Collaboratives
About Our Collaboratives
A collaborative is a quality improvement model in which there is an organized effort of joint learning and support involving a network of sites. State and national experts provide learning opportunities, guidelines, materials and coaching and there is significant knowledge sharing between participating organizations. Participants engage in improvement activity during action periods of the collaborative, punctuated by in-person and virtual learning sessions.
Our collaborative model is based on the IHI Breakthrough collaboratives, and includes in-person learning sessions (at least annually,) monthly teleconference/webinars which alternate providing educational content and providing coaching support to project teams, quarterly individualized coaching calls with project teams, and data analysis and feedback to track progress. An expert panel of clinicians and other relevant stakeholders with expertise in the area being addressed is convened to review current literature on the issue and to develop recommendations for improvement. These experts also serve as consultants to the project, providing leadership in training sessions, webinars, review of content, and coaching of participant teams or individuals. A collaborative charter is written with input from the expert panel, clearly stating the problem statement, mission, goals and objectives, methods, expectations, and timeline of the project. Participant organizations recruit internal project teams with representation from relevant disciplines, quality improvement, patient safety, executive sponsor, unit leadership, patient/family advisory groups, and include a data contact and a team leader, usually a unit manager. Interventions and practice changes are suggested based on available evidence and experience. Project teams test and implement these changes using Plan-Do-Study-Act cycles. Data is submitted regularly throughout the collaborative and feedback reports are provided quarterly to the project teams. Within the confidentiality of the collaborative, participants transparently share data, results, tools, and solutions to barriers that may arise, developing collegial learning relationships. Tools, resources and solutions that prove to be successful are then shared statewide outside the collaborative. In addition to any technical or clinical components, cultural change is addressed in each collaborative through education on Just Culture, TeamSTEPPS, Comprehensive Unit Based Safety Programs, reliability and process improvement.
Current Collaboratives
NC Safe Surgery
Starting March 2012, participating hospitals will work together in a twelve month, statewide collaborative designed to improve perioperative safety by implementing core, evidence-based interventions within the context of an open learning network. More information...
NC Prevent CLABSI: Targeting Zero
North Carolina Healthcare facilities will have the opportunity to participate in a statewide collaborative, designed to reduce CLABSI rates with sustainment, by implementing core, evidence-based interventions. This collaborative will take place August 2011 through June 2013. More information...
NC Prevent CAUTI
Using a modified collaborative model, hospitals will receive infection prevention improvement expertise at a state level, and assistance to develop necessary, cultural foundational elements to support and sustain gains.
Each participating acute care hospital will be asked to identify a unit (example: ICU, rehab unit, surgical unit, etc.) to focus on while in this collaborative. The unit team will work to develop and or redesign care processes to prevent CAUTI and will measure the compliance to selected care processes and outcomes. In addition, the safety culture will be measured in the identified unit at the beginning and again at the end of the collaborative. Once reliable processes have been developed, project teams will be challenged to develop a spread plan to incorporate the improvements into additional areas of the hospital.
From the NC Prevent CAUTI Celebration, Nov. 18, 2011
The CAUTI collaborative resulted in a 28% reduction in the pooled CAUTI rate per 1000 catheter days among the 21 participating hospital units over the 12-month duration. By collaborative end, five participating units were CAUTI-free for over 9 months.
NC Just Culture
Creating a culture of safety is imperative for organizational learning and the design of safe systems. To do so it is necessary to create an open and fair culture, a balance between a blame-free and a punitive culture. It is necessary for all individuals to continually evaluate risks inherent in the choices they make.
The term "Just Culture" refers to a system of shared accountability where healthcare organizations are responsible for the systems they have designed and for supporting the safe choices of patients, visitors and staff. Staff, in turn, is accountable for the quality of their choices within those systems.
Past Collaboratives
NC Safer ICUs: Eliminating CLABSI
North Carolina has been selected as one of ten states by the Health Research and Educational Trust (HRET) of the American Hospital Association to participate in a national initiative to reduce central-line associated blood stream infections (CLABSI) in intensive care units (ICUs). The project is funded by the Agency for Healthcare Research and Quality (AHRQ) and is in partnership with the Michigan Health & Hospital Association’s (MHA) Keystone Center for Patient Safety & Quality and the Johns Hopkins University Quality & Safety Research Group (JHU).
In October 2003, the Keystone Center worked with Dr. Peter Pronovost of JHU on a a two-year project to reduce CLABSI rates in Michigan ICUs. A total of 108 ICUs participated in this collaborative which focused on the implementation of evidence-based interventions aimed at reducing the incidence of CLABSI and ventilator associated pneumonia (VAP); improving teamwork and communication between clinicians; and enhancing the culture of safety and improving staff satisfaction. The project resulted in a decrease in the median infection rate from 2.7 per 1000 catheter days at baseline to zero at 3 months after implementation of the intervention. The benefit from the interventions was sustained resulting in a 66% reduction in CLABSI at the end of the study period.
AHRQ seeks to replicate the success of the Michigan ICUs in dramatically reducing CLABSI throughout the nation. Michigan used the Comprehensive Unit Based Safety Program (CUSP) and CLABSI reduction protocols developed by JHU to significantly save lives and reduce costs.
Download the fact sheet and the flyer for more information.
NC SCIP
The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations committed to improving the safety of surgical care through the reduction of postoperative complications. Launched in 2005 the goal of SCIP is to reduce the incidence of surgical complications by 25% by 2010. SCIP identifies evidence-based process of care related to prevention of cardiovascular events, surgical site infections, postoperative pneumonia and venous thromboembolism.
In August 2007, forty-nine North Carolina hospitals, representing over 70% of the surgical volume for North Carolina came together to improve the surgical care delivered to North Carolinians and joined the NC 2007 Surgical Care Improvement Project (SCIP) Collaborative. The year long collaborative supports NC hospitals to develop reliable systems/processes using characteristic collaborative components and encourages the sharing of best practices amongst the participating hospitals.
The NC 2007 SCIP Collaborative is led by the NC Center for Hospital Quality and Patient Safety in partnership with the Carolinas Center for Medical Excellence (CCME), NC Area Health Education Centers (AHEC), Southern Atlantic Healthcare Alliance (SAHA) and the NC Chapter of the American College of Surgeons (NC ACS).
The NC SCIP collaborative uses the NC SCIP Tool Kit as a resource document.
NC Cardiac Care
There are a number of evidence-based, highly effective guidelines that can significantly improve outcomes and reduce recurrent events for patients with cardiovascular disease. Nationally, four inpatient heart failure (HF) treatment processes are measured and reported, they include ACE - inhibitor or angiotensin receptor blockers (ARB), evaluation of left ventricular systolic (LVS) function, discharge instructions and smoking cessation counseling. In North Carolina, hospitals are measured on how well they provide the entire bundle of the measures called "optimal care".
The NC Center for Hospital Quality and Patient Safety (NC Quality Center) has partnered with other state leaders to develop the NC Cardiac Care Collaborative (NCCC). The other partners include the NC Chapter of the American Heart Association (NC AHA), the Carolinas Center for Medical Excellence (CCME), the Southern Atlantic Healthcare Alliance (SAHA), WakeMed Health and Hospitals Heart Center and Carteret General Hospital. The collaborative focused on providing reliable evidence-based care to congestive heart failure patients across the continuum of care.
The NCCC used the AHA's Get With The Guidelines (GWTG) Program as the primary improvement tool. GWTG provides hospitals with a systematic approach to measuring and improving quality of care by utilizing tools to ensure compliance with evidence based recommendations. Since its launch in 2001 over 1,500 US hospitals have used the program. Participation in GWTG has demonstrated substantial improvement in the delivering the key evidence-based therapies and clinically relevant improvement in care. The AHA highlights healthcare organizations utilizing GWTG, which have achieved 85% compliance in all four heart failure measures, in US World Report and Circulation. Through AHA grant funding combined with NC Quality Center funding, hospitals participating in the NCCC Collaborative will receive a one-year license for the heart failure module with GWTG.
NC Eliminating MRSA
Hospitals in the US and other countries have taken aggressive action to reduce MRSA infections acquired during hospitalization. These actions include screening of high-risk patients and healthcare workers, barrier precaution, enhanced environmental cleaning, hand hygiene awareness, pre-emptive isolation of high-risk carriers and decolonization of carriers.
VHA lead a national effort for its member hospitals in 2006 to eliminate MRSA. Through a partnership developed with VHA Central Atlantic, the NC Center for Hospital Quality and Patient Safety and North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) extended this program to non-member North Carolina Hospitals.
In November of 2007, sixteen North Carolina hospitals joined six VHA groups, mostly associated with regions of the country, to eliminate MRSA infections for their patients. Using tools developed by VHA and supplementing additional tools for North Carolina hospitals, the year long collaborative supports hospitals to develop reliable systems/processes to eliminate MRSA infections.
The NC Eliminating MRSA collaborative uses the NC Eliminating MRSA Tool Kit as a resource document.
Medication Reconciliation
The North Carolina Center for Hospital Quality and Patient Safety has worked in partnership with others to provide medication reconciliation collaborative programming to North Carolina hospitals from 2005 to 2008. The other partners over the three-year period include Carolinas Center for Medical Excellence (CCME), North Carolina Hospital Association, Western North Carolina Health Network (WNCHN), Institute for Healthcare Improvement (IHI), Mountain Area Health Education Center (MAHEC), Coastal Carolinas Health Alliance and the Coastal Area Health Education Center. Leveraging the expertise unique to each of their organizations, partners contributed resources to the collaboratives.
The purpose of the collaboratives was to assist hospitals to ensure a process for medication reconciliation for all patients at hospital transition points (admission, transfer and discharge).
The first of the three collaboratives started in October of 2005, two months prior to the Joint Commission's release of the National Patient Safety Goal to accurately and completely reconcile medications across the continuum of care and two months before the IHI 100,000 Lives Campaign release of their proven intervention to prevent adverse drug events by implementing medication reconciliation. The North Carolina 2005 Medication Reconciliation Collaborative was six months in duration, had ten hospitals form across the state ranging in size from a 25 to 900 bed facilities. The collaborative focused on developing reliable admission medication reconciliation care processes.
The second collaborative started in October of 2006, and was a regional collaborative focusing in on the western North Carolina called the North Carolina 2006 Medication Reconciliation Collaborative. This collaborative was 12 months in duration and had eleven hospitals enrolled. The collaborative's expanded focus was to develop reliable admission, transfer and discharge medication reconciliation care processes.
The third and final collaborative started in October of 2006, and was a regional collaborative focusing in on the eastern North Carolina called the North Carolina 2007 Medication Reconciliation Collaborative. This collaborative was 12 months in duration and had thirteen hospitals enrolled. This collaborative, like the 2006 collaborative focused on developing reliable admission, transfer and discharge medication reconciliation care processes.
The Medication Reconciliation Collaborative supported NC hospitals to develop reliable systems/processes using characteristic collaborative components and encouraged the sharing of best practices amongst the participating hospitals.
The NC Medication Reconciliation Collaboratives used the Medication Safety Reconciliation Tool Kit as a resource document. This Tool Kit has received national recognition from the Institute for Healthcare Improvement (IHI) and the Department of Defense (DoD).
NC 2006 Just Culture
Creating a culture of safety is imperative for organizational learning and the design of safe systems. To do so it is necessary to create an open and fair culture, a balance between a blame-free and a punitive culture. It is necessary for all individuals to continually evaluate risks inherent in the choices they make.
The term "Just Culture" refers to a system of shared accountability where healthcare organizations are responsible for the systems they have designed and for supporting the safe choices of patients, visitors and staff. Staff, in turn, is accountable for the quality of their choices within those systems.
To assist hospitals with establishing a culture that supports safety the North Carolina Center for Hospital Quality and Patient Safety partnered with Outcome Engineering a Dallas-based risk management firm that helps high-risk organizations develop safety supportive practices and culture.
In July 2006 nine North Carolina hospitals participated in the NC 2006 Just Culture Collaborative, a yearlong collaborative program endorsed by the North Carolina Board of Nursing.
To learn more about Just Culture go to www.justculture.org.
Teamwork and Communication
Learning from the aviation industry, healthcare providers are avoiding potential errors by using standard cockpit procedures like communication protocols and checklists. These techniques employed in aviation have received endorsement from the Agency for Healthcare Research and Quality (AHRQ), the Institute of Medicine (IOM), the Institute for Healthcare Improvement (IHI) and JCAHO as a means to assist with communication among healthcare teams. Additionally, healthcare professional training has focused on individual performance rather than the performance of the team. Changing the paradigm from individual to team responsibility fosters participation from all members to ensure a safe outcome. Enhanced teamwork enables all team members to speak-up when they see potential harm, thereby avoiding errors. As with communication, teamwork is a learned behavior.
The NC Teamwork and Communication Collaborative was an eighteen-month pilot collaborative, to test methods of implementation of the evidence-based, Department of Defense TeamsSteppsTM tools.
The North Carolina Center for Hospital Quality and Patient Safety partnered with Duke University Health Systems to assist seven North Carolina hospitals with the implementation of these tools. The partnership is supported by funding from a Duke Endowment grant.
Rapid Response Teams
Rapid response teams (RRT), also called medical emergency teams (MET), refer to the establishment of a system to provide critical care expertise to the patient in the non-critical care setting. The team responds to the call regarding a patient that is failing but has not (yet) experienced full cardiopulmonary arrest.
The North Carolina Rapid Response Team Partnership, supported in part by grant funding from the Robert Wood Johnson Foundation, was a partnership between the North Carolina Hospital Association (NCHA), North Carolina Area Health Education Centers (NC AHEC), Carolinas Center for Medical Excellence (CCME), VHA Central Atlantic and Premier. The purpose of the NC RRT Partnership was to assist North Carolina Hospitals in developing, implementing and maintaining rapid response teams.
The NC RRT Partnership assisted over 50 North Carolina hospitals in establishing, improving and maintaining rapid response teams. The yearlong RRT Collaborative Program offered characteristic collaborative components and encouraged the sharing of best practices amongst the participating hospitals.
The NC RRT Partnership collaborative used the NC RRT Partnership: A Learning Collaborative Tool Kit as a resource document.
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