Spring 2012 Quarterly Newsletter
CONTENTS:
Director's
Column
Partner
Focus
Special
Feature
RHAC
Profile
SPRING
2012
Printable PDF
(PDF: 189KB/11pgs)
REGISTER NOW!
JUNE 25-26 is the
2012 RURAL
HEALTH
CONFERENCE.
We invite you to
forward this
newsletter to your
colleagues.
Contact Darcy
Dungan-Seaver at
[email protected]
or 651-201-3855
with comments.
Photo
courtesy of
Lorry
Colaizy
DIRECTOR'S COLUMN
THE CENSUS AND THE SAFETY NET
The 2012 Minnesota legislature recently adjourned, and candidates are turning their focus to
the fall campaign. Members of Congress are also gearing up for the 2012 election. Candidates
will be running in districts recently reconfigured by 2010 census results and the decennial
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
redistricting that follows. Driven by the census, there are some important changes in the
legislative map. Demographics have also altered the location and characteristics of those who
use Minnesota’s rural and urban health care safety net. These changes are connected in
important ways.
Mark Schoenbaum
The central trend reflected in the U.S. Census graphic above is continued growth in the Twin
Cities suburbs and a significant increase in populations of color statewide. There is also
population loss in many rural counties and static populations in Minneapolis and St. Paul. The
fringe areas of the metro area grew, with their blend of suburban and rural territory. Also,
poverty rates have increased in a number of suburban counties, accelerated by the 2008
recession.
Minnesota’s demographic changes are confounding how we traditionally think about health
care access challenges and the safety net system that responds to them. Population changes
have dispersed health care access challenges more evenly across the state. The challenges
to finding health care may be economic, geographic, language and cultural, age or disability,
depending on the area, but communities across Minnesota now have more of these issues in
common than they have had in the past.
For policymakers, there are both federal implications -- largely related to Medicare and the
Affordable Care Act -- and numerous state issues. For example, Minnesota’s safety net clinics
have historically been located in the inner city and remote rural areas. But these providers are
now emerging elsewhere as well: the federal government has funded a southern Minnesota
community health center in Mankato, and planning for safety net clinics is underway in Bemidji
and in Mille Lacs and Sherburne Counties.
Population changes are, of course, directly reflected in new legislative and congressional
districts. The legislative make-up is now predominantly suburban, and as we’ve seen, these
districts now include more low-income and minority residents who are likely to seek services
through the health care safety net. Growing exurban districts may begin to be affected by
rural-like drive time and transportation challenges to finding care at a reasonable distance.
And many rural areas will continue to face challenges to sustaining facilities needed to serve
an even sparser population.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
In the coming decade, policymakers across Minnesota will have more of these issues in
common than ever before. Educating all policymakers and elected officials will be essential to
maintain and improve Minnesota’s health care safety net over the next 10 years.
Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be
reached at [email protected] or 651-201-3859.
top of page
PARTNER FOCUS
CREATING A CULTURE OF PATIENT SAFETY IN RURAL CRITICAL
ACCESS HOSPITALS
by Janelle Shearer, R.N., B.S.N., M.A., Program Manager, Stratis Health
Stratis Health, a nonprofit Minnesota quality improvement organization, and the Minnesota
Department of Health’s Office of Rural Health and Primary Care are addressing patient
safety in a new collaborative project dedicated to improving safety culture in rural Minnesota
critical access hospitals (CAHs). The following CAHs have signed on to participate in the
project, which focuses on achieving organizational changes in each facility to improve the
culture of patient safety:
Appleton Municipal Hospital
Cook County North Shore Hospital
Deer River Health Care Center
LakeWood Health Center
New River Medical Center
Perham Health
Rainy Lake Medical Center
Redwood Area Hospital
River's Edge Hospital and Clinic
Sanford Health Bagley
Through this project, Stratis Health is assisting CAHs in assessing their safety culture and
providing them with assistance and resources to improve performance in targeted areas of
need, such as teamwork, communication and leadership engagement. Adapted from the
Institute for Healthcare Improvement Breakthrough Series collaborative model, the project
builds on Stratis Health’s previous work on safety culture conducted with 16 Minnesota
CAHs in three separate projects.
The new collaborative brings together Minnesota CAHs and provides a forum for
discussions and the exchange of ideas and strategies for implementing safer practices and
processes. Together teams learn about patient safety theory and proven strategies, try out
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
tools and processes, and leverage resources. They have the opportunity to capitalize on
lessons learned and best practices from other CAHs that have successfully applied culture
change strategies in their organizations.
Melissa McGinty-Thompson, Clinical Nurse Specialist and Clinical Leader from the
Chippewa County/Montevideo Hospital, participated in an earlier safety culture initiative and
offers tips for CAHs participating in the new collaborative: "Get as many different disciplines
involved in the project from the beginning -- including physicians and front-line staff. And
communicate, communicate, communicate!”
The process
Each hospital begins the project by forming a multidisciplinary team dedicated to supporting
organizational culture change. The team includes clinical and administrative leaders,
physicians, nurses and front-line staff who attend learning sessions, participate in project
activities, and regularly test and make improvements.
"..the single greatest impediment
to error prevention in the medical
industry is that we punish people
for making mistakes."
Dr. Lucian Leape, Professor,
Harvard School of Public Health,
Testimony before Congress on
Health Care Quality Improvement
An initial key step in the project, completing the Agency for Healthcare Research and Quality
(AHRQ) Hospital Survey on Patient Safety Culture, is designed to help CAHs assess the
existing culture of safety in their facilities, identify strengths and areas for improvement, then
evaluate improvement efforts. Joint Commission studies on leadership standards show that
higher scores on patient safety surveys are correlated with improved clinical outcomes and
higher staff retention. The survey assesses areas such as communication openness,
feedback related to errors, non-punitive response to errors, frequency of events reported,
hospital handoffs and transitions, and management support for patient safety. Stratis Health
assists hospitals in interpreting their survey results and in building organizational capacity to
improve their culture, and provides regular support including one-to-one coaching calls
throughout the project.
Educational sessions include evidence-based models to improve teamwork, leadership and
communication, such as the philosophy and practice of a Just Culture and the
TeamSTEPPS® approach to improving teamwork and performance. The project ends with a
re-measurement survey and analysis of the final results.
Creating shared accountability
In a culture of patient safety, managers recognize there is seldom a single reason for a
mistake -- when something goes wrong, it is not necessarily someone’s fault. A chain of
events that has gone unnoticed most often leads to a recurring safety problem, regardless of
the personnel involved. Solutions are based on prevention, not punishment. Stratis Health
Project Manager Janelle Shearer says, “We believe that people come to work to do a good
job. Given the right set of circumstances, any of us can make a mistake.”
In the new collaborative, CAHs also learn how to adapt Just Culture principles in their
hospitals. Just Culture, a patient safety model developed by David Marx, JD, describes a
shared accountability approach to patient safety that recognizes the inevitability of human
error and encourages supervisors to avoid inappropriate disciplinary actions. Staff must feel
comfortable speaking up about problems, errors, conflicts and misunderstandings without
fear of blame or punishment. However, in a Just Culture, individual accountability is not
ignored. When incompetence, sub-standard performance and reckless violations are
identified through a thorough investigation of facts, corrective or disciplinary action is taken
appropriately.
Participating hospitals also learn about the TeamSTEPPS® approach. TeamSTEPPS®
focuses on creating high performing teams and increasing awareness of a team’s
responsibility for fostering patient safety. Teams learn how to improve information-sharing
and resolve conflicts, as well as how to eliminate barriers through engaged leadership,
strategic communication, situation monitoring and mutual support.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
By the end of this project, the participating CAHs will have a better picture of how to
implement a culture of safety in their facilities. “In this rapidly changing health care
environment, a cohesive team approach, based on collaboration and direct communication,
ensures that patients receive safe, quality care,” said Jennifer Lundblad, PhD, MBA,
president, and CEO, Stratis Health. “Open discussion promotes patient-centered care, which
assists health care providers in delivering the highest quality and safest care to patients."
Read more about improving patient safety culture:
AHRQ Surveys on Patient Safety Culture
AHRQ Survey adapted for CAHs
Teamwork and Safety Attitude Questionnaire
Just Culture
TeamSTEPPS®
top of page
SPECIAL FEATURE
READY TO WORK: BUILDING THE HEALTH IT WORKFORCE
by Sunny Ainley, Associate Dean, Normandale Community College
In June, 150 students -- ranging from seasoned health care practitioners to information
technology professionals -- completed the first six-month, intensive Minnesota Health
Information Training Program. The U.S. Department of Health and Human Services and the
Office of the National Coordinator for Health Information Technology sponsored the program
and Normandale Community College trained the students. Read about three graduates and
their expectations, career opportunities and enhanced skills.
Michael Bayliss
When Michael Bayliss’ information technology position at the Bloomington Public Schools
system was eliminated, he decided the Minnesota Health IT Program would complement his
skills in project workflow and redesign, and his associate’s degree in computer science.
Michael Bayliss
“The program was an excellent opportunity for me to bridge my IT training to the health care
industry. While I was still in the program, I met with the Mille Lacs Health System about a
practicum. We talked about the program and industry trends. It became clear that Mille Lacs
Health System really needed someone with my training to help them implement their
electronic health record system. That was a great moment: My skills and everything I had
learned in the program were relevant enough to be hired.”
Because Mille Lacs Health System is a small critical access hospital, Bayliss was able to
wear many different hats: building information systems, troubleshooting and dealing with
project management, workflow redesign and help desks. His work was so valuable that the
practicum turned into a paid position with Mille Lacs.
Stefanie Klein
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
Stephanie Klein
Alicia Nesvacil and Carol Lundstrom
Stefanie Klein entered the MN Health IT Program passionate about holistic medicine and
complementary health care. She wanted to incorporate her personal health care
experiences and beliefs with her professional information technology background.
After completing the program, Klein joined Mighty Oak Technology, a Minnesota-based
certified electronic health record vendor specializing in speech recognition for the
chiropractic and specialty clinic industry.
“I’m working with clinics that use integrative health and healing techniques such as
acupuncture, yoga and massage to help patients. As a result of my training, I’m able to
speak the health care language with the chiropractors, understand what they are saying and
translate meaningful use requirements. It is very satisfying to see the role medical records
are playing in helping patients. Recently one of our clients was updating a patient’s active
medication list when a drug-to-drug interaction alert came up in the electronic health record
software. The patient notified the primary care provider who immediately stopped the
medication and the muscle weakness that the patient had been experiencing was resolved!"
Alicia Nesvacil
Alicia Nesvacil had been steadily working her way up at HealthPartners -- from quality
management into information technology to project management -- when she enrolled in the
MN Health IT Program.
“I wanted to focus on meaningful use and incorporate other health information technology
related areas into my work at HealthPartners to make things simpler from a patient care
standpoint. In trying to improve the process, I saw a gap in quality management and
information technology when it came to health records. Knowing and understanding the
connection that health information technology has in providing excellent care is a great
benefit to our patients. The program helped me make links that weren’t clicking before.
Thanks to the resources and the curriculum, I am able to customize the tools, which is very
helpful.”
HealthPartners appreciates the link between Alicia’s HIT work and patient care.
“HealthPartners is not new to electronic records, but government measures have helped
organizations in contributing to better patient care, insuring patient safety, reducing medical
errors and giving the patients and doctors the information they need at their fingertips,” said
Carol Lundstrom, director of Care Delivery Systems at HealthPartners.
About the program
Normandale Community College is among 17 midwestern community colleges training
workers to help health care facilities and medical practices meet the requirements of the
Health Information Technology for Economic and Clinical Health Act (HITECH). Estimates
based on data from the U.S. Bureau of Labor Statistics, the U.S. Department of Education
and independent studies indicate a national shortfall over the next five years of
approximately 51,000 qualified health information technology workers as hospitals and
physicians move to adopt electronic health care systems.
The colleges are using the HITECH grant funds to provide training to current and future
health care workers through a six-month training program. The MN Health Information
Technology (HIT) Training Program focuses on four roles:
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
Practice Workflow and Information Management Redesign Specialist
Clinician/Practitioner Consultant
Implementation Support Specialist
Electronic Health Record/Application Trainer
The training incorporates “hard” technical skills with “soft” skills such as problem solving,
decision making and time management. The program is online, distance learning with
intermittent face-to-face meetings. To be eligible for the program, students must have
experience in an information technology or information system role in business or health
care, or have experience as a clinical practitioner or in medical records, health information
management, medical billing or in a hospital business office.
Despite the training, finding a permanent position can be challenging. Many health care
employers are still unsure which HIT roles and positions their organizations need. Others
are reluctant to hire candidates who don’t have prior clinical experience, or who aren’t
trained in a specific, proprietary software system (such as EPIC or NextGen). Despite these
challenges, 84 percent of recent participants in Normandale’s program have found
employment.
Read more about the Minnesota Health IT Training Program at Normandale.
top of page
RHAC MEMBER PROFILE
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE (RHAC)
MEMBER SEN. TONY LOUREY
Please explain your professional work to us.
Before my election to the Senate, I consulted with states and counties around the country to
help them restructure and refinance their health and human services departments. My
business partners and I brought in expertise on federal regulations and were able to help our
clients leverage funds to reform and improve their services.
Sen. Tony Lourey
In the Legislature I serve on the Higher Education and Transportation Committees. But health
is where I continue to live and breathe and I am the caucus lead in the Health and Human
Services Committee.
And your life away from work…
I have always farmed, but since the Legislature is set up for an agrarian schedule of January
through May, I am able to really throw myself into farming. I raise grass-fed beef. I experience
the struggles that all farmers have, but I love my cows! My wife runs an apple orchard so we
are both working the land.
What do you think are the most important issues facing rural health? Well, speaking of grass-fed beef and apples, the food we eat is critical to bringing health to
our population, and that is not a focus often enough. If we are not eating the right food, we can
provide all the health care available and it still won’t matter.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]
Spring 2012 Quarterly Newsletter
But workforce is also a really tough issue. We need solid primary care and preventive care
and this is especially challenging in greater Minnesota because of the changes that have
come online for funding medical education.
What do you think would make the most difference for rural health?
We need to change how we fund medical education so graduates are financially able to
pursue a career in primary care, if that is the path they choose. Today’s economics essentially
force them into specialty fields in order to earn a salary high enough to repay their medical
school debt.
Some of the transparency efforts underway in Minnesota have the potential to help us
understand this dynamic better. If we do Provider Peer Grouping properly, we have the
opportunity to shine a light on today’s funding of medical education. Greater public funding of
medical education is warranted, although I am not wedded to any particular approach. We
have to look at what we want as a society. If we leave the system as it is, we will continue to
bear increasing costs and the heath care workforce needs -- particularly for greater Minnesota
-- will become more difficult to meet.
top of page
VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
DON'T MISS OUT!
REGISTER NOW for the
JUNE 25-26 2012
RURAL HEALTH
CONFERENCE!
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc
MISSION
To promote access to quality health care for rural and underserved urban Minnesotans.
From our unique position within state government, we work as partners with communities,
providers, policymakers and other organizations. Together, we develop innovative
approaches and tailor our tools and resources to the diverse populations we serve.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2012/spring.html[5/25/2012 12:20:15 PM]