Improving Care Together

2017-2018 Annual Report

Collage of photos from MHA Keystone Center eventsEvery day, the MHA Keystone Center is connecting with members, sharing knowledge, learning from one another, and improving care together. Over the past 15 years, the MHA Keystone Center has been firmly committed to fulfilling its vision and mission by helping member hospitals and health systems provide safer and more reliable care. To enact change, create sustainable efforts and cultivate a culture of safe care and continuous improvement, the MHA Keystone Center is educating and empowering others to lead the transformation.


A Message from the CEO

Brian PetersCollaboration in healthcare is imperative for improvement, whether it occurs in the traditional hospital setting or in the communities that MHA members serve. Healthcare teams must be willing to work together, learn from peers and implement the changes necessary to make patient care safer and more reliable. In addition, their work with patients and families is integral to the advancement of person- and family-centered care in Michigan.

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Stories of Collaboration & Change

MHA Keystone Center Equips Members with Tools to Succeed

Readmissions – Karmanos Cancer Center

Focused on readmissions after participation in a GLPP HIIN Improvement Action Network

Karmanos’s Readmissions Taskforce team.In August 2017, the Karmanos Cancer Center, Detroit, the largest cancer research and provider network in Michigan, began its focus on readmissions through its voluntary participation in an Improvement Action Network (IAN).

IANs are hosted by the MHA Keystone Center and provide a small group of hospitals with the opportunity to receive specialized coaching on mitigating an area of harm. The IANs require a strong commitment from the hospitals — typically three to four months — to dedicate staff time and resources to understand areas of opportunity through use of quality improvement skills.

“When we participated in the Readmissions IAN, we realized we had a great opportunity to take an in-depth look at our inpatient data and readmission rates,” said Patrice Tims, RN, BSN, MSA, director of Quality, Regulatory Affairs and Clinical Excellence at Karmanos Cancer Center. “By participating in this unique MHA Keystone Center initiative, it required us to look at what we were doing, make a plan and create changes for improvement.”

One of the first tasks was to collect and understand the data.

“This was challenging at the beginning, as we wanted to solve the problem before we understood the contributing factors or determined the root causes of patient readmissions,” Tims said. “We learned the number one reason for readmissions was pain, closely followed by nausea, vomiting and acute kidney injuries.”

Karmanos opted to drill down on readmissions to determine patients’ point of entry when being readmitted to the facility.

“We discovered that 85 percent of patients that were being readmitted came from another facility’s emergency department (ED), since Karmanos currently does not have its own dedicated emergency department,” said Vera Szram-Senyk, quality improvement specialist. “We also learned that 70 percent of our patients were at risk for being readmitted to the hospital after being discharged.”

One of the biggest preliminary initiatives was to drive patient traffic to the Karmanos Acute Care Clinic (ACC), a facility that supports the continuum of care for Karmanos patients, in lieu of an emergency room at another hospital.

“Karmanos started the ACC so patients would have a place to go to treat or manage acute symptoms or side effects,” said Szram-Senyk. “The ACC gives our cancer patients a very unique environment to manage symptoms. For example, they can come in and receive IVs if they’re dehydrated or have their medications revised, if needed.”

Karmanos’ ACC is open Monday through Friday from 7 a.m. to 7 p.m. Appointments are scheduled in advance and can occur the same day or even within an hour, depending on the specific patient’s needs.

Karmanos also sought to drive improvement in readmissions by focusing on the following efforts:

  • Identify high-risk patients by implementing a readmission risk assessment tool and developing discharge protocols for those patients.
  • Schedule a follow-up appointment in the clinic prior to the patient leaving the hospital. Patients at high risk for readmission have this appointment scheduled within three days after discharge.
  • Have medications filled and given to patients prior to being discharged.
  • Include physician and ACC contact information with discharge information.
  • Direct patients to call their physician to review symptoms prior to going to an ED. Physicians can also schedule an ACC visit after reviewing patient symptoms.
  • Improve utilization of ACC for management of chemotherapy and cancer pain.
  • Increase patient referrals to supportive services to improve pain management and psychosocial support.
  • Increase patient compliance with discharge instructions by placing follow-up phone calls within 72 hours of discharge to ensure patients understand their instructions, have pain medications and keep their follow-up appointment.
  • Review data collected from follow- up discharge phone calls to identify opportunities to provide needed information and appropriate follow-up care.

Success of the Karmanos readmissions task force is due to the involvement of multiple disciplines, including quality, case management, nurses and physicians, who have the same goal – to provide high-quality, safe care that is effective and patient-centered. The team’s overall goal is not only to reduce readmission rates, but provide a greater patient experience through improved service and better communication among physicians, staff and patients.

Photo Caption: (From left to right) Karmanos’ Readmissions Taskforce team includes Patrice Tims, RN, BSN, MSA, director of Quality, Regulatory Affairs and Clinical Excellence; Kirsten Dahlgren, director, Utilization Management and Admitting; Anne Payne, director, Karmanos Clinics; Truvella Murray, manager, Case Management and Social Work; Kathy Fedoronko, director, Patient Care Services; Michael Stellini, MD, leader of the Supportive Service Multidisciplinary Team; and Nina Hudgins, manager, Patient Care Services. Not pictured are Steve Rea and Vera Szram-Senyk, quality improvement specialists, and Philip A. Philip, MD, PhD, FRCP, leader of the Gastrointestinal and Neuroendocrine Tumors Multidisciplinary Team at Karmanos.




Pressure Injuries – St. Joseph Mercy Ann Arbor

Team-based approach and interdepartmental collaboration reduces hospital-acquired pressure injuries

St. Joseph Mercy Ann Arbor staff.Collaboration in healthcare has been proven to drastically improve quality of care. A team-based approach allows each person’s perspective to be considered, including that of the patient, so the best possible care can be delivered.

The MHA Keystone Center partners with its member hospitals and health systems daily to improve healthcare quality and patient outcomes by sharing evidence-based practices and offering various educational offerings, such as workshops, conferences, monthly check-in calls and resources.

Last year, St. Joseph Mercy Ann Arbor primarily focused on its pressure injuries in the ICU and medical device pressure injuries. As a result, it formed an ICU subcommittee and focused on high-risk critical care units. It also sought to drive improvement in pressure injuries by implementing the following measures:

  • Develop a focus on problem solving and continuous change for all pressure injuries.
  • Develop a “body map” tool, which is used to assess all skin areas.
  • Use root cause analysis as a structured process to brainstorm action plans for risk modification.
  • Identify key stakeholders and have skin champions from each unit.
  • Have skincare products for patients readily available on each nursing unit.
  • Add additional wound ostomy and continence (WOC) nurse to team.
  • Institute/coordinate daily rounds (Monday- Friday) that include a WOC nurse and nursing staff.
  • Conduct daily interdisciplinary rounds, including executive leaders.
  • Deep-dive into 2017 pressure injury serious reportable events and identify common issues.
  • Focus on respiratory support devices and develop criteria for the prevention of medical device-related pressure injuries.
  • Conduct monthly, random validation of daily checks to ensure quality.

In 2017, the focus for St. Joseph Mercy Ann Arbor was driving improvement. The significant reduction in pressure ulcers systemwide is attributed to collaboration across the board – from looking inward at its own processes and equipment, getting feedback from its staff, being transparent with its data and incorporating leadership into the entire process, to visiting other hospitals to identify potential improvement methods and taking advantage of interprofessional learning opportunities offered by the MHA Keystone Center.

From March 2017 to February 2018, St. Joseph Mercy Ann Arbor worked diligently to reduce hospital-acquired pressure injuries (HAPI). During that period, there was a 54 percent reduction in stage 3, 4 and unstageable hospital-acquired pressure injuries within its facility.

The significant decrease is attributed to a mixture of an interdepartmental collaboration within St. Joseph Mercy Ann Arbor and the MHA Keystone Center resources related to HAPI.

Since the MHA Keystone Center’s inception, St. Joseph Mercy Ann Arbor has been deeply involved in its various patient safety and quality initiatives, which has allowed for improved safety culture practices and hospital-acquired infection prevention strategies.

St. Joseph Mercy Ann Arbor staff and leadership team members regularly attend MHA Keystone Center workshops and conferences, including intensive care unit (ICU) initiatives that are patient safety-related.

Furthermore, St. Joseph Mercy Ann Arbor continually uses the MHA’s technical work process and Agency for Healthcare Research and Quality’s Comprehensive Unit-Based Safety Program Toolkit to help shape its overall organizational culture.

Photo Caption: St. Joseph Mercy Ann Arbor staff have worked diligently to reduce hospital-acquired pressure injuries. Staff members shown above include (top) Wendy Walker, BSRT-RRT; Saadiq Jamaluddin, BSRT-RRT; (middle) Emily Pasola, RN; Jennie Bowerson, RN; (bottom) Sandy Basch, WOC RN; Denise Hoffman, RN; Molly Patterson, WOC RN; Barb Boylan Lewis, WOC RN; and Danielle Mastin, WOC RN.

High reliability culture chartHigh Reliability

The partnership between the MHA Keystone Center and the Joint Commission Center for Transforming Healthcare is in its third year. The relationship has facilitated the sharing of concepts of high reliability with more than 100 Michigan hospitals as they transition toward becoming high-reliability organizations. The goal is to reduce all-cause harm throughout Michigan, with the end point of zero preventable harm.

Quadruple Aim

The MHA has focused largely on the Triple Aim: improving the individual experience of care, improving the health of populations, and reducing the per capita cost of healthcare. For the 2017-2018 program year, the MHA expanded to the Quadruple Aim, adding the fourth target of improving the experience of providing care by focusing on healthcare providers finding joy and meaning in their work. As part of this effort, the MHA and its governing boards committed to prioritizing workplace safety and physician burnout.

Orange chevronConcerns regarding caregiver burnout and workplace safety are ever-present. A safe workplace is crucial to provide safe, high-quality care, and addressing the root cause of burnout requires addressing the wellbeing of caregivers.

Collaborative conversations with experts in the field and other healthcare advocacy organizations are ongoing as the MHA will continue to engage partners in addressing these very important issues.

Person- and Family-Centered Care

Patient & Family Engagement logo

MHA Launches Person and Family Engagement Council
The MHA formally added a member council to promote and accelerate person and family engagement in Michigan hospitals. The Person & Family Engagement Advisory Council seeks input from patient and family partners, serves as advocates for their needs, and ensures their voice is incorporated into MHA quality and safety initiatives.


VerifyMICare hompageVerifyMICare: In support of increasing transparency of hospital data, a new website – – launched January 2018. The website allows the public and patients to compare Michigan hospitals side-by-side on various quality measures, such as C-section rates, readmissions, mortality, retained surgical items, early elective deliveries and more. It was created voluntarily by the MHA and its member hospitals and has received more than 14,000 hits since the launch.


GLPP HIIN logoThe MHA Keystone Center, Illinois Health and Hospital Association, and Wisconsin Hospital Association along with 316-member hospitals across Michigan, Illinois and Wisconsin have united with a common goal: to reduce hospital-acquired conditions by 20 percent in 11 areas of harm and achieve a 12 percent reduction in all-cause readmissions.

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Patient Safety Organization logoSafety 

The MHA Keystone Center is recognized as a Federally-listed Patient Safety Organization (PSO) by the Agency for Healthcare Research and Quality (AHRQ). The MHA Keystone Center PSO works with members to adopt a strong cultural stance on patient safety by emphasizing the importance of improvement at the organizational and unit level.

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Celebrating 15 Years of Safe Care

  • MHA Keystone Center 15 years of safe care2 national awards won for quality improvement & safety.
  • 35+ publications in peer-reviewed literature.
  • 4 international events to teach about successes in Michigan hospitals.
  • $822 million cost avoidance between 2006-2017.
  • 68% reduction in early elective deliveries since 2010.
  • 10.5% decrease in severe maternal morbidity since 2015.
  • 51% decrease in urinary catheter utilization since 2012.
  • 15% reduction in C. diff since 2014.
  • 30% reduction in surgical-site infections since 2015.

“It is with gratitude to the physicians, nurses and other members of the healthcare team that we look back at the incredible results we have achieved together to make care safer. The success that we have seen in improving the quality and safety of care is the result of the great work of providers, the generous support of Blue Cross Blue Shield of Michigan and the investments of the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality.”

Sam R. Watson, MSA, MT (ASCP), CPPS, executive director, MHA Keystone Center, senior vice president of patient safety and quality, MHA.

MHA Keystone Center Communications

Digital Outreach and Social Media
The MHA Keystone Center provides regular content updates on social media that promote events, provide tools and resources, highlight the work of Michigan hospitals, and encourage participation in making Michigan care safer.

  • 10 videos.
  • 273,901 impressions.
  • 5,780 clicks/comments.
  • 647 Twitter followers.
  • 204 LinkedIn followers.

MHA Keystone Center Monthly Newsletter
The MHA Keystone Center provides a monthly newsletter that highlights the latest safety and quality news, important updates, member highlights and upcoming MHA Keystone Center and GLPP HIIN events. It is distributed during the first week of every month.


Sam WatsonWatson Recognized As A Top Patient Safety Expert
Sam R. Watson, MSA, MT (ASCP), CPPS, executive director, MHA Keystone Center, senior vice president of patient safety and quality, MHA, was named one of the 50 Experts Leading the Field of Patient Safety by Becker’s Hospital Review, a leading healthcare publication.

MHA Keystone Center Visits Helen Devos Children’s Hospital
MHA Keystone Center team at Helen Devos Children's CenterMHA Keystone Center staff visited Helen DeVos Children’s Hospital in Grand Rapids to learn about its iHub, an innovative and multifaceted approach to performance improvement and the management and communication of quality improvement projects. Lessons learned from the visit help inform the MHA Keystone Center’s collaborative efforts and its work on best practices in promoting the advancement of safety culture and quality improvement among all Michigan hospitals.

MHA Advancing Safe Care Award
Advancing Safe Care AwardThe Neonatal Intensive Care Unit Antibiotic Stewardship Team from Bronson Children’s Hospital, Kalamazoo, was the recipient of the inaugural Advancing Safe Care Award. The award recognizes teams of healthcare professionals who demonstrate a fierce commitment to providing quality care to diverse socio-economic populations, lead the charge for quality improvement, promote transparency to improve healthcare, and achieve better outcomes due to a strong culture of safety.

BMJ Publishes Study by MHA Keystone Center Leaders
Brittany Bogan and Sam WatsonThe BMJ Quality & Safety international medical journal published Providing Feedback following Leadership Walkrounds is associated with Better Patient Safety Culture, Higher Employee Engagement and Lower Burnout in late 2017. The study was done by Bryan Sexton, PhD, MA, partners from Safe and Reliable Healthcare and the MHA’s Sam R. Watson and Brittany Bogan.

2017-2018 Board of Directors

  • Brian Peters, (CEO) MHA
  • Robert Riney, Henry Ford Health System
  • Michelle Schreiber, MD, (Chair) Henry Ford Health System
  • Robert Welsh, MD, (Vice Chair) Beaumont Hospital, Royal Oak
  • Matthew Rush, FACHE, (Past Chair) Hayes Green Beach Memorial Hospital
  • Sam R. Watson, MSA, MT (ASCP), CPPS, (Board Secretary) MHA
  • Lawrence Abramson, DO, Michigan Osteopathic Association
  • Paul Conlon, PharmD, JD, Trinity Health
  • Robert H. Connors, MD, Helen DeVos Children’s Hospital, Spectrum Health
  • Rick Boothman, Michigan Medicine
  • Robert Hyzy, MD, Michigan Medicine
  • Mark Janke, Bronson Healthcare Group
  • Cheryl Knapp, RN, MBA, CPHQ, CPPS, Bronson Healthcare Group
  • Kevin McCarthy, Trillium Staffing
  • Marjorie Mitchell, Michigan Universal Health Care Access Network
  • James E. Richard, DO, Michigan State Medical Society
  • Barbara Smith, MS, NHA, Burcham Hills Retirement Community
  • Jonathan So, Detroit Regional Chamber of Commerce

MHA Keystone Center Annual Report Talking Points


The 2017-2018 MHA Keystone Center Annual Report highlights the collaborative work being done by the MHA Keystone Center and its member hospitals and health systems to advance the health and overall well-being of Michigan residents. It also features information about the MHA Keystone Center’s 15-year anniversary and its accomplishments over the years to provide safer, more reliable healthcare in Michigan and beyond.

Key Findings in This Year’s Report

  • Feature stories highlight how Michigan hospitals are specifically tackling the opioid epidemic, readmissions and hospital-acquired infections.
  • Thanks to efforts to reduce adverse events, Michigan hospitals avoided nearly 6,400 instances of harm, which amounted to a savings of $80.6 million in healthcare costs during the 2017-2018 program year. From 2006 to 2017, efforts to avoid preventable harm have helped Michigan hospitals save $822 million in healthcare costs.
  • The MHA Keystone Center Speak-up! Award was launched in March 2016 and celebrates safety through the recognition of individuals in MHA Keystone Center Patient Safety Organization (PSO) hospitals who speak up to prevent harm. To date, the MHA Keystone Center has received 429 nominations from 39-member hospitals. That’s an average of one nominee every two days for the past two and a half years. 
  • Since 2012, Michigan hospitals have seen a 49 percent drop in catheter-associated urinary tract infections.

Talking Points

Over the past 15 years, member hospitals have participated in various educational opportunities provided by the MHA Keystone Center to make care safer and more reliable. 

  • Since 2006, Michigan hospitals have saved an estimated $822 million in healthcare costs. Additionally, since 2015, there has been a 10.5 percent decrease in severe maternal morbidities and a 30 percent reduction in surgical-site infections. Hospitals have also experienced, a 15 percent reduction in clostridium difficile (C. diff) since 2014.
  • Over the past eight years, Michigan hospitals have experienced a 68 percent decrease in early elective deliveries.
  • The MHA Keystone Center regularly hosts conferences, workshops, monthly check-in calls and webinars to facilitate peer-to-peer learning and to drive improvement.

Michigan hospitals, along with participating hospitals in Illinois and Wisconsin, are working together to reduce hospital-acquired conditions by 20 percent in numerous areas of harm.

  • Improvement efforts in the 2017-2018 program year resulted in an estimated cost savings of nearly $81 million.
  • The Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN) contract celebrated its first anniversary in 2017. In 2016, the MHA Keystone Center, Illinois Health and Hospital Association and Wisconsin Hospital Association signed a two-year contract with optional third year as part of the Centers for Medicare & Medicaid Services HIIN to reduce patient harm.
  • Michigan hospitals participating in the GLPP HIIN have achieved a 20 percent reduction in the following areas:
    • Central Line-associated Bloodstream Infection (CLABSI) in both intensive care units (ICUs) and hospitalwide.
    • Catheter-associated Urinary Tract Infections (CAUTI) in the ICU and hospitalwide.
    • Surgical-site Infections (SSIs) following hysterectomies.
    • Possible ventilator-associated pneumonia.
    • Adverse drug events related to anticoagulants.
  • Michigan hospitals participating in the GLPP HIIN have achieved a 10 percent reduction in the following areas:
    • SSIs following total knee replacements.
    • C. diff.
    • Adverse drug events related to glycemic control.
    • Venous thromboembolism (deep vein thrombosis and pulmonary embolism).
    • Total infection-related ventilator-associated complication plus.

The MHA Keystone Center is committed to tackling the toughest and biggest issues in healthcare.

  • Over the past year, the MHA Keystone Center and its member hospitals focused specifically on sepsis, falls, health equity and opioids through specialized member trainings, simulations, regional learning sessions and webinars.
  • MHA Keystone Center PSO member hospitals that administered a Safety, Communication, Operational Reliability and Engagement survey showed an 8 percent improvement in burnout culture scores, compared to previous survey administrations.
  • The MHA Keystone Center created several opioid stewardship tools and resources for physicians, healthcare providers and the public to help fight against the opioid epidemic.

Additional Resources

  • Members with questions about the report should contact the MHA Keystone Center.
  • Media inquiries regarding this year’s report should be directed to Laura Wotruba at the MHA.

MHA Keystone Center: A Certified Patient Safety Organization

The MHA Keystone Center acknowledges and appreciates the generous financial support of Blue Cross Blue Shield of Michigan.

Supporting healthcare providers to achieve excellence in the outcomes desired by the people they serve.

Excellence. Innovation. Compassion. Teamwork.

Achieving the highest quality healthcare outcomes that meet individual values.

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Download a PDF of the report to learn about everything the MHA Keystone Center is doing to promote high quality healthcare in Michigan. 

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