Transcript of QUALITY AND OUTCOMES: MEASUREMENT, TRACKING, AND REPORTING.
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- QUALITY AND OUTCOMES: MEASUREMENT, TRACKING, AND REPORTING
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- 2 Quality Outcomes Data Quality Improvement Performance Quality
Assurance QAPI Improvement
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- Introduction to QAPI 3
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- Quality Assurance Meeting quality standards Assuring that care
reaches an acceptable level A reactive, retrospective effort WHAT
IS QAPI? 4 Performance Improvement A pro-active and continuous
study of processes The intent to prevent or decrease the likelihood
of problems By identifying areas of opportunity and testing new
approaches to fix underlying causes of persistent/ systemic
problems
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- QAPI 5 QUALITY ASSURANCE PERFORMANCE IMPROVEMENT Motivation
Measuring compliance with standards Continuously improving
processes to meet standards Means InspectionPrevention Attitude
Required, reactiveChosen, proactive Focus Outliers: bad apples
Individuals Processes, systems Scope ProviderResident care
Responsibility FewAll
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- THE FEDERAL GOVERNMENT CARES 6
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- Section 6102(c) of the Affordable Care Act Nursing homes
Requires CMS to establish regulations in Quality Assurance and
Performance Improvement (QAPI) Requires CMS to provide technical
assistance to help them develop best practices to comply with the
forthcoming regulations HEALTH CARE REFORM 7
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- Not just for nursing homes Our industry is growing up Solve
quality problems Prevent recurrence Achieve new goals Fulfillment
for caregivers Better care and quality of life WHY IS QAPI
IMPORTANT? 8
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- Major investors, particularly REITs care about quality Health
Care REIT HCP LTC Properties INVESTORS CARE 9
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- Using data to not only identify your quality problems, but to
also identify other opportunities for improvement, and then setting
priorities for action Building on residents own goals for health,
quality of life, and daily activities Bringing meaningful resident
and family voices into setting goals and evaluating progress
Incorporating caregivers broadly in a shared QAPI mission FEATURES
OF QAPI 10
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- Developing Performance Improvement Project (PIP) teams with
specific charters Performing a Root Cause Analysis to get to the
heart of the reason for a problem Undertaking systemic change to
eliminate problems at the source Developing a feedback and
monitoring system to sustain continuous improvement FEATURES OF
QAPI 11
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- Group Project! Whispering Pines has had a problem with staff
turnover. The administrator, Mary, feels like she just cant seem to
keep good staff. But she wanted to see how she measures up to the
rest of the industry as well as other communities in her area. So
Mary started tracking turnover on a monthly basis. CASE STUDY
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- Group Project! 13
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- Group Project! How could tracking turnover help reduce it? What
factors should be considered when preparing to track turnover? Who
should the data be shared with? CASE STUDY 14
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- NCAL QUALITY INITIATIVE 15
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- NCAL QUALITY INITIATIVE 16
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- Five Elements of QAPI 17
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- FIVE ELEMENTS OF QAPI 18
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- Must be ongoing and comprehensive Deal with the full range of
services offered by the community, including the full range of
departments Should address all systems of care and management
practices, and should always include care, quality of life, and
resident choice. Utilize the best available evidence to define and
measure goals 1: DESIGN AND SCOPE 19
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- Administration develops a culture that involves leadership
seeking input from community staff, residents, and their families
and/or representatives Assure adequate resources exist to conduct
QAPI efforts Develop policies to sustain QAPI despite changes in
personnel and turnover Ensure staff accountability, while creating
an atmosphere where staff are comfortable identifying and reporting
quality problems as well as opportunities for improvement 2:
GOVERNANCE AND LEADERSHIP 20
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- Put in place systems to monitor care and services, drawing data
from multiple sources Actively incorporate input from staff,
residents, families, and others as appropriate Includes using
Performance Indicators Includes tracking, investigating, and
monitoring Adverse Events 3: FEEDBACK, DATA SYSTEMS, AND MONITORING
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- A concentrated effort on a particular problem in one area of
the community or community wide Gathering information
systematically to clarify issues or problems, and intervening for
improvements Examine and improve care or services in areas that the
community identifies as needing attention 4: PERFORMANCE
IMPROVEMENT PROJECTS 22
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- Use a systematic approach to determine when in- depth analysis
is needed to fully understand the problem, its causes, and
implications of a change Root Cause Analysis Includes a focus on
continual learning and continuous improvement 5: SYSTEMATIC
ANALYSIS AND ACTION 23
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- Group Project! Off-label use of antipsychotics Reduce by 15%
Decreases side affects and adverse drug reactions Used as a weapon
by trial attorneys Improved resident and family satisfaction QAPI
IN ACTION 24
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- Group Project! QAPI IN ACTION 25
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- Action Steps 26
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 27 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 28 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 29 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 30 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 31 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 32 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 33 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 34 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 35 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 36 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 37 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- 1. Leadership 2. Teamwork 3. Self-Assessment 4. Guiding
Principles 5. Develop Your Plan 6. Awareness Campaign 7. Data
Collection Strategy ACTION STEPS 38 8. Gaps and Opportunities 9.
Prioritize 10. PIPs 11. Get to the Root of the Problem 12. Take
Systemic Action
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- Leadership Responsibility and Accountability 39
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- Create a culture to support QAPI Develop a steering committee
Provide resources Set the tone LEADERSHIP RESPONSIBILITY 40
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- It starts with leadership Support from the top is essential
Foster participation from every member of the team, including all
caregivers CREATING A CULTURE TO SUPPORT QAPI 41
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- Group Project! Discuss in small groups Identify 5 potential
barriers to a culture that is supportive of QAPI and 2-3 ways to
overcome those barriers Be prepared to share at least one
barrier/solutions with the group CREATING THE CULTURE 42
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- A team that provides QAPI leadership Overall responsibility to
develop and modify the play, review information, and set priorities
Involve clinical expertise, when possible Who would be on your
steering committee? DEVELOP A STEERING COMMITTEE 43
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- Caregivers will need time to attend team meetings during work
hours Equipment (computers, poster supplies, resource books, etc.)
Specialized training PROVIDE RESOURCES 44
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- Open door policy Staff feel they can bring quality concerns
forward without fear of punishment Create expectations Everyone
should feel free to speak up Expect and build effective team work
OPEN COMMUNICATION AND RESPECT 45
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- A Deliberate Approach to Teamwork 46
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- Having a clear purpose Having defined roles for each team
member to play Having commitment to active engagement from each
member CHARACTERISTICS OF AN EFFECTIVE TEAM 47
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- Caregivers Administration/leadership Outside vendors (pharmacy,
home health, etc.) Family members (watch for confidentiality issues
TEAMS SHOULD BE INTERDISCIPLINARY 48
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- Self-Assessment 49
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- Group Project! SELF-ASSESSMENT 50
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- Guiding Principles 51
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 52
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 53
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 54
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 55
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- QAPI has a prominent role in our management and Board
functions, on par with monitoring reimbursement and maximizing
revenue. Our organization uses quality assurance and performance
improvement to make decisions and guide our day-to-day operations.
The outcome of QAPI in our organization is the quality of care and
the quality of life of our residents. In our organization, QAPI
includes all employees, all departments and all services provided.
EXAMPLES 56
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 57
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- Step 1: Locate or develop vision statement Step 2: Locate or
develop mission statement Step 3: Develop a purpose statement for
QAPI Step 4: Establish Guiding Principles Step 5: Define the scope
of QAPI Step 6: Assemble document DEVELOP PURPOSE, GUIDING
PRINCIPLES, AND SCOPE 58
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- Develop Your QAPI Plan 59
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- Group Project! Break into groups Each group will be assigned to
complete one section of the QAPI plan from the handout provided Be
prepared to share with the group DEVELOP YOUR QAPI PLAN 60
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- QAPI Awareness Campaign 61
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- Let them know often and in multiple ways Plan ongoing education
Provide training in small chunks QAPI is about systems Everyone is
expected to raise concerns Discuss the hard questions (e.g., safety
vs. autonomy) COMMUNICATE WITH ALL CAREGIVERS 62
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- Their views are sought, valued, and considered Ask them to tell
you about quality concerns Open-door policy Suggestion box
Resident/family surveys COMMUNICATE WITH RESIDENTS AND FAMILY
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- Collecting and Using Data 64
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- Falls Off-label use of antipsychotics Clinical care (pressure
ulcers, narcotics, etc.) Hospitalization rates Re-hospitalization
rates Resident satisfaction Employee satisfaction State survey
results and deficiencies Business processes (financial, turnover,
call outs, etc) AREAS TO CONSIDER 65
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- Data collection should be systemic, community- wide, big
picture Keep it simple! Monthly, quarterly, annually Incidence vs.
prevalence Per 1000 resident days is a common standard (# of
residents X # of days) HOW TO COLLECT DATA 66
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- Limited national assisted living data available Internal
benchmarks are often the best BENCHMARKS 67
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- GOAL SETTING 68
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- Gaps and Opportunities 69
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- Potential areas to consider when reviewing your data: Survey
results and plans of correction Resident service plans for
documented progress towards specified goals Trends in complaints
Resident and family satisfaction for trends Patterns of caregiver
turnover or absences Patterns of ER and/or hospital use IDENTIFY
GAPS AND OPPORTUNITIES 70
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- Problems vs. opportunities Choose issues that you consider
important Consider which ones to make the focus of a PIP PRIORITIZE
OPPORTUNITIES 71
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- A PIP project typically is a concentrated effort on a
particular problem in one area of the community or community wide
It involves gathering information systematically to clarify issues
or problems, and intervening for improvements PIPs are selected in
areas important and meaningful for the specific type and scope of
services unique to each community PERFORMANCE IMPROVEMENT PROJECT
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- PLAN, CONDUCT, AND DOCUMENT PIPs 73
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- Root Cause Analysis 74
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- A term used to describe a systematic process for identifying
contributing causal factors that underlie variations in performance
Structured Designed to get to the underlying cause of a problem
which then leads to identification of effective interventions that
can be implemented in order to make improvements Focuses primarily
on systems and processes, not individual performance ROOT CAUSE
ANALYSIS 75
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- Take Systemic Action 76
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- Depend on staff to remember their training or what is written
in the policy Weak actions enhance or enforce existing processes
WEAK ACTIONS 77
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- Double checks Warnings/labels New policies/procedures/memoranda
Training/education Additional study WEAK ACTIONS - EXAMPLES 78
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- Actions are somewhat dependent on staff remembering to do the
right thing But they provide tools to help staff to remember or to
promote clear communication Intermediate actions modify existing
processes INTERMEDIATE ACTIONS 79
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- Decrease workload Software enhancements/modifications
Eliminate/reduce distraction Checklists/cognitive
aids/triggers/prompts Eliminate look alike and sound alike Read
back Enhanced documentation/communication Build in redundancy
INTERMEDIATE ACTIONS - EXAMPLES 80
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- Actions that do not depend on staff to remember to do the right
thing May not totally eliminate the vulnerability but provides
strong controls Change or re-design the process Help detect and
warn so there is an opportunity to correct before the error reaches
the resident May involve hard stops which wont allow the process to
continue unless something is corrected or gives the chance to
intervene to prevent significant harm STRONG ACTIONS 81
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- Physical changes: grab bars, non slip strips on tubs/showers
Forcing functions or constraints: design of gas lines so that only
oxygen can be connected to oxygen lines; electronic medical records
cannot continue charting unless all fields are filled in
Simplifying: unit dose STRONG ACTIONS - EXAMPLES 82
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- Group Project! Hospital readmissions Reduce by 15% Decreases
unnecessary hospitalizations Improve relationship with hospitals
Improve resident retention QAPI IN ACTION 83
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- ANY QUESTIONS 84