North Carolina Flex State Profile
The Technical Assistance and Services Center (TASC), a program of the National Rural Health Resource Center, provides technical assistance for the Rural Hospital Medicare Flexibility (Flex) Program in the form of information, tools and resources. State Flex Programs benefit from sharing information with one another and the Flex State Profiles are meant to be a method to encourage that sharing.
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North Carolina (NC) has a long history of supporting quality improvement efforts in hospitals. Dating back to 2004, the Office of Rural Health & Community Care has worked collaboratively with the North Carolina Hospital Association to improve core measure and Hospital Compare reporting and improvement currently (including all-or-nothing scoring) is over 140% improvement in pneumonia measures, and more than 200% improvement in heart failure measures for all 23 of NC’s critical access hospitals (CAHs). This work will continue and expand in line with the Medicare Beneficiary Quality Improvement Project (MBQIP). Other collaborative work with the Hospital Association includes; board quality training, 340B Drug Program enrollment, the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Surveys and technical assistance (TA), efforts to increase hospital consumer assessment of healthcare providers (HCAHPS) survey utilization, and the adoption and spread of Lean culture within our rural hospitals.
Currently there are three active Carolina Lean collaboratives with a total of 18 rural hospitals participating in three-year projects to transform the culture of their organizations. While this can be seen as a quality improvement “tool,” the reality of Lean is that when it is done correctly, it changes the way the hospital operates as the culture of the organization embraces systematic, ongoing improvement. The most successful hospitals have seen multi-million dollar returns on these efforts and the entire staff is engaged in improvement like never before. The NC Office of Rural Health & Community Care believes that Lean Management requires a change in culture beyond the implementation of Lean tools and that it is the future of health care management. The NC Office of Rural Health & Community Care is also doing work to help hospitals facilitate transition to meaningful use, providing for consultative support, and plan development.
The NC Office of Rural Health and Community Care continues to support critical access hospital (CAH) and small rural hospital trauma readiness through the ongoing dissemination of the Rural Trauma Team Development (RTTD) Courses. The state is divided into nine Trauma Regional Advisory Committees (RACs). The RAC staff provides the training to the hospitals by contract. In conjunction with the development of the trauma system, this is a critical, base line course.
For hospitals that were unable to meet the criteria to join a Lean collaboratives, a new program designed to support Lean Transformation Coaching and Improvement is being developed at North Carolina State University (NCSU). We are engaging the Lean Healthcare services of NCSU'sIndustrial Extension Services to provide Lean coaching and transformation model for two small, rural hospitals paired together. The two hospitals will join the shared learning of the Carolinas Lean Collaborative, but receive lean coaching services entirely from NCSU. The NCSU's proposed lean coaching services include executive and front-line training, lean facilitator training, value stream development and managing rapid improvement events.