— Participation Agreement —
Commencing March 1, 2010
Hospital Name
Agrees to participate with the Hospital Council of Northern and Central California (Hospital Council), Anthem Blue Cross and the National Health Foundation (NHF)
in the
Patient Safety First…a California Partnership for Health
My facility commits to participate in the Beacon Patient Safety collaborative in:
○ Beacon Greater Central Valley Patient Safety Collaborative
○ Beacon Greater Sacramento Patient Safety Collaborative
Project Components and Activities
Detailed descriptions of project components and participant activities are available in the FAQs, and Participant Activities documents sent to each hospital in February 2010.
I understand that to improve the effectiveness and reach of the program, there will be a modest cost associated with participation.
- The Beacon Greater Sacramento Valley and Greater Central Valley Collaboratives will charge a $40.00 per person fee for in-person sessionsto cover basic costs such as catering and room charges to ensure the grant dollars can be spread across the Council Regions to support as many hospitals as possible. Active participation will ensure hospitals learn from each other, the strategies for successful implementation through quarterly in-person meetings, webinars, and networking, web site resources of tools and protocols as well assupport via improvement advisors. The improvement advisors will work with hospitals individually to support learning and provide guidance as identified.
- Optional staff development through the Beacon Institute, participation in theBay Area annual program and special targeted educational topics will continue to be fee based.
We commit to submitting data for both the Perinatal Improvement initiatives as well as the Sepsis/HAI improvement efforts.
We commit to identifying a key contact for the hospital, to serve as the central communications conduit for disseminating information and conveying decisions.
Hospital Representative Considerations
Identify at least 2-3 persons, including physicians, to regularly attend the collaborative convenings relevant to their expertise and interest while ensuring the hospital is always represented;
- Identify “initiative leaders” and physician champions for each improvement strategy being undertaken, whose responsibility includes attending sessions to take learnings back and disseminate in the organization, help champion the improvement effort internally, and be willing to share successful strategies with the larger group regionally;
- Participate in scheduled data submission and receive periodic reports to guide internal efforts (every effort will be made to use data that is already collected for other purposes and/or obtain that data from third party sources (OSHPD, CHART, CalNOC, etc.);
- Provide meeting rooms as requested/available to ensure stewardship of resource dollars.
Confidentiality
Hospital Counciland NHF will keep confidential any information collected from the hospital. This means that:
- No identifiable information can be shared with another party without the written permission of the hospital.
- Identifiable information that the hospital shares with Hospital Council and NHF will not be used for purposes other than for participation in this initiative, unless approved by the hospital.
- No proprietary information (such as business plans, business strategies, protocols, policies, procedures, or educational materials) will be shared with other parties unless the hospital gives its written consent.
- Aggregate outcomes will be used to demonstrate regional and statewide improvement. It will also be compiled in interim reports for Anthem Blue Cross at the end of year-one and year-two of the program with a comprehensive at the conclusion of the third year.
For purposes of reporting to stakeholders and other interested parties, the hospital grants Hospital Council and NHF permission to release the hospital name as an active project participant.
Agreed
Hospital NameName, Chief Executive Officer
______
Signature and TitleDate