• Article
  • February 1, 2019

Building a Focus on Pediatrics in a Health Care System

How Mercy Kids coordinated a new approach to developing pediatric quality measures in an adult system.

Mercy Kids delivers high-quality care

As a result of its efforts, Mercy Kids:

  • Increased children engaged in HPV series by 12.4 percent
  • Increased well care visits for 3- to 6-year-olds by 14 percent
  • Decreased outmigration and leakage by 3.5 percent
  • Established enterprise-wide contracts with suppliers supporting consistent clinical care guidelines; for example: inhaled nitric oxide utilization led to 80 percent adherence to clinical practice guideline

By Tracy Breece, RN, M.S.N., CPHIMS; Christine Crain, RN, M.S.N., NEA, BC; Joseph Kahn, M.D.; Elizabeth Kubik, MBA

Mercy Kids delivers high-quality care and patient- and family-centered experiences across a diverse landscape of health care settings, which are embedded in a primarily adult care system. Established in 2012 as a division of Mercy health system based in Chesterfield, Missouri, Mercy Kids serves children at more than 40 Mercy hospitals and hundreds of clinics in Missouri, Arkansas, Oklahoma and Kansas.

By aligning people and strategy across the four-state system, the organization fosters collaboration of all co-workers who care for kids. It empowers teams to deliver the right care by the right provider as close to the patient's home as possible. Clinicians serve kids at all levels of care in all types of settings—many traditionally designed for meeting the needs of adult patients.

Creating a blueprint for care

Mercy Kids' Levels of Care strategy differentiates the unique needs of kids in health care. A blueprint of expectations for each type of treatment site—from a tertiary hospital to a critical access hospital—the Levels of Care standards guide all sites to deliver their highest level of service for kids based on clinical evidence and the standards of pediatric professional organizations. Developed when Mercy Kids was established, the living document evolves with best practices.

"Our approach with Levels of Care has been foundational to establishing our ministry-wide charge to better serve kids," says Joseph Kahn, M.D., president of Mercy Kids. "The tool has guided our strategy forward and allows the Mercy Kids leadership team to partner with each Mercy community to together identify the ways we can advance clinical care for the kids served in that particular setting—whether it's a few kids a week in a rural hospital or hundreds a day at one of our children's hospitals."

With foundational goals defined in Levels of Care, Mercy Kids develops partnerships and listens to the needs of providers across its system to eliminate operational barriers and advance care guidelines and quality outcomes. The organization established a pediatric quality portfolio to align and measure its work against national quality standards for kids.

Organizing teams across locations

Leading through relationships—not a direct reporting structure—Mercy Kids has an established network of clinical expert teams with representatives from each of its communities. By bringing teams together, Mercy Kids extends the pediatric expertise located at its children's hospitals to clinicians across the system to enhance the care of kids.

These teams include physician councils for pediatricians and neonatologists, in addition to teams of pediatric intensive care nurses, neonatal nurses, respiratory therapists, pharmacists, physical/occupational therapists, child life specialists, registered dieticians, social workers, lactation consultants and infection preventionists.

Co-workers of similar expertise from across the system meet routinely, virtually and in-person, to identify common goals and outcomes measures. Progress comes in many forms, such as sharing best practices, development of policies and clinical practice guidelines, electronic medical record (EMR) optimization, data reporting development and standardization of supplies. The system-wide clinical expert teams are essential for the provision of consistent, evidence-based care, realizing cost savings and the strengthening of a link for all sites to access resources.

Organizing and integrating teams requires consistent communication, leadership commitment and clearly defined measures of success. Each facility supports the performance goals, which the pediatric quality portfolio outlines, and they build toward a system target inclusive of all locations and providers.

Ensuring access to data

Real-time access to pediatric data is necessary to achieve a coordinated approach to improving pediatric quality measures. Leveraging internal data development resources and its enterprise-level EMR, Mercy Kids built a platform to visualize progress through data.

The interactive, broadly accessible and ever-changing dashboard displays key outcomes measures, including volume trends for discharges by unit, transfers, surgeries, ED visits and virtual visits by location, in addition to program-specific metrics.

Leaders and co-workers in all communities and at all levels have immediate access to pediatric metrics and therefore the ability and resources to create individual plans for improvement. "The fundamental concept of real-time data sharing through an easily accessible and understandable dashboard allows and promotes data-driven decision making for all teams," says Kahn. "In turn, communication and analysis of this level of detail has served—and will continue to serve—as a catalyst to safer and more effective models of care."

In partnership with these teams, Mercy Kids promotes a shared vision, systems thinking, a virtual extension of limited resources and effective utilization of data, and achieves goals derived from national quality initiatives, financial opportunities, evidence-based clinical standards and strategic planning for growth. "The realized quality improvement gains add value to our families and our organization," Kahn says.

"But, the strength of Mercy Kids' pediatric system of care is in its people. With different expertise and experiences, our teams commit to sharing knowledge and collaborating to improve outcomes for kids—wherever the child lives in the Mercy ministry."

With support and encouragement from leadership, Mercy Kids remains focused on its systems approach to team-based care to improve its service to its communities. In the future, Mercy Kids will leverage Mercy's virtual experience to more directly bring pediatric experts to kids and will continue to build its quality metrics portfolio.

Tracy Breece, RN, M.S.N., CPHIMS, is the director of Quality, Safety and Clinical Excellence; Christine Crain, RN, M.S.N., NEA, BC, is COO and vice president of Operations; Joseph Kahn, M.D., is president; and Elizabeth Kubik, MBA, is the director of Strategic Initiatives at Mercy Kids. Send questions or comments.