Nebraska Flex State Profile

The Nebraska Flex Program uses the Baldrige model as a framework for improving quality and the overall performance of critical access hospitals (CAHs). This model is used because it emphasizes the importance of leadership in changing the culture of the organization and improving communication at all levels. There is also a strong focus on customer satisfaction, and measuring results. The key activities under quality improvement are:

• Support CAHs participating in the Medicare Beneficiary Quality Improvement Project (MBQIP) (currently all of the hospitals are in the program). In order to improve our scores, staff is working with the Nebraska Hospital Association, the quality improvement organization (QIO), and the CAH networks to identify best practices and share these practices in all of the CAHs.
• Continue to support the training and implementation of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). Thus far, 52 CAHs have implemented TeamSTEPPS.
• Continue to support the CAH Executive Fellowship Program which has trained over 30 CAH administrators and other leaders by providing them with the leadership competencies and tools that are necessary to build a culture of change.
• Conduct mock surveys in 90 percent of the CAHs.
• Support participation of CAHs in Quality Health indicators (QHi) multi-state benchmarking project with the Kansas Hospital Association.

Good financial performance is also based on the elements in the Baldrige model. For example, good leadership and open communication throughout the organization will enhance both operational and financial improvement. The key activities under this area are:

• Providing training and education to critical access hospitals (CAHs) on Lean Management techniques. Once training has been completed, monitor and provide technical assistance on the implementation of Lean Projects. Thus far 14 CAHs are receiving or have completed the training and have implemented at least one Lean Project
• Conduct a comprehensive financial and operational assessment for low or negative margin CAHs. Once the assessment has been completed, a tracking system has been developed to assess the progress and changes in meeting the recommendations contained in the report. Thus far ten assessments have been completed and a total of at least four more will be done by the end of 2013.

There are two main areas of focus for health system development. The first major area is to enhance emergency medical services (EMS) capacity by expanding the number of trauma centers (46 so far), provide training and support to medical directors, conduct emergency medical services (EMS) needs assessments, and organize a leadership development program. The second major area is to develop strategies that will lead to a strong regional system of care for patients who need immediate treatment for a heart attack. These strategies involve developing more formal acceptance agreements between critical access hospitals (CAHs) and referral hospitals and increase the use of telemedicine to reduce the time for transfers.