A Community of Hospital Safety Champions

 

By Mia Arias, MPA, National Health Foundation Director of Programs

For seven years, Patient Safety First (PSF) has provided hospital staff with an opportunity come together, learn from each other, and share success stories and best practices all in the name of providing safe, quality care to patients that step through the doors of their hospitals. As a statewide collaborative, PSF has provided over 200 in-person meetings, webinars and calls to support hospitals’ improvement efforts.

Many times, the faces you see at these regional meetings change, but there are some that become very familiar. One such face is that of Donna Young. Donna is Director, Performance Improvement at Chino Valley MedicalCenter. Donna has been an RN for sixty years and attests to seeing a lot of changes in healthcare during that time. For the past seven years she has consistently attended PSF meetings in the Southern California region. I had the opportunity to sit down with Donna and ask her a few questions about her experience participating in PSF, what effect it has had on her work and why she makes coming to these meetings a priority.                  

How has PSF supported quality improvement efforts at Chino Hospital? 

“PSF provides us practical tools to drive improvement, it also enables us to have good data to present to our staff and medical board. Our leadership often asks, how does our data compare with local and national hospital programs? PSF provides a credible comparison point.I really appreciate the consistency of the PSF goals and how the program stays relevant to changes in performance improvement measures and requirements. PSF is a very reliable resource.”

What are some of the practices your hospital has undertaken to effect positive patient safety changes?

“We focus on safety at every single staff meeting and understand that building and supporting a culture of safety is paramount to ensuring we provide the highest quality of care to our patients. We use the Agency for Healthcare Research and Quality (AHRQ) survey on patient safety culture to asses where staff are and we’ve seen great results. Chino Valley Medical Center recently received three awards recognizing our successes in safety, including the Truven Top 100 Hospitals, 2015 Women’s Choice Award for Emergency Care and HealthgradesPatient Safety Excellence Award™ Winner 2016. Our involvement with PSF has helped us both achieve and demonstrate our improvement.”

In your experience what has been the single best component of PSF and why?

“I like the peer-to-peer learning aspect. Working at a fast pace in a hospital can sometimes feel isolating. Coming to these meetings and networking with your peers helps take you out of your routine. You find people you can talk to about the same issues you might be experiencing. PSF is a community, so when you are asked to present, you feel comfortable because you are in front of your peers. It is still a challenge, but a good one that expands your competencies.”

As we finished our discussion, Donna told me that she certainly hopes PSF continues for many years. For her, and for many of the hospitals that participate in the free, statewide collaborative the resources and information they receive is just as valuable as the networking and social aspects of the program. PSF truly is a community.

Patient Safety First (PSF) is a groundbreaking partnership between National Health Foundation, California’s Regional Hospital Associations, Anthem Blue Cross and over 160 hospitals across the state. The efforts of Patient Safety First have been recognized by several awards, most notably the esteemed 2013 John M. Eisenberg Patient Safety and Quality Award from the National Quality Forum and The Joint Commission, for the demonstrated Phase 1 accomplishments of its first three years (2010-2012).

Bridge Housing: Connecting the Homeless to Housing After Hospitalization

The recent 2015 homeless count conducted by the Los Angeles HousingServices Authority showed a staggering 44,359 homeless individuals in LA County, a 12% increase in the last two years. Although partly due to a change in methodology, the count is seen as more accurate than ever before. In addition, LA’s chronic homeless population has grown to 12,536 since 2013, accounting for more than 1/3 of the Nation’s chronically homeless. Many of these individuals are plagued by chronic health issues, frequently sending them to the hospital for care.

At the core of these individuals’ health issues is their lack of housing. Social determinants of health tell us that housing equals health. But to help these individuals make the transition into a home, it takes more than finding a vacancy.

Each year, National Health Foundation (NHF) provides recuperative care to more than 1,000 homeless patients who have been safely discharged from partnering hospitals. Recuperative care provides homeless patients with a safe place to heal while receiving comprehensive care management. Often during their stay in recuperative care, clients experience a disruption in homelessness and, if they were not already, become willing to participate in the process to secure housing. When the client is interested, securing housing is a goal. However, funding for recuperative care rarely last more than 14 days and this is often not enough time to connect a client to needed housing resources, let alone transition them into their new home. If a client is forced to return to the street while waiting to transition, their chances for a successful move diminish.

Through its bridge housing program, NHF is able to provide these individuals with additional or “bridge” time in the recuperative care center. During their lengthened stay, they receive help with applications for birth certificates, identification cards, and applications for state and federal benefit programs. Connections are made to medical homes and referrals are made to substance abuse and/or mental health programs and social support groups. Clients have a safe, clean place to stay while waiting for their home to become available. When the time comes, bridge housing clients receive comprehensive discharge instructions and continued follow-up for six or 12 months post-transition.

Bridge housing makes transitioning into a home more feasible for homeless clients and is more economical for the community. According to the Los Angeles United Way Homeless Cost Study (2011), the total cost of public services for two years on the streets was estimated at $187,288 compared to $107,032 for two years in permanent housing with support services—a savings of $80,256 or almost 43%. But more than that, housing the homeless resolves one of their biggest barriers to a healthy life.

With support from the Conrad N. Hilton Foundation, the Ahmanson Foundation and the Harold Edelstein Foundation, NHF is implementing the bridge housing program with a goal to place 150 clients in permanent or permanent supportive housing over two years.

Recuperative Care: Healing the Homeless

In 2005 and 2006, Los Angeles’ Skid Row grabbed national headlines after images surfaced of individuals in hospital gowns being dropped off on the street. These images brought immediate and substantial attention to a struggle that continues today, ten years later: safe discharge options for homeless clients after an acute hospital stay.

Public outcry for better treatment of the homeless, steep fines for poor discharge practices, and hospitals’ clear need for safer, healthier discharge options resulted in development and subsequent proliferation of the region’s recuperative care programs. For National Health Foundation (NHF), a multi-year pilot project that began in 2007 to conceptualize and test recuperative care resulted in a strategic shift in our services several years later. Not only did NHF help to develop a self-sustaining program concept that serves both homeless clients and hospital partners in Los Angeles and Orange Counties, but in 2014 it took on the operation of direct service for the first time. Operating these services has provided valuable insight into best practices for delivering compassionate and cost-effective care to the homeless upon discharge from the hospital setting. Perhaps more importantly, the program has demonstrated how a safe and supportive environment in tandem with a concentration of services can create a disruption in homelessness, result in clients’ willingness to move into a permanent home, and ultimately dramatically shift their long-term health outcomes.

Pathway Recuperative Care a program of National Health Foundation in Los Angeles, now in its sixth year of operations, bridges a critical healthcare service gap by providing homeless clients who are transitioning out of an acute care hospital with basic medical oversight in a clean, safe environment. This service allows clients to continue their recovery and receive treatment for any additional minor illnesses, thereby reducing the chances of relapse and costly re-hospitalization. Prior to partnering with recuperative care facilities, hospitals would be forced to keep patients no longer in need of acute care for roughly 4.5 additional days to provide the basic oversight. The differential in cost for one day of hospitalization versus one day of Recuperative Care is in the thousands. . To date it is estimated that this program has helped hospitals avoid $17,924,184.00 in cost. Partnering hospitals have also noted that streamlined referral procedures, diligent communication with the hospitals, data collection and analysis, as well as an innovate ‘pod’ concept (allowing for more service points in large geographic areas) have improved the experience for the partners while maintaining excellent service for the patients.

For NHF, the real measure of success has been the percentage of recuperative care patients who were discharged into housing. Through intensive care management, care managers help clients identify the root causes of their health issues, work to overcome those challenges, facilitate connections within the community that support a clients’ continual improvement, and for many, provide smooth transitions from the hospital to housing. NHF prioritizes the needs and wishes of the client, working to understand their housing and supportive service preferences, and securing housing during their time in recuperative care. In 2015, NHF added a “bridge housing” component to its program, enabling clients to remain in the recuperative care facility past their hospital-provided days, so they did not have to return to the street while waiting for their housing placement to become available. During fiscal year 2015-2016, NHF served 694 clients with recuperative care, 45% having been discharged into permanent or transitional housing. In addition to helping these clients recover from injury and illness, many of these homeless individuals were connected to critical social and healthcare services. NHF has been able to house approximately 30% of these clients within 14 days, in either transitional or permanent housing (7-10% in permanent housing alone).  As a result of NHF’s partnerships, recuperative care is able to address both health and social service needs of the client while connecting patients to a stable home.

Currently, NHF operates two sites in Los Angeles County, one in the Mid-City area of Los Angeles and another in San Gabriel Valley.  Under the current model, NHF offers 40 recuperative care beds to clients from 60 participating Southern California hospitals. This fall, NHF anticipates launching a third site in Ventura County.

Support in School for Pregnant and Parenting Teens in South Los Angeles

On February 9, 2016, National Health Foundation began its eighth year of the Harold Cares About Your Future: Pregnant and Parenting Teen (PPT) program, which was created to empower teen mothers to have healthy pregnancies and parenting experiences. The program serves low-income, predominantly Latina and African American girls in South Los Angeles.

For many of our participants, maintaining a healthy pregnancy is a daily effort that requires what seem like simple, yet are significant changes in behavior. Whether it be eating healthier, taking prenatal vitamins or exercising more, the program provides space for each mom to discuss behaviors she is trying to improve. The program also connects participants with community resources for healthcare, child care and career planning. The combination of small-group education sessions with community partners gives participants access to different forms of support. Ultimately, the goal of the PPT program is to increase rates of high school graduation, and decrease the incidence of low birthweight babies and recidivism.

This year, a group of 22 girls at Thomas Riley High met once a week for 10 weeks to learn about nutrition, fetal development and child development, to share their experiences with labor, delivery and motherhood, and to discuss healthcare, child care and other family services.

Rebecca, an expectant mom and a sophomore at Thomas Riley High, had a few things to share about her experience in the program:

How did you find out about the Pregnant and Parenting Teen (PPT) program?

I found out about the program through my principal, Ms. Roussel. My math teacher, Ms. Vester, encouraged me to attend. She wanted me to get involved in a program for new moms.

What did you think the PPT program was going to be about? Were you surprised by what it really was?

I thought it was going to be a class with tips for pregnancy and parenting. I was surprised with how open the meetings were. Everyone got a chance to share their experiences. Before being in the group, I was scared to go into labor but after hearing the girls’ stories, I’m happy to know that everything will end up okay.

What was one thing that really stuck with you?

I really liked everything we learned. When we talked about fetal development, for example, I learned that a baby can open and close their eye lids starting in week 26, during the second trimester. The topic that stuck with me the most was when we talked about sleeping patterns. I never realized how important sleeping schedules could be, for both the mom and the baby.

Did any of your behaviors change or improve throughout the program?

Yes, I started practicing meditation and relaxation techniques after we learned about how stress can affect a pregnancy. I also started walking more. It was a little hard at first, but I was able to make the changes I needed to have a healthier pregnancy.

How will you use some of the things you learned going forward?

I’m going to keep all the notes we took in class to use in the future, especially the ones about child development because I think that’s really important.

Participants at Thomas Riley High graduated from the program and received their certificate of completion on May 3, 2016. The PPT program is currently in session at McAlister High School. They are set to have their graduation on June 8, 2016.

Harold Cares About Your Future: Teen Pregnancy Prevention with a Heart

During Teen Pregnancy Prevention Month, celebrated each May, we turn our attention to our teen pregnancy prevention programs. These services are critically important in encouraging young people to develop life-long goals, helping them to understanding the consequences of their actions and supporting them as they realize their potential.

Harold Edelstein had a simple wish: to help individuals who needed it most through programs that deliver immediate, maximum effect. In the years since his passing, The Harold Edelstein Foundation has funded National Health Foundation’s Be A Star and Harold Cares About Your Future programs, which provide pregnancy prevention education and support to at-risk young men and women in participating Los Angeles high schools.  Harold would be deeply proud of the roughly 680 graduates to-date.

Fred Simmons of the Harold Edelstein Foundation

Today, the foundation is run by three trustees; Fred Simmons, Marvin Burns, and Susan Rothenberg. Fred Simmons is the trustee we know best. Over the years, we have worked closely with him and he has tirelessly championed our teen pregnancy prevention education programs, which the Foundation seeded. The foundation eschews long grant application processes in favor of deeply personal relationships with the programs they choose to support. Simmons understands that teen parenthood leads to lower graduation rates and limited options, and he is passionate about giving underserved young men and women a fighting chance for a better life. His eagerness to make a positive difference in others’ lives is a living embodiment of Harold’s wish. This is not surprising since Harold Edelstein and Fred Simmons knew one another for over 30 years.

Recent graduates of the Be A STAR Girls program.

This year’s Be a Star Boys and Be a Star Girls programs were held at five high schools throughout Los Angeles. The programs work directly with young men and women who have been identified as at-risk of becoming teen parents and dropping out of high school. The 10-week prevention curriculum promotes responsible behavior and empowers youth to make a commitment to their futures by avoiding risky behavior and focusing on values such as integrity, accountability, self-determination, and goal-setting. The program provides individual services, strong linkages to community resources, and peer group education sessions at partner school sites. 

For young women who are pregnant or parenting while in high school, the Harold Cares About Your Future program coordinates community resources and offers strategies to prevent subsequent pregnancies to young women at two Los Angeles high schools. At the same time, this program supports participating students as they set academic goals and pursue educational interests and opportunities.

Recent graduates with their new ties.

The success rate of the program provides a strong argument for further programming: At six-month follow ups, 91% of the teen girls who went through the Harold Cares program were still in school or had graduated. When compared to the Los Angeles Unified School District overall dropout rate of approximately 17%, that’s an 8% improvement. Even more, only 50% of teen mothers receive a high school diploma by age 22; these young women are soaring above that statistic. In addition, the teens who participated in the Harold Cares program showed a 5% rise, from 81% to 86%, in their recognition that a high school diploma was important. Perhaps most heartening is the fact that 100% of the teen girls who went through Harold Cares program were not pregnant (or pregnant again) at follow-up six months later.

At a recent program graduation, all of the girls received gifts with "Harold Cares About Your Future" printed on them. They wanted to know who Harold Edelstein was and were a little sad and surprised to hear he was long dead. However, they expressed a deep gratitude for the foundation’s continued efforts to honor Harold by caring so deeply for them. Meanwhile at the Be A Star boys program graduation, participants were given a necktie as symbol of their having learned to put their best foot forward. The young men, equipped with sharpened decision making skills and a deeper sense of self-confidence about their futures, were excited to dress the part, as well.

Walk This Way! Caminale!

Four of the eleven wayfinding signs and the group of Health Academy students who made it happen.

In a city that was built around cars and driving, walking is something we do to get to and from our cars. But if we told you that if 10% of adults began walking on a regular basis, $5.6 billion in heart disease costs would be averted, would you rethink walking? Not to mention the improved health experience of those adults.

With the support of National Health Foundation and Los Angeles Walks, the Jefferson High School Health Academy students have come together to bring walking (and biking!) back to Los Angeles and have created a walking corridor along Central Avenue in South Los Angeles.  Their goal was clear: Have Angelenos fall in love with walking and reap the enormous health benefits. Twelve blocks along Central Ave., from 33^rd to 45^th streets, will be marked by clever wayfinding signs that will be unveiled in time for a celebratory walk scheduled for May 18th between 3:00 and 4:30 p.m.

The students led a community-based process to vote on designs and determine sign placement. The wayfinding signs give information on walking and biking times between various destinations, show connectivity between neighborhoods, and celebrate community history and assets. Equally important, they encourage walking and change perceptions that many places are too distant to get to on foot. These wayfinding signs will go a long way in help making the neighborhood’s public spaces more vibrant and active.

“Walking provides numerous health benefits and anything we can do to encourage our community to walk to their favorite shops, to the park, or even to downtown L.A., is going to create a positive impact. Programs such as these are bridging gaps in health in an innovative and accessible way. We salute the students on this accomplishment!” said National Health Foundation CEO, Kelly Bruno.

Of course, none of this could have been done without the support of many: Los Angeles Walks, National Health Foundation and its Health Academy program, Jefferson High School, Los Angeles Department of Public Health, Champions for Change, Mayor Eric Garcetti’s Great Streets program, Councilman Curran D. Price, Jr., Council District 9, LADOT, The Youth Envisioned Streets Team (National Health Foundation, A Place Called Home, Coalition For Responsible Community Development, and the Los Angeles County Bicycle Coalition), This South Central Neighborhood Council, IOBY, The Central Avenue Business Improvement District, Community Health Councils, and TRUST South LA.

For more information on the Walk This Way/Caminale event, please click HERE.

The BUILD Health Challenge: BUILDing Change from Within

The BUILD Health Challenge Community Health Liaisons presented their plan at the most recent National Health Foundation board of directors meeting.

In the Historic South Central Los Angeles area, a group of highly motivated youth spent several months surveying and interviewing members of their community in an effort to craft solutions that reduce the prevalence of obesity, diabetes and other cardiovascular disease in their neighborhood. It’s a tall order for the ‘Community Health Liaisons,’ but their enthusiasm and creativity have proven to be just the antidote for a community looking to improve its health.

The youth, National Health Foundation (NHF), Los AngelesCounty Department of Public Health and California Hospital Medical Center, have partnered to develop a Community-Driven Action Plan for the Historic South Central community based on the findings of their research. The purpose of the plan will be to implement upstream, meaning preventative rather than curative, solutions to the health issues faced by the community. By lowering or even eliminating some of the social and environmental barriers to health, the youth hope that the community will defy the current statistics that point to lower life expectancy and a higher than average rate of preventable illnesses.

A robust environmental scan for the neighborhood (inclusive of South Central, Central Alameda and Zapata King)  formed the basis of this proposed 4-point action plan:

1) Finding: Local markets do not carry healthy food options.

Proposed Solution: By offering merchants the opportunity to be part of a cooperative purchasing program where the owners would able to buy fresh produce at a lower cost, the community would have access to fresh fruits and vegetables at competitive prices.

The Community Health Liaisons present their findings to the community.

2) Finding: Local clinics are positioned to be more involved in the prevention of disease.

Proposed Solution: The plan calls for doctors to provide patients at risk of developing diabetes or obesity with a healthy meal recipe and a voucher to a participating small market where patients could purchase the ingredients at a reduced price. The plan also calls for doctors to ‘prescribe’ physical activity at one of the local park fitness programs.

3) Finding: Parks are not always inviting or safe and recreational facilities offer limited programming.

Proposed Solution: The plan calls for reaching out to local organizations to expand their fitness programming to include classes in the parks. Low cost options for expanding these services include partnerships with kinesiology students or other relevant volunteers.

4) Finding: Marketing is important in reaching out to the community.

Proposed Solution: The plan calls for the development of a place-based and community-focused marketing plan and peer-to-peer education to push this program forward, to increase store involvement and clinic participation, and raise awareness for addressing social determinants of health and health equity in the Historic South Central community.

The youth have spent the last few weeks speaking to their community at local events and they have received strong support from families and community agencies as well.

“The parents we spoke to all agreed that it was far easier and cheaper to buy fast food than it was to buy healthy food and cook it. Many of them are shuttling between multiple jobs so convenience and cost are key.  But simultaneously, they are acutely aware that they are setting a bad example for their children,” shared BUILD youth engagement program coordinator John Rivera. “These same parents are beginning to experience health issues like pre-diabetes and their doctors are urging them to fix their diet. They realize they need to make a change.”

Parents also shared that once their children go to school, the control they have over what their children eat fades and they are then co-parenting with the community. “Once the children are in school, parents realize that they need to become involved with creating change at the community level and that these changes will benefit their children and those of their friends and neighbors,” shared Alba Peña, BUILD youth engagement program manager. “They are poised to press for healthier options in school and in their community!”

Perhaps the most important finding of the program has been the enthusiasm of the Community Health Liaisons and the respect they have garnered from their families and the entire community. NHF President and CEO Kelly Bruno’s excitement for the program is well founded, “The students have really risen to the occasion and have demonstrated incredible poise and creativity during their planning and presentation process. Their message is resonating with the community in a way that no outside agency or organizational message could because they are creating this change from within. Their families, friends, community officials and elected leaders are actively listening and are joining them to move these ideas forward. These young people are truly bridging gaps in health.”