News & Updates

New Sacral Injury Prevention Top 10 Checklist Available 
HRET and Jackie Conrad, Cynosure Health Improvement Advisor, have developed an important new tool to assist in preventing injuries to the sacral region.

The sacral region is the most frequent anatomical location for pressure injuries due to the following factors:

  • Pressure from supine positioning
  • Friction and shear during repositioning and from sliding down in bed
  • Moisture from incontinence and perspiration

Click here to access this checklist. 


Were you aware that in California, one in five mothers suffers from pregnancy related depression? The California Health Care Foundation created a diverse task force including project staff from Cynosure Health to explore the barriers, models, and potential solutions that affect a half-million California mothers and their babies each year. Maternal mental helath conditions are treatable and early detection can make a significant, positive impact. Our goal is to recognize and build systems to address them during the vulnerable perinatal period. To learn more, read the full article here.

New Change Packages added to our Tools and Resources: 

Preventing Malnutrition, 2017 Update

Culture of Safety, 2017 Update: Developed by HRET and Cynosure Health Improvement Advisor, Betsy Lee

Preventing Multi-Drug Resistant Organism (MDRO) Infections, 2017 Update

Preventing C. Difficile Transmission and Infection, 2017 Update

Preventing CAUTI, 2017 Update: Developed by HRET and Cynosure Health Improvement Advisor, Betsy Lee

Preventing Harm from CLASBI, 2017 Update: Developed by HRET and Cynosure Health Improvement Advisor, Barbara DeBaun

A Venous Thromboembolism (VTE) Safety Session was presented by Dr. Steve Tremain, a Cynosure Health Physician Improvement Advisor

The Illinois Health & Hospital Association held an Improvement Action Network in April where Dr. Tremain provided coaching and subject matter on VTE.



Steve Tremain, Physician Improvement Advisor, Cynosure Health, will be speaking in Tampa, FL


Check out our Tools & Resources!

New/updated Change Packages by HRET HIIN have been added with additional packages to follow.
Our most recent additions include:

Readmissions, 2017 Update      Pat Teske MHA, RN, Cynosure Health Chief Implementation Officer & Improvement Advisor updated the Readmissions Change Package with HRET

Undue Exposure to Radiation, 2017 Update

Airway Safety, 2017 Update

Preventing Harm from Injuries from Falls and Immobility, 2017 Update

Peventing Surgical Site Infections, 2017 Update

These, as well as other updates, can also be found on the Hospital Improvement Innovation Network Library page.

Maryanne Whitney, a Cynosure Improvement Advisor, shares her drive and passion for quality improvement at the Arkansas Hospital Association Roadshow.

The AR Roadshow hosted over 70 people from over 50 hospitals energized to hear about "how better to engage their teams" and "becoming a High Reliable Organization".  A great "speed dating" activity had the participants sharing "What they are most PROUD of in their HIIN work?" and "What they NEED to take their HIIN work to the next level?".  Participants left the day feeling ready to use some of their learnings upon return to their facilities and continue to share and collaborate with one and another.
AR Roadshow

Bruce Spulock, President and CEO of Cynosure Health, will be presenting at the Georgia Hospital Association’s Patient Safety Summit on Jan 11 in Greensboro, GA.




Join Cynosure's Team Members as they facilitate HRET HIIN's first Pressure Ulcer/Injury event.

Cynosure Health Welcomes Three New Board Members

National Healthcare Experts Bring New Energy and Expertise to Non-Profit Organization Committed to Improving Healthcare Roseville, CA , November 15, 2016 ( Health, a non-profit organization that provides consulting and training services for healthcare quality and patient-safety programs, has added three national healthcare experts to its Board of Directors. 

“Our new board members will help our growing organization achieve its mission to improve healthcare,” says Sue Murphy, MHA, Board Chair, Cynosure Health. “They are well-recognized industry leaders who understand how to create real change that starts at the frontlines.” 

The new board members include: 

Mark Erath, CPA, CGMA, CSMC, CPHQ, FACHE, FHFMA, Principal,
In his current job, Mr. Erath helps customers succeed with strategy, innovation and performance excellence challenges. He previously served as Executive Vice President/CFO of the Parkland Health and Hospital System, and CFO of Geisinger. He spent 30 years as an advisor with PricewaterhouseCoopers Healthcare Partner, and was appointed by the Secretary of Defense to an expert independent review panel advising the military healthcare system. Mark earned his Bachelor of Science degree in Accounting from Louisiana State University, and is completing his Healthcare Leadership Master’s in Business Administration degree at the Haslam College of Business of the University of Tennessee.

Jane W. Swanson, PhD, RN, NEA-BC, FAAN, Director of the Geri and Richard Brawerman Nursing Institute for Professional Development at Cedars Sinai, Los Angeles, California. Previously, Dr. Swanson was a Captain in the Navy Nurse Corps and held several inpatient and ambulatory positions, including Chief Nursing Officer and Ambulatory Specialty Advisor to the Navy Surgeon General. She was an assistant professor at the School of Nursing at the University of Texas, where she taught community health, leadership, medical surgical nursing, and women and children’s health. Dr. Swanson is a Fellow in the American Academy of Nursing, a Magnet Program Appraiser, Past President of American Academy of Ambulatory Nursing and Distinguished Alumni from Medical College of Georgia, School of Nursing. Her PhD in Nursing and Leadership is from the University of Texas.

Ron C. Whiting, Senior Director of Corporate Development, The Permanente Federation. Mr. Whiting has more than 20 years of experience working with hospitals, health systems, medical groups and not-for-profit organizations. His current work includes supporting care delivery strategies with an emphasis on developing third-party relationships that support Kaiser Permanente's goals to deliver high-quality, cost-effective care. Before joining Kaiser Permanente, Mr. Whiting was a co-founder and Executive Director of the Wichita Business Coalition on Health Care and also operated a strategic health care consultancy. He holds a master’s degree in Industrial/Organizational Psychology from Alliant University.

“Each new board member brings unique perspectives and skills, and is deeply committed to improving and redesigning the healthcare system,” says Bruce Spurlock, MD, Executive Director, Cynosure Health. “We’re very pleased to welcome these individuals to our team, because they share our commitment to improving care for patients and families.” 

For the official press release, please click here.

NYSHealth Awards Grants to Empower Health Care Consumers 

Cynosure Health is proud to announce that it is one of five awardees under the New York State Health Foundation’s Empowering Health Care Consumer Grants. Under this project, Cynosure Health will conduct a comprehensive analysis of New York provider network adequacy, including network composition, performance, and accessibility. Findings will be disseminated in a series of issue briefs with recommendations for policymakers, health plans, and other relevant stakeholders. To learn more, please see the award announcement at 

Cynosure Health Adds National Healthcare Experts to Board of Directors


We are pleased to welcome our new board members:  

Jason Byrd, JD, Assistant Vice President, Regional Group, Carolinas HealthCare Systems. This public, not-for-profit, integrated health care system is comprised of 41 hospitals and more than 900 care locations serving the residents of North Carolina and Georgia. Byrd has worked in quality policy, practice management and lobbying roles for various national associations, including the American Society of Anesthesiologists (ASA), American College of Cardiology (ACC) and United Network for Organ Sharing (UNOS).

Cheryl Damberg, PhD, Principal Senior Researcher at RAND and RAND Distinguished Chair in Healthcare Payment Policy. She's a national expert in the areas of pay for performance (P4P) and value-based purchasing applications of performance measures, measures of cost efficiency and resource use, and evaluating alternative payment models. Dr. Damberg's research also focuses on understanding changes that providers and health systems are making to improve quality and costs.

Please see our press release to learn more about our new board members.  

  "ALL IN" Press Release February 2, 2016

We are excited to present the Press Release for "ALL IN: Using Healthcare Collaboratives to Save Lives and Improve Care". 

Click here to view. 

   New!  "ALL IN" page and content

We've added new content about our new healthcare book, All In:  Using Healthcare Collaboratives to Save Lives and Improve Care, now available on

Just click the "ALL IN" tab at the top of the page, or use this link.



We have a series of ALL IN related webinars coming up.  You will hear key tips from our expert contributors beginning with Sarah Stout MPAff, Managing Consultant for The Lewin Group and Bruce Spurlock MD, Cynosure Health's Executive Director on March 2nd at 10-11am (PT).  
Watch the Events section for upcoming webinars! 

Healthcare Learning Collaboratives 1st National Conference

Cynosure Health’s 1st national conference: Healthcare Learning Collaboratives, Lessons Learned and Future Opportunities was held on November 4-5, 2015 at the Baltimore Maryland Inner Harbor at Camden Yards.  World leaders and experts in healthcare collaboratives shared their experiences in areas such as design, funding, implementation and execution.   

Marybeth Sharpe, Ph.D., Program Director for the Moore Foundation and Bruce Sprulock MD, Executive Director of Cynosure Health, opened the conference. Marybeth shared the poignant story of Betty Moore's own medical error experience that led the Moore Foundation to add Patient Care/Safety as one of their key programs.  Bruce acknowledged and thanked the many contributors to the new book, All In: Using Healthcare Collaboratives to Save Lives and Improve Care, including Brent James, MD, MStat, who provided a testimonial for the book, identifying the power of collaboratives to rapidly spread knowledge.

"Knowledge comes in two flavors - knowledge that and knowledge how"

Donald M. Berwick, MD, MPP, FRCP provided the keynote address, Collaborative Improvement: a Brief and Recent History, taking us from the development of the IHI Breakthrough Series model, through early collaborative work, to more recent collaboratives. Plenary speaker Andrew Cooper provided an evidence-based framework for communication to support improvement.  The framework can be applied to large scale campaigns or to unit based initiatives.  Janhavi Kirtane Fritz with the Network for Regional Healthcare Improvement (NRHI) addressed the use of technology to advance collaborative learning  and moving knowledge management to “social learning”.  During her presentation, Janhavi introduced the HealthDoers Platform, an online open community aimed to provide a platform for connection and learning across the ecosystem.

A conference highlight was the launch of the new book, All In: Using Healthcare Collaboratives to Save Lives and Improve Care with all registrants receiving an advance copyMany of the book contributors were at the conference, either as speakers, panelists or attendees, providing a great book-signing opportunity! The book will be available for purchase at the IHI National Forum and through in January.

Conference presentations are available here as well as under Tools and Resources.

Elements of Effective Design

Paul McGann MD and Dennis Wagner MPA

Chris Queram MA

Marie Schall

Turning Knowledge Into Action

Karen Feinstein Ph.D.

John Chessare MD, MPH

The Numbers:  Budgeting, Funding and Data

Gail Amundson MD

Steve Hines Ph.D.

Deneil LoGiudice

Using Technology to Advance Collaborative Learning

Janhavi Kirtane Fritz

Patient and Family Engagement

Karen Feinstein Ph.D.

Nancy Zionts MBA

Libby Hoy

Leadership and Governance

Joe McCannon

Sam Watson MSA, CPPS

Lucy Savitz PhD, MBA

Diane Stewart MBA


Marybeth Sharpe PhD

Marybeth Sharpe, Ph.D., Program Director, Moore Foundation

Keynote Speaker: Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement
Download a chapter by Joe McCannon, Co-Founder and Principal, The Billions Institute, here.
conference banner
Join the Who's Who in the field of designing and running large scale healthcare improvement collaboratives at the first national conference todiscuss the past, present, and future of learning collaboratives. This highly interactive event will add to the growing knowledge in this field. If you design or run improvement collaboratives or intend to do so in the future, this is a must attend meeting.
Keynote speaker: Donald Berwick, MD, MPP, FRCPPresident Emeritus & Senior Fellow, Institute for Healthcare Improvement
Don Berwick MD, MPP
Plenary speaker: Andrew CooperInterim Director of Communications, Public Health Wales
Andrew Cooper
Registration is limited (maximum 300 registrants) to support an interactive learning environment and networking opportunities. Each registrant will receive a complimentary copy of the soon-to-be released Healthcare Collaborative Guide.  


Crossing the Bridge for Community Impact

ARC's final in-person learning session was held October 13, 2015 at the South San Francisco Convention Center.  The "Crossing the Bridge for Community Impact" conference was attended by 300 individuals, many of whom contributed to the collaborative's results: 13,911 readmissions prevented and $133,545,600 saved!  
ARC was a healthcare collaborative improvement effort under the leadership of Cynosure Health and CQC, with funding from the Moore Foundation.      


Bruce Spurlock MD, Executive Director, Cynosure Health

After reading a couple of articles on checklists recently, I'm even more convinced we need to rethink how we approach safety.  One good observation is that the use of checklists to promote teamwork is low yield.  You may have also heard me talk about how the aviation-healthcare comparison is not as good as the baggage-healthcare comparison.

None of this is to excuse poor performance in healthcare, but as my HRO colleagues talk about most systems, and healthcare in particular, are complex, non-linear systems where things like checklists stifle curiosity, oversimplify ambiguity and reduce organizational resilience.

And it is also true that we have unnecessary and unwarranted variation in healthcare which drives errors and harm.  So it is a ever changing, dynamic tension between "standard" and "adaptive" behaviors and attitudes that optimizes a system.

Just saw this interesting TED talk on why we think we are correct even when we are wrong...

Don't want to spoil the presentation, but you won't be surprised by the fact that it is built into our human design.  But her thesis on why it is built in is fascinating.

Paralleling this topic is the growing interest in diagnostic error, and I must admit that the single limiting factor in this arena is an absolute inability to count diagnostic errors. Hindsight bias, especially, changes our own views about diagnostic decisions that incorrectly assign pre-test probabilities based on post-test outcomes.

That's why I was glad to see the new guide for RCAs from NPSF promote risk-based analysis instead of outcome based analysis.  When you are in the midst of making a diagnosis you weigh options based on your perception of future risks/benefits.  These may be entirely correct and prudent and the outcome less likely at that point - but it still happened.  If we made every decision like the last play of the Super Bowl when the Seahawks were on the 2 yard line and decided not to run, we would always be second guessing every decision.  And that is how we (mostly) look at diagnostic errors today.

To see the new guide for RCAs from NPSF go to:

We don't have all of the answers, but we know we need to continually refine our thinking, especially our thinking about errors.

Nourishing a Lagging, Cross-Disciplinary Improvement Project

Marsha Chan, Cynosure's Chief Administrative Officer, was interviewed for this recent article published in HFMA's Leadership magazine (5/1/2015).  Here is a link to the article on HFMA's Leadership website 
And, here is a link to the entire magazine issue where you can download a PDF of the issue, if you'd like:

Decoding the Data - Part II

Our last message talked about the perils of BIG data and how crucial it is for hospitals in a rapidly changing environment to prioritize the optimal actionable opportunities based on a nuanced understanding of the data.  This time the issue is linking data to strategic opportunities.  
Now the quiz:
If you are trying to manage the move from volume (fee-for-service) to value (quality or population at-risk payments) which measures should senior leaders, middle managers and the Board be targeting?  My guess is you probably figured out already – it depends.  What we are seeing all across the country, though, is an attempt to keep up with the Joneses (or Smiths if your last name is Jones) by collecting and monitoring an ever growing list of performance indicators.  Our response in a moment…
With increasing pressure and reporting from CMS, state agencies, private reporting organizations like Leapfrog, Healthgrades and special reports from organizations like 3M, Truven, Datagen, Treo, Premier, VHA, and a host of others it is no surprise that hospitals are feeling it from all angles.  Its like flying cross country with a bad head cold and your ears never pop –  you’re just miserable.
Worse, now there are financial penalties and incentives attached to many of those results.  There is no way to ignore them and the trajectory of added measures is not encouraging.  One way hospitals try to manage this is to create green, yellow, red reports and then focus first on the reds and then on the yellows.  But that really isn’t strategic.
So while your sinking trying to keep up with an exploding data load that demands accountability, the strategic direction of your organization is looking forward, much much further than you can even raise your head up to view. Can you see the link between the PSI-90 and substance abuse issues that drive population health performance? We can’t either.
But the PSI-90 measure is here and now; you or others in the organization may even have a bonus tied to your performance making it predictable it gets more attention than focusing on chronic complex patients or dual eligibles that drive population based costs.
Finally, the biggest challenge we see is the organization has  4-5 major strategic domains, each with 5-10 metrics (or more!) and conflicting incentives, attention, accountability all rolling up to frustration at the Board, senior leader and middle manager level.  Someone even has the nerve to consider why can’t they all get fixed at once!
The Answer to which measures an organization needs to focus on in the move from volume to value depends on their strategic priorities.  But some common features that point to a manageable set of priorities include:
  • Evaluating populations not diseases
  • Targeting outcomes and then processes
  • Priorities based on the impact to patients (harm, lives saved) and then finances
  • Having a core set of performance incentives applicable to most that address priorities both in the present and the future
  • Getting data as close to real time as possible and then adapting quickly 

One measure that you can start now that helps you think about value but is also here and now is the Medicare Spending Per Beneficiary (MSPB).  Its part of Value Based Purchasing and the opportunity is with post-acute care partners that align with your vision.  MSPB is a baby step to understand bundled costs and how care outside of the hospital directly relates to a long-term value orientation. 

Decoding the Data - Part I

Successful leaders tackle BIG problems.  And the current rage is to use BIG data to solve them. Which often leads to BIG costs and NOT BIG improvement.
Here’s a quiz that illustrates the problem.  Your hospital is working hard to reduce avoidable readmissions.  Should you prioritize the clinical condition with readmissions 200% times higher than expected or the one with only a 25% higher rate? Well if you remember back to high school algebra, you would say you don’t have enough information – too many unknowns.  To solve this equation you need to know the “N” or number of patients each condition.  We’ll share the correct answer in a minute. With performance expectations, penalties and the move from volume to value, the pressure on hospitals has never been greater to focus on high-yield opportunities and to link those to your organization’s strategic priorities.  The problem is, you just don’t have the time, know-how or resources to get the information you need.
That’s a problem.  A BIG problem.  Too much data and the inability to translate it into information that generates strategic action.   Most of the time the answers are not that far away, they’re just buried under the clutter. 
If you were predicting what competency most hospitals need to develop and grow over the next 3-5 years, data analytics is in the top 3.  At least that is what a recent study from CDW Healthcare (published 3.15.15) indicates. We call it Decoding the Data.
It’s like the old spy watch with the rings around that deciphered the message in code – once you learn the tricks (the algorithms) and can use them quickly, a whole new world opens up. Suddenly, the answers are much more obvious and decisions much easier to make.
Now back to our algebra problem. If your liver failure patients are being readmitted 200% more often than expected and you have only a handful of them, say less than 20 patients, then even if you get that down to the expected rate your only talking about 12-13 patients.  And if your sepsis readmission patients were just 25% above expected but you had 400+ of them, typical for a medium sized hospital, it is more like 25-30 patients.  And you probably have much more control over the reasons why they are readmitted than your liver failure patients who often have complex social factors intertwined.  This is the kind of simple data translation that is important but often missing, potentially resulting in wasted resources (energy, focus, and time) and less than optimal clinical results. We witness this way too often.
Over the next few months, we’ll share more examples where Decoding the Data is important.  Next up: how too many measures, and the wrong kind, can actually take you away from your strategic agenda.  Another way to cut through the clutter. 

Cynosure recently participated in Avoid Readmissions Through Collaboration (ARC)'s California Readmissions Summit, Keeping the Pulse on Readmissions

Four hundred participants shared the day on Friday, February 13, 2015 with the Avoid Readmissions through Collaboration (ARC) team, the Health Services Advisory Group of California, and other planning partners to continue learning and sharing their work in care transitions. The theme for the day: Keeping the Pulse on Avoiding Readmissions, was celebrated throughout the keynotes and breakout sessions. Participants left with new ideas about how they can augment their current efforts to make even more impact.As healthcare moves from volume to value organizations need to stay ahead. Participants were challenged to leave behind disease specific targeting strategies and move forward with overall risk based approaches. Medical reimbursement changes will further support a strong focus on this patient population. Additionally, expanding care transitions work in to the ED and behavioral health are two great strategies going forward.
Standing room only breakout sessions included:
  • Community Partners: The Heart of Your Readmission Reduction Program - A shared review of the CMS Community Care Transitions Program (CCTP) California has developed at UCLA in collaboration with Partners in Care Foundation.
  • Best Practices for Managing High Risk Patients – An overview of the Intensive Outpatient Care management programs for patients with multiple medical conditions.
  • Dignity Health's Approach to Reducing Readmissions- An interview sharing the strategies used enterprise wide.
Download presentations at


Cynosure served as a proud sponsor of the 2015 CAHQ Spring Conference, Connecting Across the Continuum.

Cynosure's Pat Teske MHA, RN, Implementation Officer, presented "Avoiding Readmissions Through Collaboration (ARC)". Our Improvement Advisor Kim Werkmeister is also a member of the Board of Directors for the California Association for Healthcare Quality (CAHQ). As the Leadership Development Chair, she is responsible for the planning and development of all educational webinars and conferences for CAHQ including the Spring Conference in an effort to continue keeping quality leaders throughout the state of California up to date.
To download the conference presentations, please click here.
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