Episode 25 - Malea Hartvickson - Connecting Hospitals with Tools to Improve Care

What tools do hospitals, especially those in rural areas, need to reduce their risk of adverse events?

  • 00:10:11 - 05:10:11

    Jerrod Bailey 00:02

    Welcome to Reimagining Healthcare: A New Dialogue with Risk and Patient Safety Leaders Presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations across the country, please subscribe to get the latest news and content. And if you found value in this episode, please share it with your colleagues to create meaningful dialogues in your own communities. If you're interested in participating as a guest, by the way, just email us at speakers @Medplace.com. And also check out our related content like articles, videos, and more at blog dot Medplace.com/resources. My name is Jared Bailey. I am the CEO and founder of Medplace - I'm going to be playing host today. And since last time, we were joined by Julius Bogdan guests remember of the Healthcare Information and Management Systems Society, who gave us some insight into the ways we can use data and tech to push healthcare forward. Today, I'm joined by Malea Hartvickson. Did I get that right? You did? Hey, all right. So Malea, you're the executive director at Kansas healthcare collaborative. Welcome.


    Malea Hartvickson 01:28

    Thank you. I'm, I'm pleased to be here.


    Jerrod Bailey 01:31

    Oh, fantastic. Okay, so for those of us who don't know, what the heck is the Kansas Health Care Collaborative, and what do you executively direct there?


    Malea Hartvickson 01:42

    Right. So the Kansas Health Care Collaborative is an organization, we're not for profit organization in Kansas, and we do quality improvement with health care organizations. So we've worked with clinics, we've worked with hospitals, we have now started some community work. And really our main role our expertise is quality and process improvement, and project management types of things. We're doing all kinds of new and exciting things, and in that, hopefully benefit the health of Kansans and our communities,


    Jerrod Bailey 02:22

    it's amazing. Well, I think we discovered you through a podcast that you did, and I was, I was like, shocked by the breadth in types of engagements that that you guys do, it's, it seems like you really meet all of these different facilities kind of where they're at, and you kind of focus on the key problems to solve,


    Malea Hartvickson 02:42

    right? That's exactly it. We are we provide technical assistance. And so a lot of times we go out to the clinic or the hospital, and just work with those folks. And like you said, meet them where they are it's, it's really important that we're engaging the folks that we're working with, and so he listening to we spend a lot of time listening to their problems and, and what they need help with. And so we were able to basically just plug in there. And sometimes were able to even bring grant funds into their facilities and communities and just depending on what kinds of projects that they would like to work on.


    Jerrod Bailey 03:18

    Interesting. Well, you and I are going to have to tie off on that, I have a couple of ideas for grants that I think the industry needs, so maybe I'll have some some tips for me. So I love that you're starting by listening to them, right? We all do a lot of a lot of talking a lot less listening, as you're, as you're asking these questions of these these different facilities, what are some of the more common pain points that you see kind of rising up or that you that you end up getting involved with?


    Malea Hartvickson 03:50

    Yeah, well, so right now, honestly, I mean, I think this is the case across the country, but we have heard a lot about workforce and turnover in health care. And we also hear a lot about mental behavioral health and, and how that's impacting our health system, and our communities. And so we do all kinds of things for preventative and screenings and those kinds of things. But also right now, we have started a new program. It's a clinic Assistance Program. And so it is we have expertise in houses that have run clinics, they know everything from X to Z, or A to Z. And so they're able to go in and help those clinic managers, those new clinic managers with everything from putting out a bill to submitting for MIPS and for quality measures. So, we're really excited about that one. And so that's our kind of our attempt at helping with workforce. That's not necessarily our forte, but we certainly can help with those folks that are new and getting them trained in and then for mental behavioral health. We are working on a mengi doing some more of our behavioral health facilities here in the state of Kansas. Many of them are moving to this CCBHC model. And so we're really excited to hopefully partner and join along with that. But we do work with hospitals on things like readmissions, and ER visits, that's a lot of times where people with some kind of a crisis end up in the emergency room. And then, and I'm sure this is the same as what happens in Arizona, they end up in the emergency room for hours or even days sometimes. So really just kind of working through how do we partner how do we assist these hospitals and behavioral health facilities in partnering to keep patients at the level of care where they're best served?


    Jerrod Bailey 05:45

    And so just that advice, just as the site a assume that you're kind of looking at, like, what are they what is their identified problem and you're looking at some of the systems and the processes that they've got that sort of underpin either contributing to that problem, or what they're trying to do to sort of mitigate it? Are you are you then coming in with advice and like programming in like technology and like services? Like, what all are you able to sort of bring to the table to try to help create sort of a change?


    Malea Hartvickson 06:22

    That's a great question. And honestly, I think the most valuable thing that we bring to the table is the ability to collaborate with others in the state who have done something so if we have somebody that is struggling like I was talking about with readmissions, or something like that, we're able to connect them with another facility that's maybe done some things that might work in their community, Kansas is largely rural. And so that's really, really helpful to have them connect with other rural facilities on how do you how do you kind of reduce some of these readmissions or hospital visits? And how do you connect across the state? Because there may not be services in your community directly. So how do you partner with those communities around you? So it's more I would say, it's more the collaboration, it's more the technical assistance expertise that we bring, our staff have all kinds of expertise in, we have nurses, we have folks that are more academia, we have, I mean, just a wide range of expertise. And so we're kind of able to partner with each other, as well as other communities to bring that knowledge.


    Jerrod Bailey 07:34

    It is sort of the end, you and I were talking just before we started here the answer is going to come from within, right? We're all talking about some magic wand or whatever the answer is already there. It's just, it's organizing and tapping into the experience of others that are already in the healthcare field, whether they be at the administrative side or the clinical side. I mean, it’s not like these problems are unique ever, right? There's always somebody who's dealt with them. But like creating the connectivity and getting that engagement from the community has been where I think where the friction has been. And I think once you're in an IRL environment, you have less opportunity for connectivity and learning from others quickly. So I think it's great that you guys are doing that we're going to do some stuff and launch some stuff next year, that's going to hopefully help create opportunities for connectivity as well. So we'll have to exchange some notes on that. Okay, so you had some really interesting stats on the podcast that I listened to, for example, hit a question here, how does a hospital bring CCM readmissions down to one? So you've got some and you got some fun anecdotes? What do you got to share with me here? How is this?


    Malea Hartvickson 08:48

    Yeah, so for that particular organization I just want to be clear, it wasn't all readmissions, it was those patients that were referred into the chronic care manager. And so really, what happened is that that chronic care manager was able to just be there for the patients. She was kind of the stop gap for before you go to the emergency room, you call me or if you're experiencing these symptoms, you call me and so then hopefully catching that before they are admitted to the hospital for example, a patient with CHF rapidly gaining weight, then you need to call me and let me know, or just kind of the signs and symptoms, she used some kinds of like stoplight kinds of posters and send those home with folks, or I guess, brochures more like and just said if these things are happening, that's when you connect with me, and that's keeps them from going and getting even sicker if she's able to kind of intervene before then. And then she has that ability to just kind of be on call for these patients. And so it's not like they have to try and make an appointment with a physician or anything like that. And if it becomes really critical She has that that in with the doc and says, Hey, we need to get this person on your schedule today.


    Jerrod Bailey 10:05

    Wait and forgive me she's a staff member of yours or she's a consultant now knows


    Malea Hartvickson 10:10

    she was a staff member of the hospitals


    Jerrod Bailey 10:12

    of the hospitals, you just got her into the position of being able to do these things.


    Malea Hartvickson 10:16

    Right? Yeah, she was a chronic care manager, nurse, she was new to the organization. This was a whole new program for them. And so she really works out of the clinic. And we've been working on things like hypertension, and diabetes management, prevention and management. And the hospital really wanted help with some of these patients, they had a pretty high readmission rate. And so what they started doing is referring patients that would qualify for the for the CCM program into her. And then like I said, she was really able to during, let's see, the measurement period was nine months. And she was able to reduce she had one readmission, and that was a patient that had COVID. And so that's really I mean, yeah, and honestly, we were working with our mental behavioral health patients, that's what we're finding to is the most exciting successful is when you can connect them with somebody that can guide them to the right care at the right time.


    Jerrod Bailey 11:16

    That's amazing. What a great example. What a great program, have you been able to replicate that in other places? Is that something that is become part of the playbook now.


    Malea Hartvickson 11:25

    Um, yeah, so we've done a lot with chronic care management type, folks. But every organization is different. And so their solution is probably a little bit different. We had another organization that was able to read reduce readmissions across the board, because they would enroll them in a program where the nurse practitioner would go out to the after they'd been discharged, the nurse practitioner would go out to the home and kind of do an evaluation, kind of a modified lace tool, which is a risk tool for readmission. And, but in their home, and she so she kind of took that in a hybrid of a couple of other different tools and looked at everything from the medications that they were taking to their physical surroundings, to their social network, and was really able to kind of, I don't know, refer them into social service whatever services they needed, and, and help that they needed. We also partnered with the local fire department. And so if she saw something that was maybe a, I don't know, a loose rail, or something that was really high risk, she would contact the fire department, and they'd come out and kind of just do some of these quick fixes. And so that was a really good program. And I know, during COVID, they had to stop doing these home visits. And I'm, I don't know that they saw readmissions go back up. But I do know that that was it was a hard time for them.


    Jerrod Bailey 12:52

    Yeah, no doubt. Gosh, so, so maybe demystify the process a little bit for me or for others who are interested, because we're a national platform, and we have people in risk and patient safety across the US. And a lot of them don't have access to something like this, or they don't, maybe they're in a position to be able to create this kind of collaborative sort of fabric in their particular markets. And they maybe could use a little bit of what does it look like? But how does, how does an organization today engage in collaboration, like, what does that look like? Mechanically, they raise their hand go, Hey, I really like what Malea is talking about, I'd like to figure out if we can collaborate more ourselves, what does that look like?


    Malea Hartvickson 13:38

    Yeah, well, I mean, collaboration is just that right? I reached out to everybody in anybody and I tried to connect with them. We actually the Kansas Health Care Collaborative is kind of modeled after the after the Iowa Health Care Collaborative. And we're funded, like I said, a lot through like, we have the CMS QIO community work. We are funded, but we don't directly take the grants, we subcontract generally for Kansas facilities, and so we have sub contracts through the CDC and through CMS, but also some local folks that, that if we can find some funding there. And then I would just say, just reaching out and you know, getting to know everybody in your community. And getting to know, I don't know, we I attend like the Kansas Hospital Association meetings I attend. Just basically anything I can and get the word out. I mean, we've been an organization for is it getting close to 10 years, I want to say so the work was already kind of done before I took over the role as far as collaborating within the medical community, but I just, I just try to meet everybody I can you have the model, we just use PDSA. I mean, it's, it's that simple. We have everybody attend IHI Open School, I don't know if you've heard of that. But it's really the model that we use. And then we just get really good at it.


    Jerrod Bailey 15:09

    Interesting. So I know I, it's the whole spectrum of organizations, providers out there, some of them are very, very open to collaboration, some of them are on the other side of the spectrum, right? Do you have you ever run into like defensiveness or skepticism or No, we're fine. Like, we don't need to collaborate, like? And if so, like, how do you? Do you chip away at that? You know, those walls? Or how do you do? Yeah,


    Malea Hartvickson 15:37

    yeah. So we, we do, we absolutely do. And a lot of times, that'll happen, even with with turnover if you have somebody that's really, really engaged, and then you get somebody that's new, and they just don't have the bandwidth, you get people that are just yeah, that we don't need any help. And really, the way we kind of, we continue to ask them if they want to participate in different if there's a new project you know, what, I started as a quality improvement advisor for our organization. And so I would get that push back in, but I'd also listened for they'd say, Well, maybe we have problems with substance use disorder in our community or something like that. And I would say, okay, that's fine, and then have that in my back pocket. So when we started working on things like that, I was able to go back to them and say, Hey, we have a program for you now that maybe you would like to collaborate with. And then just like, like you said, kind of keep an eye out it just connecting with them, and just touching base and saying, Hey, we're here, we charge nothing to our member organizations. So we're really free of service. And that's kind of an end sometimes to just by saying, Look, you don't have the office staff to be able to do this work. And so let us help you let us let us kind of give you that that tools, tools that and the and the skills and the


    Jerrod Bailey 16:59

    resources to do it. Yep. Yeah. That's great. Are there any places that you're hearing about more and more that you're that cage see is being asked to move into, like, certain kinds of trends, like where's the hockey puck heading in in safety and quality?


    Malea Hartvickson 17:18

    Right, so, I mean, the big hot topic right now is health equity, and inclusion. And, and so there's a lot of pressure from CMS and CDC, and just kind of all organizations to really move into that arena. And, and to help folks understand what it means to look at look at their population and really try to create equal access as much as possible. And in a state like Kansas I was talking to our board chair earlier today, and, and she was saying it's really is even rural versus urban, right? If you are in a rural community, and you have a terrible car accident, your Access to care is is not going to be as good as somebody that is close to trauma center. Yeah. Just the time alone to get there. So, so, yeah, it's I think there's a big lien on that. And then like I said it's the mental behavioral health, the workforce challenges and then there's always this chronic disease prevention and management, cancer screenings. That's another big one that we work on and with you know, COVID Again, I there's, those are so important, a lot of people just skip them and said, well, we'll wait until we can you know, get back in to see our doctor again safely.


    Jerrod Bailey 18:43

    Well, yeah my dad who has since passed he was he had a really bad fall. In he they were living up in Kimber rural part of Arizona, right, probably 30 minutes outside of a reasonable sized city called Payson. And it took an hour and a half to get to the emergency for what he needed to be in as a trauma facility. It took an hour and a half to get to the Payson facility. And then it was like, it was like, eight hours later, he finally ended up in a actual trauma facility in Phoenix, it was just it was tough. And that was a that was a big, a big deal at amount of time, especially if you're at that age the clock starts ticking. And it's, it's tough. Well, so what kind of tools if you rec end up recommending tools, because I'm always interested because we're like we met place where like a tool in this safety quality stack, right. And I'm interested in what else is in this stack? Like I do you guys, are you aware of iPass you've ever heard of that company or seen anything I


    Malea Hartvickson 19:50

    pass? I have heard of it, but I am completely blanking on No, I'll


    Jerrod Bailey 19:55

    catch you. They have this really interesting it's, I say it's really simple technology. They, they deal with the handoff process from one provider to the next. And like how to make that handoff as, as effective as possible, make sure that all the core and essential information gets communicated in the right way. And because that's where a lot of the issues can ultimately stem from, it's just the handoff on one provider to the next. And we'll get lost in that. Right. So anyway, there's just like a company that I look at, that's putting up really interesting stats as far as their ability to move the needle and in, in patient safety. And I just wonder, like, what else is out there? Is there any anything out there and coming communication? Or? I mean, one, one area I'm interested in is peer support, which we can talk about in a little bit. But is there anything out there that we should know or audience should know about? Or keep an eye on?


    Malea Hartvickson 20:49

    Right? So through some of the orange or some of the programs that we work, there is a we have a chronic care manager, chronic care management toolkit. So it really does from nuts to bolts describe how you should implement a CCM program or how you can how do you bill for it? How do you structure it? We have, we're working on a vaccine confidence toolkit. So basically, resources for providers to you know, just like, quick posters or talking points or those kinds of things that we do. I mean, we have, we have several different toolkits. I'm trying to think of some other ones but then there's also like the real really well known toolkits, like the red readmissions toolkit some of those AHRQ tool toolkits that we will use those too, and will promote those too. And so really, yeah, I mean, it just really starts with that assessment, we assess each organization to see where they are, and then kind of figure out what it is that would fit that fit their need. But we have, yeah, we've kind of built


    Jerrod Bailey 21:59

    some tools resource, that's great. You know, I keep thinking there's this opportunity. I know, there's an opportunity here we Medplace were born on the risk side of patient safety, which most people are there's most companies there's, there's a there's a hard like, there's a wall between risk and patient safety and quality. And I don't know why that is? Well, I do know, I've heard reasons. But it's really interesting, because it's really all it's this big continuum, right? It's, it's right, when unintended things happen. On the risk side, it's like now it's something we have to like deal with. And this might become a lawsuit or might be become a claim or that sort of thing. But upstream from that, from bad things happening are like the delivery of care. And that's where things like, like CRP programs, like early resolution communication programs come in, or even upstream from those you got peer review. And this idea that it's really all one big continuum of like, how are we trying to avoid unintended outcomes and continuing to increase our quality. And when you find that, that firewall between risk and patient safety, you lose a lot of the opportunities to like, learn and get better, and that sort of thing. And there's also like this business case that I think a lot of people on the patient safety and quality side miss is that there's like real dollars that are happening over on the risk side when things finally go bad. And now you've got to get law firms, and you're settling claims and all this stuff. There's like real quantifiable dollars. And there's tons of data. There's a company called Candela. For example, I don't know if you've ever heard of them, they, they are the how to explain this. So Harvard medicine has a captive insurance company, right, the self insurer, and that insurance company started collecting a bunch of data on their claims over the years, and it's really, really rich data that they use to feed back to their quality and patient safety systems to try to get better at everything, right. It's like, hey, we know what we're, we're getting sued for, we know what bad outcomes are happening, let's use that data to get really good upstream, right. And they did this really great model. And then since then, all these companies and hospitals and carriers even started subscribing to this database. And it's really valuable stuff and like, actually quantify the dollar value of, of when bad things happen, right? And why it's worth investing in this this safety program. Right? So I don't know, I just I keep like banging this drum. And there's some really bright spots in the industry that hear it and or had been banging out for longer than I have. But I think if we look at safety and risk is this continuum in the spectrum and it's all really should be pointed back to patient outcomes and safety. Anyway, I feel like I'm on a little bit of a diatribe here. But I think there's an opportunity there. I think there's I think there's datasets that are available. And you'll see next year we're going to be doing some stuff to try to make more of that more accessible to patient safety, folks. because it's really, really powerful stuff. And it really helps make the business case for like, this is why we need to invest here because this is the you know, this is our, like, sort of financial exposure on the other side of it anyway. Cool stuff. Yeah.


    Malea Hartvickson 25:14

    Hard to, to demonstrate the cost of avoiding something. Yeah.


    Jerrod Bailey 25:22

    Yeah. So that modifies it.


    Malea Hartvickson 25:25

    Yeah, those the when I were used to work in a hospital and that risk and quality, you have to be like best friends because if you start getting notifications for something for near misses those kinds of things, you better be paying attention to that on the quality side, because then you need to start working on some process improvement internally, before it becomes an actual risk a lawsuit or where somebody really gets harmed. And so, yeah, I mean, there just has to be that relationship. Absolutely.


    Jerrod Bailey 25:54

    Yeah. Yeah, for sure. And I think that the best institutions, the best organizations I've interacted with, have a very, very collaborative culture and a very, very much a non punitive culture, it really becomes more of a game of how do we who's going to be the next person to find the next opportunity to continue to level up. And those are just amazing, right. And I think with what you guys are pushing with collaboration, I think you're naturally going to attract more of those companies, any of the companies who want to collaborate who want to reach outside of their four walls, and in pull in all of the data and the insights and the experience of others that have been in the same situation before. I mean, those are the ones that seem to be leading the way and


    Malea Hartvickson 26:44

    in the whole game, right? Yeah, yeah, absolutely. Those that kind of embrace the just culture. And really it's the, it's the process, not the person. And you'd all say that every day, it is the process, not the person most of the time, there is no evil intent behind a bad action, there was just something in the process that broke down that that allowed that person to make that accident because they were tired, or because this is what we always do. And so you know, you have to really investigate those things.


    Jerrod Bailey 27:17

    I tell this applies to every industry, but I tell my own team, good system beats individual heroic efforts every day good system design. And the opposite of that bad systems design will take really great people and hamstring them or put them in positions where they can't they can't really exercise their full their full potential.

    Well, Leah, this was awesome. What else? Is there anything else that you we didn't cover that you feel like is important for people to know? Um,


    Malea Hartvickson 29:33

    you know, the only other thing I would say is I am just very blessed to be a part of a team where every single one of us is passionate about the work that we do. And I just I can't say that enough, because that's probably the most important thing is that everyone within my work, just they really care about how do we improve health outcomes?


    Jerrod Bailey 29:55

    Yeah, and it really comes through you can I can feel the heart and the mission behind it. behind what you guys are doing, and it's, it's awesome. It's awesome to see. And it's I'm really looking forward to seeing like, what next year looks like. But you know, I think, yeah, maybe it's because my Enneagram subtype is social, but I think that the answer to all problems ultimately comes through collaboration and, and getting outside our four walls and in figuring out who else is has plowed the road before. And it sounds like you guys are doing a great job of bringing all of that connective fabric together and then helping facilitate real analysis. And, and, and really like finding the wins, like what's the program that you can really develop to say we solved that and then building playbooks out of those that can be reused. I mean, that is just gold. Love it. Yeah, yeah. We're,


    Malea Hartvickson 30:49

    we're very lucky to be able to do this work. So


    Jerrod Bailey 30:53

    amazing. Well, anything else you want to add before I finish this off?


    Malea Hartvickson 30:59

    I don't think so. I really appreciate your time today. This has been kind of fun.


    Jerrod Bailey 31:04

    Likewise, I know you're, we established that you're now on the podcast circuit. So yeah, good luck. Good luck on the next one. But I definitely will keep tabs on what you're doing and see if there's some opportunities to collaborate as well. For those of you who want to get a hold of Malea, I can post your LinkedIn in the show notes and just make sure that people know how to get a hold of you. If they hear this, they know where to go. And yeah, I think that that should work. Anything else any other way that people should get ahold of you? What's the website for? Oh, yeah, he


    Malea Hartvickson 31:40

    would ask me that. It is k www.kh. The online.org I believe


    Malea Hartvickson 31:54

    I'm always open to people giving me a call, like I really don't mind at all. were emailing me. I don't know. If you have my email, you can post that that's happy to you know, again, the more I can collaborate with folks, the better your collaborator and it can be online.org KH ca online.org. Perfect. Yep. Okay, love it. Well, for everyone else, thank


    Jerrod Bailey 32:21

    you for listening to reimagining healthcare and new dialogue, and risk and patient safety leaders podcasts, subscribe and share if you found it valuable. And for deeper dive on the content we covered today. Check out the Knowledge Center for articles, videos and more at blog dot Medplace.com/resources. And again, if you'd like to be a guest, in joining this conversation, just email us at speakers at Medplace.com And make sure you follow Malea you'll see her information on the show notes. You can connect with her on LinkedIn. And Malea This was awesome. Thanks for making the time. Thank you. Yeah. Okay, we'll talk soon. Bye bye.

Malea Hartvickson discusses examples of the Kansas Healthcare Collaborative's work helping rural hospitals reduce readmissions. She explains some of the tools they offer and how to form partnerships with facilities. Hartvickson also discusses examples of hospital staff breaking down the barrier between risk management and patient safety.


Guest - Malea Hartvickson

Executive Director of the Kansas Healthcare Collaborative

Malea has dedicated her career to working with Kansas physicians and to ensure that all have access to the very latest evidence-based practices,” said Brian Williams, Chair of the KHC board and President and Chief Executive Officer of Labette Health. 
Before joining KHC in January 2018, Hartvickson worked for 12 years at NMC Health in Newton. Most recently she was NMC Health’s Director of Quality Management/Accreditation and was responsible for implementing the Physician Quality Reporting System, interpreting federal rules and regulations, communicating changes and updates throughout the hospital and clinics, and guiding the hospital in continual process improvement efforts.

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