In the five months since the contracts were announced, the HENs have hit the ground running, Wagner says. “We awarded the contracts on Dec. 9 and we were in the first face-to-face meetings on Dec. 12, three working days later,” he says. “Some HENs convened their first learning sessions within 30 days of the awards. That is lightning fast.”
The HENs have since enrolled a total of more than 4,000 acute-care hospitals, Wagner adds.
“We had letters to hospital CEOs already drafted and ready to go before we even knew we got the award,” says Dr. Carol Koeble, senior vice president of the North Carolina Hospital Association, which was chosen as a HEN, and executive director of the North Carolina Center for Hospital Quality and Patient Safety.
North Carolina's HEN—called the North Carolina-Virginia hospital engagement network because of its partnership with the Virginia Hospital & Healthcare Association—now has 117 members, 83 from North Carolina and 34 from Virginia.
In the rush to recruit hospitals, a few states have even seen competition among HENs, Koeble says. In Virginia, for instance, some hospitals chose to join the networks of national HENs, such as Premier, VHA and HRET, while several academic medical centers affiliated with Chicago-based UHC chose to join its HEN.
“We did court some hospitals, and we got many to come aboard,” Koeble says. “The most important thing, though, is that all hospitals participate in a HEN, no matter which one it is.”
North Carolina's HEN has chosen to tackle its duties using intensive collaboratives addressing conditions such venous thromboembolism, as well as less-intensive learning networks targeting areas of harm such as pressure ulcers and adverse drug events. Some hospitals are participating in all activities, while others—particularly smaller ones—can choose from a narrowed list of topics.
Transylvania Regional Hospital, a 25-bed critical-access hospital in Brevard, N.C., has signed up to target seven areas, including surgical-site infections, says Scotta Orr, the hospital's director of quality and accreditation.
“Smaller hospitals are required to meet the same guidelines as larger ones but with fewer patient and fewer employees, so the people here have to wear many hats,” Orr says. “If we can get best practices and tools that someone has already invested in, such as patient education or a checklist, that saves us a great deal of time.”
The Michigan Health & Hospital Association, also chosen as one of the 26 HENs, decided to build on its existing quality-improvement infrastructure, well known for its successes in areas such as central line-associated bloodstream infection prevention.
“We have an advantage because we already have the contacts and we have the teams engaged,” says Brittany Bogan, director of healthcare innovation at the association's Keystone Center for Patient Safety & Quality.
The larger national HENs have also taken their own approach to meeting the program's goals. HRET, which secured $75 million from HHS and has enrolled more than 1,600 hospitals in 31 states, has rolled out its enormous HEN using partnerships with state hospital associations, says Maulik Joshi, HRET's president.
State hospital associations do their own recruiting while HRET coordinates the improvement activities, explains Joshi, who says the partnership with state associations is HRET's “secret sauce.”