at Delray Medical Center, where she also serves as the co-chair of the
hospital’s Patient Experience Council.
Clinical Operations Annual Report | 29
Diabetic Patients Inspire a Therapist’s Quest
Nina decided that she could do something to improve
patients’ lives. She developed a collaborative program
to support diabetic patients in sub-acute care. When
Nina reached out to nurse educators and dietitians in the
hospital’s outpatient diabetes program, she found her idea
enthusiastically received.
Nina Robbins’ work with patients rings true to our
mission of helping people live happier, healthier lives.
She truly wants the best for her patients and takes the
time to understand their individual needs. In her role as a
sub-acute occupational therapist at West Suburban Medical
Center in Oak Park, Illinois, the vast majority of patients
who Nina works with have diabetes. She envisions the
day when diabetes patients enjoy better health and fewer
hospital admissions.
Nina decided that she could do
something to improve patients’ lives.
In speaking with her patients, Nina realized that most didn’t
understand their condition, led sedentary lives and faced
recurring hospital admissions. She wanted to provide support
and education for these patients. She started by asking a
long-time diabetic patient to identify the greatest needs of
patients with this condition. His answer came quickly. “We
need a diabetes store in the community,” he said. Nina
understood that patients need a place to go to learn how to
live better with their disease.
Nina sees her role in creating the program as part of her job.
“As occupational therapists, we strive to help patients enjoy
meaningful, purposeful lives by being their own advocates,”
she said.
New diabetes training programs began in November, which
also happens to be Diabetes Awareness Month. Patients were
invited to attend sessions by dietitians and diabetes nurse
educators. Occupational therapists helped patients practice
monitoring and recording blood sugar levels, perform proper
foot care and discover ways to become more physically
active. In just a few short months, Nina has observed
improvements in patient’s emotional and physical well-being.
She is now developing a pre- and post-program assessment
to document the program’s performance. As she gathers
data, Nina hopes to use it to secure grants for funding to take
the program into communities where it will be accessible to
more diabetes patients.
For their efforts, the
compassionate caregivers
at West Suburban
earned the American
Diabetes Association’s
recognition for their work
in diabetes education.
This is just one example of how our Tenet colleagues
are providing outstanding service and care to patients.
Each one of us can make a difference.
30 | Clinical Operations Annual Report
Amisha Bhakta of Valley Baptist:
Making Processes Patient-Centered
Amisha Bhakta may not be directly responsible for
patient care, but she still plays an important role in
making sure patients have the best experience possible.
As a process improvement specialist at Valley Baptist
Medical Center in Harlingen, Texas, Amisha looks for
solutions that benefit the patient.
“She is known for reminding the team to keep the focus on
the patient,” says Stephen Hill, chief nursing officer at Valley
Baptist. “She always asks how a certain process will affect
a patient.”
Many patients are admitted to the hospital suddenly. It can
be a confusing time, and the admissions process can be
cumbersome. That’s where Amisha steps in.
“My role is to review processes and enable tools that will
make the admissions process most effective. It’s an integral
step not only to patient care, but to improving the throughput
of patients, reducing wait times and making it easy for
physicians and office staff to use,” Amisha said.
“She always asks how a certain
process will affect a patient.”
Amisha recently co-led the implementation of Dash, a
process to streamline direct admissions to Valley Baptist.
Dash gives providers and hospitals the ability to admit a
patient via a web-based tool, eliminating the need for phone
calls and paper orders that take up time. Patient registration
and bed assignment are expedited.
Prior to Dash, providers had to call or fax orders to Registration
and Bed Control departments. Often, the facility would not
have prior knowledge of a patient’s arrival. The patient
would then have to wait until a bed was available. If the
patient’s case was severely urgent, the patient would have
to go through the Emergency Department prior to inpatient
admittance. The Dash system has decreased the need for
urgent patients to be admitted through the ED.
Amisha worked closely with the Dash implementation team to
ensure an effective rollout of the new system. This included
obtaining buy-in from stakeholders then developing WebEx
and other types of training sessions so that colleagues could
understand the system. She also created a “go-live” checklist
to make sure the new system would be effective from the
start. Once the system is in place, she monitors for admission
delays and notifies house supervisors immediately, should
an issue arise. Amisha also provides Valley Baptist with the
ability to see progress with Dash in comparison to the
previous system.
She continues to work with the implementation team to
expand Dash.
Clinical Operations Annual Report | 31
SAFETY
QUALITY
QUALITY
SERVICE
VALUE
Tenet Physician Resources (TPR)
“This program allowed me to expand my
educational background and gave me greater
confidence in my daily interactions with patients.”
By Scott Anders, M.D., Chief Medical Officer, Tenet Physician Resources
Valuable Support Tools Help Tenet Physicians
and Providers Enhance Quality of Care
TPR Quality Dashboard
To provide us with a standardized view
of quality data for all TPR practices, we
are developing a quality dashboard for
practices that currently use Athena or
NextGen electronic health record (EHR)
software. This is the first platform at this
level to combine quality metrics from
multiple platforms. In the past, certain
EMRs have only had the capability to
produce reports within their own system.
The new quality dashboard will allow
us to view key quality metrics from
a system-wide standpoint, ultimately
driving value for our integrated networks
and providing informational strength for
negotiation with payers.
A pilot will launch soon for primary care,
cardiology, pediatrics and obstetrics/
gynecology practices, and will allow us to
review data by region, market, practice
and provider. We anticipate rolling
the dashboard out to all markets and
specialties that use Athena and NextGen
with expanded capabilities by the end
of 2016.
34 | Clinical Operations Annual Report
– Barbara Grace, Medical Assistant
at Shelby/Alabaster Cardiovascular Associates, Alabaster, AL.
Medical Assistant Credentialing Program
Caring for patients is priority number one for physicians, but sometimes, the dayto-day activities of running a medical practice can take up valuable time. Tenet
Physician Resources (TPR) works with physicians on those challenges so that they
can focus on what matters most – their patients. As more and more physicians
and non-physician providers seek employed positions over independent practice,
TPR has evolved to meet their needs.
In 2015, we focused on a number of key initiatives to improve our candidate
selection process, ensure our physician and non-physician providers meet
rigorous quality and care standards and provide care that aligns with Tenet’s values.
Improved candidate selection process
TPR seeks physician candidates that share Tenet’s values of quality, integrity,
service, innovation and transparency. Last year, to ensure physicians joining Tenet
met our high standards of quality and service, we updated our candidate selection
and review process.
•Physician candidates who practice high-visibility or high-risk specialties will
be interviewed by either TPR Chief Medical Officer Scott Anders, M.D. or
one of our regional chief medical officers in addition to the standard review
process. Examples include neurosurgery, cardiovascular/cardiothoracic
surgery and bariatric surgery.
•Assessment of online presence on sites such as Propublica.com,
surgeonratings.com as well as public review sites such as Yelp and
ZocDoc when applicable. This allows us to gain an understanding of how
a candidate is perceived in the community, in addition to their official
performance statistics.
In support of better clinical care and to enhance the professional development
of our medical assistants, we rolled out the Medical Assistant Credentialing
Program. More than 1,000 medical assistants were credentialed in 2015,
and we are moving toward a credentialing requirement for all of our
medical assistants.
The program has been an overwhelming success among
TPR medical assistants, as many feel their credentials
are a badge of honor. It has also significantly boosted our
meaningful use scores for the computerized physician
order entry (CPOE) system. This is important – as the
healthcare world becomes more technologically advanced,
interoperability and standards for operating excellence become increasingly
important. The Centers for Medicare and Medicaid Services (CMS) created
meaningful use to serve as a roadmap to provide guidance and financial support
for electronic medical records (EMR) adoption, clinical decision support and
health information exchange in an effort to improve patient care and safety. In
one year, we have improved our CPOE meaningful use scores from 40 percent
to 97 percent.
In 2016, we will introduce a medical assistant competency assessment and
annual review process. The goal is to promote continuous education, support
professional growth of our team and enhance the safety of care delivered within
our offices.
Looking ahead
Quality & Safety
In 2015, we set the foundation for safety
and the reduction of harm in our practices.
A safety event and risk management
system was implemented to track safety
events at TPR facilities and identify
opportunities for improvement. All of our
practices are moving toward the use of
safety needles to reduce the number
of needles/sharps incidents, as well as
undergoing additional training. We also
introduced a standardized tuberculosis
(TB) exposure protocol for practices
that provide a process and information
on testing, evaluation and follow-up for
TB cases.
TPR recognizes the important role our employees play, including our physicians
and non-physician providers. We will continue our efforts to help them provide
the right care at the right time, in the right manner so that they are able to meet
patient and community needs while maintaining prudent financial stewardship.
Clinical Operations Annual Report | 35
Benefits of Standardization
Stroke Outcomes
It’s a balancing act.
The use of stroke order sets has greatly improved stroke mortality rates at our
hospitals. This year, our data science team identified a significant association
between standard stroke order set use and stroke inpatient mortality rates. Tenet
used this insight to develop a regular reporting system to monitor outcomes and
improve use of the order sets.
To provide a superior patient
experience, we must treat each
STANDARDIZATION
patient as an individual. Providing
CUSTOMIZATION
patient-centered care means that
we treat each patient according
to their personal needs, which often requires customized care. Standardization of
processes and procedures ensure better communication among staff and help to
maximize patient safety and quality. The key is to recognize when each is called for
so that we find that balance to deliver optimal outcomes.
Tenet Healthcare is a system
made up of many different
facilities, each of which take
pride in their own unique history
and identity. However, all of us are
here to fulfill our mission to help
people live happier, healthier lives.
As a company, we strive to
deliver optimal patient outcomes
and superior customer service.
Many aspects of patient care can
be provided through evidencebased, standardized processes
that ensure more consistent, safe
outcomes throughout all of our
hospitals. These practices provide
a common set of expectations
that can help us to eliminate harm
while making it easier for our
colleagues to provide safe patient
care – ultimately leading to better
outcomes in:
•Safety
•Quality
•Timeliness
•Cost efficiency
•Value
36 | Clinical Operations Annual Report
Tenet is very fortunate in that we have a number of talented and renowned experts
as part of our organization. We can and do leverage their knowledge to create and
share best practices. They also help us to shape our standards for practice.
“Standardization of processes and procedures ensure better
communication among staff and help to maximize patient
safety and quality.”
“We have been able to make progress and see improved outcomes across more
than 50 hospitals all within calendar year 2015,” said Spencer Jones, director of
data science.
As of December 2015, use of standard stroke order sets approached 70
percent and had increased 14 percentage points over our 2014 baseline.
Over this time period, we saw lower than expected mortality rates among stroke
patients. Compliance with thrombolytic therapy for stroke increased from 92.4 percent
to 95.3 percent, which means better outcomes and survival rates for patients.
Readmission Rates
Our data science team also created a readmission report designed to help clinicians:
1. Identify current patients who will fall under the CMS readmission
penalty program.
How we’re benefiting
2. Target patients who are at an elevated risk for readmission.
The implementation of standard evidenced-based processes has already helped us
in many areas, including reduction of healthcare-associated infections (HAIs), stroke
outcomes and readmission rates.
3. H
ighlight the specific risk factors that can be addressed to reduce
a patient’s risk of being readmitted within 30 days of discharge.
HAIs
HAIs are infections that patients acquire while they
are receiving treatment for another condition in a
healthcare setting. According to the Centers of
Disease Control and Prevention (CDC), 5 to 10
percent of hospital patients are affected each year.
In 2013, Tenet began offering comprehensive unitbased safety program (CUSP) training.
CUSPs are nationally recognized best-practice
programs designed to improve a unit’s workplace
safety culture to one of bedside staff empowerment
and accountability. As a result of the CUSP initial
rollout in 2014, CLABSI rates for Tenet’s intensive
care units dropped by 23 percent. In 2015, 10
hospitals were CLABSI-free. CAUTI rates also
improved 37.5 percent in 2015, and 13 of our
hospitals had zero CAUTI infections for the year.
Central-line associated
bloodstream infections (CLABSIs)
Catheter-associated urinary tract
infections (CAUTIs)
CAUTI
CLABSI
Clinical staff can identify patients at high risk for readmission and focus on those
patients who would most benefit from a teaching intervention and telephone followup after discharge.
Though this process is still in its early reporting stages, early adopter sites have
seen significant improvement in the number of readmission patients. The number of
patients who received transitional care interventions increased more than three-fold.
Patients that receive these interventions have a relative 18 percent reduction in risk
of being readmitted within 30 days.
“The readmission risk tool helps me quickly identify potential core measure
patients that I might otherwise miss,” said Weiss Hospital Transition Care Coach
Laurie Jacob, R.N., MSN, APN. “It gives me an initial assessment of patients’ risk
of readmission.”
Looking ahead
37.5%* 23%*
*since CUSP programs were initiated
We diligently look for opportunities to standardize processes in areas that make
sense to help us provide safer, higher quality, more efficient care. As you can
see from the examples above, those processes are making a difference where
implemented. We can still provide an individual care experience for each patient,
even with standard processes to achieve the best outcomes for them.
Standard
Processes Lead to
Consistent Outcomes
Throughout Tenet
Hospital Operations, responsible for the
development and implementation of
strategies throughout our organization,
uses standard processes for many of
its endeavors.
“Achieving consistency in our processes
leads to high-reliability in our outcomes,”
says Britt T. Reynolds, president,
hospital operations. “Standardization
allows us to replicate our best practices
and provides benchmarks for us to track
our performance internally. The time
saved by standardizing key processes
means that hospital operators have
more time to focus on other areas of
the business that require innovation
and creativity.”
Another area where standard processes
are necessary is Tenet’s Information
Systems Department (ISD). They are
responsible for establishing the strategic
direction and management of our
information and telecommunications
systems across all of Tenet. While
standardization is necessary, it doesn’t
mean that ISD operates in a static
environment. Paul Browne, SVP,
applied informatics and chief
information officer, says that keeping
in line with standards allows us to better
adapt to a rapidly evolving environment.
“Many people think standardization
stifles innovation. That is not true,” says
Paul Browne. “Standardization is actually
an ally of agility.”
Clinical Operations Annual Report | 37
SAFETY
QUALITY
VALUE
SERVICE
VALUE
Tenet is Adapting to the Value-Based Care Environment
An inside look at how we’re preparing for population-based payments through
development of health plans and accountable care organizations (ACOs)
Contributing
authors:
Conley Cervantes,
AVP, ACO Strategy
Caroline Carney, M.D.,
MSc, FAPM, Chief
Medical Officer, Tenet
Health Plans
Sahana Sharan,
M.D., Director ACO
Clinical Operations
Huiling Zhang, M.D.,
MPH, MBA, VP,
Strategic Analytics
& Solutions
The healthcare industry is shifting from feefor-service to population-based payment,
intended to improve care quality, efficiency,
and to focus more on prevention. The aim of
the new payment systems is to reward highquality, coordinated care that better aligns
providers’ financial incentives with patient
health outcomes.
In January 2015, U.S. Health & Human Services
Secretary Sylvia M. Burwell announced
measurable goals and timelines to move the
Medicare program – and the health system
at large – toward a payment system based on
quality of care versus quantity of care. This
was the first time in the history of the Medicare
program that explicit goals were set forth for
alternative payment models and value-based
payments. A national Healthcare Payment
Learning & Action Network was created to
accelerate the transition, foster collaboration
between private payers, employers, providers,
consumers and state/federal partners.
The following goals were set:
•85 percent of all Medicare fee-for-service
payments to be tied to quality or value by
2016; increasing to 90 percent by 2018.
•30 percent of all Medicare payments
to be tied to quality or value through
alternative payment models by the end
of 2016; increasing to 50 percent by the
end of 2018.
Examples of new alternative payment models
include shared savings, patient-centered
medical homes incentives, bundled payments
and global payments.
How we’re responding to industry change
Tenet has looked extensively into alternate payment models,
and taken steps to better prepare our hospitals and providers
in taking on payment risks. Tenet has developed multiple
Clinically Integrated Organizations (CIOs) and Accountable
Care Organizations (ACOs) in various markets and is
actively working on CMS’ mandatory Comprehensive
Joint Replacement (CJR) bundled payment models.
In 2015, Tenet was awarded two of only 29 CMS Practice
Transformation Network (PTN) grants, a four-year program
with $15 million in grant funds to support ACO physician
transition to fee-for-value. Tenet Medicare ACOs have
generated more than $50 million in program savings to
date (2012-2014). Our Michigan pioneer ACO was the most
successful pioneer ACO in the country for 2014, based on
percent of savings.
Tenet’s CIOs are governed by respected physician leaders
within each market, in developing a strong provider
network with broad patient access. With establishment
of innovative relationships with physicians, employers,
payers and patients, and infrastructure to share data across
the care continuum, it aims to achieve high quality, costeffective care through shared best practices and increased
collaboration and alignment among physicians and hospitals.
Our ACO Clinical Care Management Model is designed
to provide cross-continuum care coordination through
provider collaboration, member engagement and health
plan partnership.
•Provider collaboration – by sharing information
and providing actionable insight across the care
continuum, the networks are able to better coordinate
care and decrease cost with improved quality and
patient outcomes.
•Member engagement – the ACOs are actively
engaging members by connecting them to wellness
programs, providing incentives for healthy living and
prevention programs. Tenet ACOs also proactively
manage high-risk members with active case
management and enrollment in appropriate disease
management programs.
•Health plan partnership – coordinates with health
plans on efficient transition of care and leveraging
plans’ existing educational and wellness programs
for member engagement.
Clinical Operations Annual Report | 41
Committed to Value-Based Care and
Delivery Transformation
Tenet recognized Nationally in Top
100 ACOs for 2014 and 2015
18 Total Accountable Care Organizations (ACOs) across
the Tenet portfolio
809K
Michigan Pioneer ACO
recognized by CMS as
most successful Pioneer
ACO in 2014 for benchmark
savings improvement
Covered Lives
(+21%)
<50,000 covered lives
50,000+ covered lives
100,000+ covered lives
79%
9
of Tenet Hospitals are participating in an ACO
Designated Medicare ACOs operating
in 15 markets
15 of 18
69%
(88%) ACOs contracted with private payers
of Tenet markets in at least one Medicare
Innovation Program in 2016
11 ACOs cover 11 of 13 (85%) Tenet states
Community Involvement
Tenet Physicians
10,361
33%
Physicians participating in Tenet
ACOs; up 8% from Q3 2015
Primary Care Physicians in
Tenet ACOs
$10M
$15.5M
Healthcare Innovation Award to Detroit
Medical Center to improve healthcare
access, quality and efficiency
Medicare Practice Transformation grants
to advance clinically-integrated care in
underserved communities
Managing 5.5M lives under Conifer Value-Based Care, up 17% from last year
Conifer ranked No. 1 among providers of value-based care solutions to
Medicare and commercial ACOs (Black Book)
42 | Clinical Operations Annual Report
How Health Plans Play a Role
Health plans play an important role in guiding and supporting healthcare for enrollee populations to ensure cost
effective, high quality care.
In recognition of this, Tenet has embarked on the
development of health plan business in Arizona,
Michigan and Texas. Our health plans are designed
to take a 360-degree view of care that includes case
management, utilization management and alignment
of the provider networks.
Case management interventions are directed at real-time
remediation of barriers that could lead to increased or
inappropriate use. Longer-term strategies for persons with
complex, chronic conditions include motivational interviewing
and coordination across the continuum of care.
Our health plans are designed to take a
360-degree view of care that includes case
management, utilization management, and
alignment of the provider networks.
We firmly believe that case management and medication
therapy management (MTM) must work in concert with
one another to ensure that services are not duplicate, and
that members receive one consistent message. Recently,
it was discovered that a young child with asthma would go
without control inhalers while staying at the home of one of
his divorced parents. Integrated case management enabled
the case manager to intervene and ensure that the child had
the needed inhalers available at both parents’ homes. This
intervention meant that the family was able to avoid a trip to
the emergency room.
Utilization management tools are essential in managing risk.
Through prior authorization, concurrent review and transition
of care at discharge, we are able to identify our members’
needs in real time.
Concurrent reviews and required notification of an inpatient’s
stay allow our health plans to be full participants with our
patients when it comes to discharge planning. They can help
arrange services such as home healthcare or skilled nursing.
These interventions during the transition of care help to
prevent readmissions while also aligning the member to less
costly outpatient support and services.
As we develop a health plan line of services, Tenet can align
healthcare coverage with our hospitals, surgery centers,
urgent care centers and outpatient primary care facilities.
One example of how we’re doing this is through the
development of community paramedicine programs. In this
program, paramedics and emergency medical technicians
work with high-risk patient populations who reside in
socioeconomically-stressed neighborhoods to target their
pre-hospital and post-discharge medical and supportive
care needs.
The creation of these narrow networks supports collaboration
between Tenet hospitals and health plans in our mission
to help people live happier, healthier lives. Tenet-owned
or affiliated provider groups and hospitals are at the core of
healthcare delivery. The health plan and clinical venues then
become one team aligned to support the patient.
Prepared for the future
Tenet is continually seeking information on how to improve and expand our ACOs so that we may continue to provide
the best quality of care at the greatest value to both our patients and our organization. We look forward to expanding
our ACOs to other regions in the country, as it will help us live out our mission.
Clinical Operations Annual Report | 43
SAFETY
QUALITY
CALL TO
ACTION
SERVICE
VALUE
2016 Call to Action
At Tenet, we are all united in our mission to help people live
happier, healthier lives.
To successfully fulfill our mission, all of us share in the responsibility to provide patients with safe,
high-quality care. If we wish to be successful and to remain hospitals of choice for our patients,
we must create the most effective healing environment.
Service
We will understand, serve and engage our patients,
their families and our colleagues.
To each of you, I issue a call to action to do all that you can to live our mission each day.
Take Action: “What can I do to improve the care
Our commitment is to our patients and their families, to the community, and to each other. We strive to honor the trust
placed in us by continuously evaluating patient care processes and adopting best practices in order to improve quality,
safety, service and value. Take a look at each of the following four areas, and ask yourself how you can help people to
live happier, healthier lives.
Safety
Service
experience of every patient I encounter?”
•Treat every person with dignity and respect
•Explain who you are, what procedure or task you are
performing and why, each time you interact with a patient
Safety
•Speak with patients to better understand their needs
and concerns; ask what is most important to them
We will be the safest provider of care. Our goal is to eliminate harm, with
zero tolerance for preventable safety events and a target of zero healthcareassociated infections within our hospitals.
•Be responsive to requests
•Always ask patients if there is anything else
you can do to make them more comfortable
Take Action: “What is the one thing I can do today to prevent
harm from occurring in my environment?”
•Assess risk with your colleagues and then mitigate those risks
•Participate in safety huddles
•Hold each other accountable for actions, both positive
and negative. Recognize “good catches”
Value
Value
We will deliver quality care that meets expectations for care
appropriateness, effectiveness and efficiency.
Take Action: “How can I work with my colleagues to ensure
the best possible outcomes for our patients?”
Quality
Quality
We will be reliable in care delivery and the advancement of
evidence-based practice standards.
•Involve patients and their families in their care plans
•Ensure appropriate length of stay
•Eliminate preventable readmissions
•Participate in leader rounding
Take Action: “How can I improve quality at my facility?”
•Identify opportunities for improvement and speak up
•Be aware of evidence-based best practices
•Complete all checklists and follow standard processes
•Increase collaboration and communication among colleagues
46 | Clinical Operations Annual Report
We’re all in this together, and we
can achieve our goals in 2016.
Clinical Operations Annual Report | 47
48 | Clinical Operations Annual Report
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