As the hospital services director for One Legacy for the past years, Karen Libs has been involved in the Collaborative since its inception. She credits One Legacy's partnerships with donor hospitals as the key to its success.

"What we've learned the most from the national Breakthrough Collaborative is when you bring all these hospitals together, they share their stories, their challenges and successes. They learn from each other and go away from meetings with a 'can do' attitude."

Getting to this point did not come without strategic planning as One Legacy is one of the country's largest OPOs serving 18 million people in seven Southern California counties; 224 hospitals and 14 transplant centers. "We found the link to success in vigorously building on our spread strategy by getting the hospitals on board and engaged in the Collaborative," says Libs.

By targeting hospitals with a donor potential of six or greater, a total of 32 hospitals, Libs' department realized they could hold learning sessions mirroring those on the national level. "We took the national model and localized it," says Libs. Starting in November 2004, One Legacy held its first local learning session in Los Angeles and invited all the OPOs on the west coast to participate and kick off the initiative. More than 150 attended.

Libs also added a unique component of urging hospitals to attend the learning session by partnering with the local CMS representative and the hospital association. "For the initial local learning session in November, we asked CMS and the hospital association to send out 'power letters' encouraging the hospitals to participate. Libs suggests that OPOs partner with their local CMS representative and hospital association on the spread strategy. "It works and has proven to work, these organizations are a great driving force."

In addition to One Legacy's second learning session in January, they recently held a third in June awarding 18 local hospitals for their efforts in achieving 50, 60 or 75 percent conversion rates. This was out of the 32 hospitals One Legacy first engaged the spread strategy. Libs states, "The Collaborative encourages hospitals to create their own strategy for implementing best practices. That's what you want, for the hospital to drive the process and not the OPO. The OPO should be a resource to the hospital, not the driving force."

The results:

• A 28 percent increase in hospitals that perform at the 50 percent conversion rate; 24 percent increase in those performing at a 65 percent rate and 17 percent are at 75 percent!
• Continual increase in the past three years in the number of donors; first half of this year alone, a 14 percent increase in donors recovered compared to 2004.
• Bottom line: more lives saved.

Libs also notes that more hospitals are understanding and accepting the donation process. "Hospitals come to us and say 'we want to do this'. They have taken ownership of the organ donation process at their hospitals." Libs also credits HRSA for bringing in outside organizations to help the initiative. "By involving organizations such as CMS JCAHO, AHA to support the Collaborative as a resource, we're able to tack into these outside agencies unlike we have never before. It is truly one of the best things HRSA has done for the donation process and the industry."

Suggestions for other OPOs:

• Connect with other hospitals and keep them informed.
• Organize an annual meeting to bring targeted hospitals together and let the hospitals interact and hear what each other is doing.
• That is the key. It's truly an all-teach; all-learn atmosphere.

As One Legacy continues the Collaborative's initiatives, Libs points out that the goal to get across to hospitals, aside from the compliance and conversion rates, is the number of lives saved. "Our common goal is to save lives and help donor families. If we keep it the forefront, we can reach those conversion rates. In the end it really means more lives saved."