All abstracts are organized by track and listed in alphabetical order by title.
Building a Better Mousetrap (for Surgeon Credentialing)
Jenna Deveau, Performance Improvement Coordinator, Washington Regional Transplant Community
Barbara Gordon, Director of Quality Systems, Washington Regional Transplant Community
Purpose: Our OPO would like to highlight how it manages the elements, pulse and rhythm associated with surgeon credentialing. OPOs are obligated by regulation and standard to ensure that all physicians who recover organs in hospitals with which the OPO has agreements are qualified and trained. Depending on the size of the OPO’s DSA and its process for managing this task, surgeon credentialing has been somewhat problematic for many in the donation community. By redesigning the process to include the utilization of Q-Pulse, our OPO has enhanced the process to better support regulatory and accrediting agency requirements.
Methods: When redesigning the workflow for surgeon credentialing, we had to consider the best way to streamline and lean the process. After implementing Q-Pulse for document control, we brainstormed how to use it for surgeon credentialing. We determined that Q-Pulse offered the functionalities we were looking for: automated reminders and escalations, along with document warehousing. We started the redesign by analyzing the current process and identifying the critical elements needed to credential physicians in our DSA: CV, licensure and malpractice insurance, recovery experience, references, and OPO-specific forms. The critical elements were then built into Q-Pulse. The next step was configuring automated reminders and escalation parameters for overdue renewable items. In setting up surgeon credentialing, we had spent a lot of time focusing on the granular details of setting up the system and then had to take a step back to look at the bigger issue of communication. We developed a master surgeon list stored in Q-Pulse (in the Documents Module) that is accessible to all staff, making it easy to confirm if a local surgeon is credentialed in the DSA. The OPO also developed a communication plan for newly privileged and departing physicians to address ‘housekeeping’ items timelier, such as:
• Creating/deactivating surgeon profiles in Q-Pulse; • Revising the master surgeon list, and • Updating the ACIN.
Results: By building the critical elements, reminders and escalations into the system, along with focusing on communication and transparency, a functional, automated process within Q-Pulse was created. Furthermore, we are able to take advantage of the surgeon snapshot offered through the requirements matrix, giving us the ability to quickly assess the compliance of each surgeon’s file.
Conclusion: By leaning the process out and using Q-Pulse, we now have a stronger, more streamlined surgeon credentialing process in place to support regulatory and accrediting agency requirements.
Collaborative Incident Analysis: Addressing What’s Wrong with Traditional Root Cause
Patricia Geftos, Chief Quality Officer, Kentucky Organ Donor Affiliates
Purpose: To engage employees in a positive experience of incident review and analysis in order to promote targeted systems improvement and increase proactive raising of CAPAs.
Methods: Introduction of a tool designed to guide the identification of mitigating and contributing factors for severe or “critical” incidents from a systems perspective. The tool replaced use of the traditional root cause analysis in the investigation and correction/prevention of such incidents. Use of the tool engages employees involved in the incident to explore various systems affecting their day to day execution of assigned responsibilities and the impact of these on the incident. An anonymous customer satisfaction survey was used to measure experience and value of the process.
Results: The average number of CAPAs raised prior to use of this tool was 30. Additionally, the general perception regarding raising of CAPAs and investigation of severe or “critical” incidents was experienced as punitive. The tool was introduced early in 2015 and utilized every year to present on all severe incidents. An anonymous customer satisfaction survey was provided to all participants post review consisting of questions related to expectations (Q1), ability to actively participate (Q2), ability to positively contribute to the discussion (Q3), focus on both mitigating and contributing factors (Q4), success in identification of systems issues (Q5), time allotted for the review (Q6) and value of the process (Q7). Overall, positive responses have been received for the 23 reviews that have been conducted using this tool from 2015 – present (see attached graph). Additionally, while the number of incidents requiring use of the tool has remained stable (2015 = 6 reviews, 2016 = 4 reviews, 2017 = 4 reviews, 2018 = 4 reviews, 2019 = 6 reviews), the number of CAPAs raised has increased by approximately 60% since introduction.
Conclusion: Use of a tool that collaboratively engages employees in positive exploration of the systems that affect them vs. traditional root cause analysis which may imply a singular, linear cause produces a more effective process to improve the issues underlying severe or “critical” incidents. It diminishes the negative perception that raising a CAPA will result in a punitive action for themselves and/or their co-workers. This ultimately results in increased organization transparency and collective learning across incidents and employees. This tool has been fully implemented as the standard for response to incidents requiring root cause analysis.
Optimize Waitlist Times for Transplant Candidates with Algorithmically Personalized Recommendations from Inverse Classification
Eric Pahl, CTO, Head of Research and Development, OmniLife
Purpose: Many organ transplant candidates die while waiting or have substantial wait times. Significant disparities in access to organ transplantation persist despite continuous and progressive allocation changes. There is a need for personalized recommendations for transplant candidates to optimize their time on the waitlist and reduce mortality.
Methods: We performed an inverse classification analysis on the UNOS STAR Files data containing transplant candidates from 2010 - 2018 in the USA. We assigned an estimated effort function mapped to changes in each of the candidate variables. Candidate variables were modeled as predictors for wait time until transplant or death. We ranked each variable by their corresponding impact on the wait time to transplant. We analyzed the impact of multiple effort totals for candidates distributed optimally among their variables.
Results: According to this model, we expect to find a list of variables that most significantly impact wait time (e.g. BMI or location) and estimate the effort associated with each unit change in those variables. Thus we will determine how much change effort a candidate must account for to make a meaningful optimization in waiting time.
Conclusion: Based upon the results of this experiment and a specific candidate, we may be able to recommend certain changes to diet, lifestyle, medication, waitlist location, etc. that may optimally reduce that candidate’s wait time before they are transplanted according to this model.
Process Improvement's Early Involvement Increases Proactivity and Reduces Deviations
Amanda Wray, Process Improvement Coordinator, Indiana Donor Network
Purpose: In 2017, we created a Process Improvement (PI) department to help identify inefficiencies, manage deviations/corrective actions, and implement innovations. In 2018, we began measuring PI’s ROI by tracking key performance indicators (KPIs) regarding Process Improvement Events (PIEs). PIEs may include root cause analyses (RCAs); plan, do, study, act (PDSA) meetings; rapid improvement events (RIEs); process mappings; or other PI initiatives.
Methods: Data is tracked via the Q-Pulse Analysis module and SurveyMonkey satisfaction surveys. The PI Coordinator pulls metrics from Q-Pulse, using pivot tables and filters to further analyze and segment the data. The PI Coordinator created surveys to measure satisfaction with 2018 and 2019 RCAs. Survey questions, scales, and audiences were kept the same for trending.
Results: Anecdotally, leadership and team members acknowledge PI’s benefits. We often receive positive feedback and appreciation, and leadership seeks our formal services and informal advice. Numerically, we have seen the following positive metrics as of 12/4/19: Teams proactively requested 12 PIEs in 2018, and 20 PIEs in 2019. In total, teams requested 19 PIEs in 2019 and 37 PIEs in 2019. Approximately 31 processes were created or updated as a result of PIEs in 2018, compared to 48 in 2019 (excluding RCA data, currently unavailable). We hosted 115 RCAs in 2018, compared to 54 in 2019 (RCAs are categorized as PIEs, but held for severe or trending deviations). Reactionary RCAs are trending downward as proactive PIEs are trending upward, meaning that PI’s early involvement contributes to fewer severe deviations. The RCA surveys used 4-scale rating questions and are reported using top-2 box scores (very satisfied/strongly agree and satisfied/agree). Key results showed: My feedback and concerns were heard: 69% in 2018, 71% in 2019. RCAs were beneficial for me/my team: 83% in 2018, 78% in 2019. The assignments/next steps were appropriate: 80% in 2018, 88% in 2019. Events discussed were worthy of RCAs: 76% in 2018, 82% in 2019. RCAs are useful for discussing deviations: 87% in 2018, 88% in 2019. RCAs did not feel punitive: 72% in 2018, 77% in 2019. Compared to 2018, RCAs were: 26% much better/better, 33% the same, 1% worse/much worse, 40% didn’t attend in 2018. We had 102 respondents in 2018, 77 in 2019.
Conclusion: PI provides demonstrably valuable services that reduce severe deviation events, promote quality throughout the company, and increase the focus on proactivity. More PIEs and proactive requests indicate that other departments and leadership see PI’s value, and want to work with us to improve. Departments frequently request our help when a new process or process changes are considered. Despite positive findings, there are still areas for us to improve, such as teams finding RCAs beneficial. Per policy, team members must attend one RCA yearly, which can result in their attending an RCA not relevant to their department. Comments indicate that team members did not value attending an RCA for a process in which they were not involved. Thus, for 2020, we will require team members to attend any PIE, not just RCAs, to broaden PI’s relevance. We will also update our survey to measure satisfaction at any PIE. We will continue to broaden our PI tools and event offerings to increase the services we can provide.
Reducing Kidney Waitlist Times with Shared Data Among Dialysis, Nephrology, and Transplant Providers
Eric Pahl, CTO, Head of Research and Development, OmniLife
Purpose: Potential kidney transplant candidate referrals and evaluations are made subjectively with limited information resulting in unfair access barriers for patients. Enhancing transparency, regulation, and bi-directional communication among kidney failure patients and providers may improve access, reduce the overall cost of care, and improve patients’ quality of life.
Methods: A Plan-Do-Study-Act performance improvement methodology was utilized to design and implement a dedicated software application (app) for the referral and evaluation of potential kidney transplant candidates. The app was utilized by dialysis, nephrology, and transplant care providers, kidney failure patients, and patient support networks. The app was implemented across the ESRD Network of the centers based in the Midwest with consenting participants from 3 different centers for a period of one year.
Results: We anticipate early/breaking results in time for the upcoming ATC 2020.
Conclusion: The study is ongoing.
Standardization of Advisory Board Management Across Three OPOs
Susan Rabel, VP/Associate Executive Director, LifeLink of Florida
Kathleen Lilly, EVP, OPO Operations, LifeLink Foundation
Liz Lehr, Senior VP/Executive Director, LifeLink of Florida
Dustin Diggs, Executive Director, LifeLink of Georgia
Guillermina Sanchez, Executive Director, LifeLink of Puerto Rico
David Marshman, Director, OPO Quality Systems, LifeLink Foundation
Paula Lawrence, Director, Strategic and Operational Initiatives, LifeLink Foundation
Purpose: An internal audit identified variability in Advisory Board structure and bylaws across three OPOs functioning under a single set of policies/guidelines. While the boards function independently in their service areas, from a leadership perspective, it was determined that board management policies and structure should be standardized where possible for consistency and to ensure ongoing CMS compliance.
Methods: A cross-functional workgroup was developed to standardize policy and develop consistent tools for Advisory Board Management. An A3 was utilized to track project progress, outline the proposed outcomes, define an implementation plan, and ensure appropriate follow up.
Results: Review of current practice identified the need to revise bylaws and develop consistent tools for Advisory Board management. A cross-functional team was identified representing each organ procurement organization with a focus on revising advisory board bylaws, conflict of interest forms, corporate compliance documentation, credentialing verification tools, educational and onboarding materials, member tracking tools, meeting templates, and communication templates. Advisory Board approval was obtained in Fall 2018 and a final review of the proposed changes were shared with the Medical Advisory Committee of the Board of Governors in Spring 2019.
Conclusion: Consistent management practices and tools for Advisory Boards in an organization with multiple service areas can be implemented to meet regulatory compliance needs while ensuring consistent oversight and allowing required service area-specific function.
Standardize Referral Related Quality Processes to Increase Number of Organs Available for Transplant
Benjamin Keebler, Quality Compliance Manager, Southwest Transplant Alliance
Heidi Wagenhauser, Manager of Triage and Placement, Southwest Transplant Alliance
Gay Johnson, Supervisor of Hospital Services, Southwest Transplant Alliance
Brad Adams, Executive VP and Chief Administrative Officer, Southwest Transplant Alliance
Jaskiran Kaur, Director of Quality Systems, Southwest Transplant Alliance
Purpose: To identify and address any gaps in referral related quality processes to minimize missed opportunities for donation.
Methods: The donation process outcomes are largely dependent on the timeliness of hospital referrals in accordance with the OPO defined clinical triggers. "Our OPO" has robust policies and protocols in place to pursue all donation opportunities. Any deviation or exception from the regulatory requirements and/or internal requirements is handled per the Quality Management System framework. A collaborative internal study was conducted to identify any gaps related to the referral process so that no donation opportunity is missed (fig. 1). The Quality Systems team collaborated with Triage and Placement, Hospital Services, and Donor Services to review the current process and gaps and inconsistencies in the identification and addressing of missed opportunities during the intake process (fig. 2). In the intake process, the gaps we identified were: A. Hospital making a referral early and then not calling back timely when the patient meets clinical triggers. B. Hospital making the initial referral after the patient has been extubated or has cardiac arrest. To address these gaps, we have instituted the process as shown in (fig.3). The final gap in identifying potential donors is found by the Death Record Review process. With an internal call center, we have the ability to review all deaths from each hospital in our DSA. Our process is outlined in (fig. 4).
Results: Missed opportunities were identified at and from the following in the referral process: 1) Initial intake. a. Early referral without a call back when patient meets clinical triggers b. Initial referral at time of death or post extubation 2) Death Record Review
Conclusion: We have streamlined our workflow to allow our triage coordinators to objectively identify, on initial intake, cases that require immediate follow-up by Hospital Services. Hospital Services conduct onsite follow up to identify breakdowns in process, if any, they also conduct more subjective reviews of patient charts to determine medical suitability of missed potential donors. We streamlined the workflow for the Death Record Review process so that follow up by Hospital Services more efficiently identifies medical suitability of potential donors who were never referred by the hospitals. Having the ability to show not only that the patient was a potential donor (met clinical triggers) but also the medical suitability of those missed potential donors makes a powerful statement when providing education to donor hospitals and maximizing donor potential All tracking and trending of corrective action, root cause analysis and effectiveness checks is handled via the OPO's variance management quality system. OPO leadership stays involved and engaged in the actions and follow-up on all missed potential opportunities.
The Clinical Responder - Creating a Pathway to Organ Procurement Coordinator
Laura Huckestein, Assist Director of Clinical Services, OurLegacy
Carlos Bonnet, BS Health Sciences, Clinical Donation Associate, OurLegacy
Purpose: The turnover of the Organ Procurement Coordinator (OPC) can create hardship for the OPO. Not only does it decrease the existing pool of OPC's but the hiring and training of a new one can be lengthy and costly. The Clinical Responder is a valuable resource to the OPO. Creating a career ladder where they can increase their skills and responsibilities that can eventually lead to an OPC position is beneficial to the CR as well as the OPO. A career ladder was developed to increase the CR's responsibilities from chart review, rounding, and drawing blood to skills that can lead to an Organ Procurement Coordinator Position. This provides a valuable pool of future OPC's that not only know the OPO the role of the OPC but can be transitioned in a much shorter timeframe thus decreasing cost for the OPO and stress on the remaining staff.
Methods: This is a poster that demonstrates the career ladder of a Clinical Responder
Results: We currently have 3 CR's that would like to transition to the OPC role. They are eager and willing to learn and are a great asset to our organization.
Conclusion: The Clinical Responder has a pathway of becoming an Organ Procurement Coordinator. This benefits the OPO as well as giving the CR a pathway to the OPC position
Tracking Hospital EMR access
Beth Wayant, Director, Quality and Regulatory Affairs, Mid-America Transplant
Kim Jordan, Senior Quality Systems Specialist, Mid-America Transplant
Coby O’Sullivan, Quality Systems Specialist, Mid-America Transplant
Ilona Stanley, Project Management Specialist, Mid-America Transplant
Purpose: The purpose of this project was to create a streamlined process for obtaining, maintaining, and tracking hospital EMR access for staff. The current process required several steps with multiple emails in order to establish access for new users. In addition, the process for tracking access was completed via a spreadsheet, and staff were frequently ‘locked out’ of their accounts.
Methods: A small workgroup was created to review the current EMR process and identify areas for improvement. The current state and desired future state were mapped to identify areas with gaps. An EMR SharePoint site was created for one source for information on hospital EMR access. All forms, instructions, and links to sites can now be accessed by staff on SharePoint. A new access request form was created on SharePoint to ensure a consistent process for requesting access. Tracking of training and access is accomplished in the quality management system. The date that training is completed, and access is received is noted for each staff with access. A system for auditing staff to verify maintenance of access was developed and proposed for a quarterly basis. Tracking and trending of access deviations will determine additional process improvements needed.
Results: The updated procedure was deployed to managers on 11/14/19. The first audit was conducted on 12/9/19 to verify that users were maintaining required access. The audit found several users whose access had lapsed. As a result of the first audit, an audit of 100% of users with EMR access will be conducted in the first quarter of 2020 to continue to drive improvements in access.
Conclusion: A review of the hospital EMR access resulted in the development of a more streamlined and effective approach to obtaining and maintaining hospital EMR access. Additional/ongoing audits will be completed to verify continued compliance with the new process.
Your Board's Role - Clear or Blurry?
Edward Marchewka, Director, Information and Technology Services, Gift of Hope
Purpose: The majority of attendees at AOPO National do not interface with their Board on a regular basis, if at all. Having an understanding of what the Board's role is and how to fully leverage that is necessary for operating an efficient organization. The communication paths up and down the organization are needed to maintain proper visibility at all levels. By understanding the Board's role all leaders of an OPO will be able to function more effectively. Also, many Boards contain members that are not fully pulling their weight for the organization. This can be due to many factors but the one addressed in this talk will be setting expectations of service.
Methods: This presentation will take an academic approach on Board governance and their roll in governing an OPO. Based on the ideas presented in the book "The Imperfect Board Member" along with other concepts of leadership.
Results: The results of this presentation will be to provide actionable items for communicating up to the Board and presenting the vision and direction from the Board down through to the staff. This talk will also provide clarity on the expectations and role of the Board and expectations of Board members.
Conclusion: The research has found that Boards can be more effective when they know what their role is within the organization. When communications up and down the chain are better organized and to the correct level the communications are more effective and efficient. In order to drive OPOs further, we need to be able to look to the governing bodies to provide the oversight needed to push us into the future.