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Engaging Front Line Staff in QI - chad.memberclicks.net Quality Improve… · •Set your data...
Transcript of Engaging Front Line Staff in QI - chad.memberclicks.net Quality Improve… · •Set your data...
*All documents are property of CURIS Consulting. Do not duplicate or distribute without written permission.
Changing-Creating-Connecting-Coordinating
Engaging Front Line Staff in QIPrepared by: Shannon Nielson, MHA, PCMH-CCE
Prepared for: CHAD
2.12.19
*All documents are property of CURIS Consulting. Do not duplicate or distribute
without written permission.
www.curis-consulting.com
Meet the Team
Brittany MarkusEngagement
Manager
Shannon Nielson
MHA, PCMH-CCE
Principal Consultant
Jennifer Calohan
RN, TQMP, PCMH-CCE
Principal Consultant
CURIS consultants bring several decades of
experience in the Health Center, PCA/HCCN, and
healthcare industry and provide the expertise
needed to help create clinical, operational and
financial excellence.
• HRSA/FTCA Compliance
• PCMH Recognition/Transformation
• Practice Performance and Operations
• Data Analysis and HIT/HIS Optimization
• Quality Improvement and LEAN-Six
Sigma
• Program Development and
Implementation
• Clinical Integration
• Strategic Organizational Leadership
• Clinical Workflow
• Risk Management
• HCCN/PCA Optimization
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without written permission.
QI01: (CORE): PLAN
A.1 IZ Measure: ______________
B. 1 Prev. Care Measure: ______
C.1 Chronic/Acute Measure:___
D.1 BH Measure:________
QI02: (CORE): PLAN
A.1 Care Coordination Measure:
______________
B. 1 Cost Measure: ______
QI04: (CORE): PLANA. Patient Satisfaction Survey Including (min
3):
A. Access Y N
B. Communication Y N
C. Coordination Y N
D. Whole Person Care Y N
B. Qualitative Feedback (Non-Survey)
Y N
QI03: (CORE): PLAN
Appointment Availability Report
Y N
QI05: (1 CREDIT): PLAN
A.Clinical Quality Disparity (min 1):
______________
B. Pt. Experience Disparity (min. 1):
______
QI108: (CORE): DO
SET GOALS TO ACT TO IMPROVE (min. 3 from
QI01 across 3 diff. categories
A. IZ GOAL: Y N: PDSA: Y N
B. Preventive: Y N: PDSA: Y N
C. Chronic/Acute: Y N: PDSA: Y N
D. BH: Y N: PDSA: Y N
QI109: (CORE): DO
SET GOALS AND ACT TO IMPROVE (Min. 1 from QI02)
Set Goal for: QI02-A QI02-B
PDSA for above: Y N
QI11: (CORE): DO
SET GOALS AND ACT TO IMPROVE (Min. 1 from QI04)
Patient Experience Measure Goal: _______
PDSA from above? Y N
QI109: (CORE): DO
SET GOALS AND ACT TO IMPROVE
Goal for QI03:__________
PDSA for QI03: Y N
QI13: (1 Credit): DOSET GOALS AND ACT TO IMPROVE (Min. 1 from
QI05)
Goal for QI05:__________
PDSA for above: Y N
QI12: (2 Credits): STUDY/ACTAchieved Performance (min. 2
from QI 08, 09, 11)
Demonstrated Improvement
Measure 1 (QI 08, 09, 11):
______________________
%Improved for Measure 1:
__________________________
Demonstrated Improvement
Measure 2 (CI 08. 09, 11):
______________________
% Improved for Measure 2:
___________________________
QI14 (2 Credits): STUDY/ACT
Demonstrated Improvement on Measure
from QI13: __________________
% Improved: _________________________
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without written permission.
FMEA Tool – Failure Mode & Effects AnalysisWhat is the process to be examined? QI PROGRAM DESIGN/STRUCTURE
Interventions
to Mitigate
Failure
Current
Process
Anticipated
Failures
What PDSA will you do?
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Improve = Do• The Plan-Do-Study-Act (PDSA) cycle is part
of the Institute for Healthcare Improvement(IHI) Model for Improvement
• Simple yet powerful tool for
accelerating improvement
• *By using the PDSA cycle to
incrementally test change in an
effort to improve, we are able to
apply pragmatic steps of Process
Improvement toward reaching the
strategic level goalshttps://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle
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Key PCMH Criteria
CRITERIA DESCRIPTION Data
Methodology
How to Use Annual Reporting
PCMH?
Alignment
TC07: Staff
Involvement in QI
The documented process
for quality improvement
activities includes a
description of staff roles
and staff involvement in
the performance
evaluation and
improvement process.
PDSA Tracking Staff/Provider
Engagement
In alignment with
monthly staff quality
dashboard
NO HRSA QI
Plan/Program
KM06: Predominant
Conditions and
Concerns
The practice identifies its
patients’ most prevalent
and important conditions
and concerns, through
analysis of diagnosis
codes or problem lists.
UDS Table 6A (if
can run by site)
Billing system;
encounters by
dx and CPT
code
Selection of relevant
interventions to
address clinical
needs
Selection of
community
resources/specialists
NO UDS: Table 6A,
Table 5
Community
Needs Assessment
KM07: Social
Determinant of HealthThe practice collect,
monitors and implements
interventions relative to
SDoH.
UDS
Patient
reporting/Staff
assessment
Community
Resource need
development
Staff Training
NO
KM20: Clinical
Decision Support
The practice has
adopted min. 4
electronic clinical
decision support
mechanisms. This will
insure efficiencies and
standardization of care
EMR
Quarterly
provider/nurse
documentation
auditing
Standardization of
care and create
efficiencies during
patient visit
NO Meaningful Use
KM27: Community
Resource Assessment
Do patients utilize
community resources
they are referred to? Are
they satisfied and do they
work for them?
Patient
Interview
Efficacy of
community
resources;
community building
NO
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Key PCMH Criteria
CRITERIA DESCRIPTION Data
Methodology
How to Use Annual Reporting
PCMH?
Alignment
AC11: Patient Visits
with Care Team
Are patients able
to/willing to see currently
designated PCP?
EMR Access. Determine
opportunities for continuity.
In alignment with other
access measures: is access
issue: Scheduling, capacity
or process?
NO
AC13: Panel size
Review and
Management
Have you calculated
realistic panel sizes due to
supply and demand?
EMR Determine utilization based
productivity and capacity.
Measure Actual panel size
vs. Right panel size
NO
CC07: Performance
Information for
Specialists
What are the clinical
outcomes for patients you
share with certain
specialists?
EMR Measure performance and
opportunities for alignment
with specialists based on
shared patient clinical
outcomes
NO
CC14: Identify
unplanned
hospital/ED visits
Who are our patients that
are accessing the
hospital/ED. Is there
appropriate utilization?
EMR/i2i Reduce # inappropriate
utilizersYES
Q01: Clinical Quality
Measures
Monitor and act to
improve 5 clinical
measures
EMR/i2i Improve quality YES Meaningful Use,
UDS, HEDIS
QI02: Resource Use
and Stewardship
Monitor and act to
improve on 2 CC or Cost
measures
EMR/i2i Improve quality YES Meaningful Use,
UDS, HEDIS
QI03: Appointment
Availability
Assessment
Determine if appointment
availability meets the
demand of your patient
population
3NA Report Improve access YES
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What we know…
PCMH
UDS
FTCA
Pt. Satisfaction
Surveys
HIE
ACO/APM
EMR
Meaningful Use
HEDIS
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What they hear…
PCMH
UDS
FTCA
Pt. Satisfaction
Surveys
HIE
ACO/APM
EMR
Meaningful Use
HEDIS
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Meaningful Quality
Efficiency Effectiveness Quality
Quality Impact Value
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Patient Staff Engagement
• Importance
• Confidence
• Readiness
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Foundations for Engagement in Quality• Importance
• Purpose
• Data
• Confidence• Ownership
• Data
• Reward and Recognition
• Readiness• Responsibility
• Data
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First Things First…Importance
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We have to do it for UDS…
Reason• We have to do it for UDS
Purpose• Improved documentation gives
us a better understanding of our opportunity to improve quality
• Where should we focus based on how patients utilize us
• We can identify a focused opportunity for growth/access
• Alignment with PCMH and HEDIS
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We have to do it for PCMH
Reason• For PCMH we need to huddle
• We need to pick a CM population and you have to document goals
• We need to complete PDSAs to show CQI
Purpose• Improved communication and pre-
visit planning should create efficiencies, improve pt. experience and maximize your skill set
• There is a population that is more at risk and we can provide ongoing care management support to mitigate the risk and reduce risk
• Where is there an opportunity to improve and how do you think we can do it?
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We have to do…. We need you to…
• By doing X we can improve Y
Yes, it’s that simple
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Importance: Systems Level DataLeadership/Governance
MoneyMission
Mid-level ManagementMoney
Staff SatisfactionEfficiency
Front Line StaffPatient Satisfaction
QualityEfficiency
PatientsQualitySafetyCost
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Data Usability
• Actionable• Lists
• Contact Information
• Population Based
• Team Relevant
• Realistic Measurable Outcomes• Process vs. Outcome
• Consistent
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Data Visibility
• PLAN without data is a Wish
• DO without data is Simon Says
• STUDY without data is Water Cooler Gossip
• ACT without data is Groundhog’s Day
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Systems Level Data Sharing
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Confidence
• Ownership
• Data
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Confidence: Ownership
• Responsibility vs. Duties• Responsible
• Accountable
• Informed
• Consulted
• Innovation vs. Direction• Quality Teams
• Staff PI teams
• Failure is Fabulous
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Confidence: Data
• Test informed data
• Can you really improve A1Cs in 2 weeks
• Qualitative Data
• Patient Feedback
• Staff feedback
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Confidence: Reward and Recognition
• Reward Money• Presentation
• Announcements
• Creative incentives
• Competition Drives Engagement• Transparent Data
• Aligned Goals
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Readiness: Responsibility
• Scope of Licensure• Team Based Care
• Role purpose
• Expected Outcomes
• Purposeful Process• Skill vs. Availability
• Communication and Access
• Expected Outcome
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Readiness: Data
• Data Rules:• Platinum Rule: How will the data be used
• Golden Rule: How are the elements defined
• Silver Rule: When should you see the data change?
• Data Process:• Set your data strategy
• Define your staff engagement needs with your data strategy
• Validate and create your data
• Provide meaningful, actionable, baseline data
• Provide ongoing demonstrative, reactive data
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Employee Satisfaction vs. Employee Engagement
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Employee Engagement Surveys
• My roles and responsibilities are clearly defined
• My daily activities match my job description
• My skills/licensure/experience is used in my daily activities
• Most of the systems and processes here support us getting our work done effectively and efficiently
• I am given the opportunity to contribute my ideas and opinions on how we can improve
• I am given the opportunity to contribute my ideas and opinions on how we can improve
• Day to day decisions demonstrate that quality and improvement are top priorities
• Our organization promotes non-management employee participation in projects and committees
• What resources, tools or systems are needed to better help you do your job?
• What activities/committees/projects would you like to be involved in or see other staff members involved in?
• What would you like to most see improved upon in the organization that would result in enhanced engagement and satisfaction? (Examples include: EMR optimization, job clarification, communication, team building...)
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Motivational interviewing for you
•O: Open ended questions
•A: Affirmations
•R: Reflective listening
•S: Summarize
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PCMH: It’s not a 4 letter word
Team Based Care
Knowing and Managing your
Patients
Patient Centered Access and Continuity
Care Management and Support
Performance Management and
Quality Improvement
Care Coordination
and Transitions
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Putting Quality into Action
Access is the
opportunity
for care
Quality is the opportunity
for cost
Cost is impacted
by
“appropriateness”
of access
Appropriate
access is driven by
your population’s
care needs
Care needsdrive a
Provider’s adoption of
quality
Adoption of quality
drives your
population health
management
activities
PCMH activities drive
the ability to improve
access beyond your
patients
Spreading your value beyond your patients is VALUE BASED
CARE
Care is the
opportunity
for quality
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UDS and PCMH
• PCMH: A Set of Population Health Management strategies that should result in improved outcomes, decreased cost and improved experience
• UDS: A data set and reporting strategy that should provide information to impact the health of the population you serve
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How to use UDS for PCMH
• Team Based Care:• No Direct Alignment, BUT…..
• Do we have the appropriate people on the care teams to address the needs identified in Tables 3A, 4, 6A, B, Table 7?
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How to use UDS for PCMH
• Knowing and Managing your Population• KM01/KM06: Use Table 6A; identify your top DX for KM06• KM07: Does Table 3, 4 or 7 indicate SDOH? Does Table 5 or Table
6A illustrate appropriate interventions?• KM09, KM10, KM11: Does Table 3B indicate need for other
languages? Does it indicate need for cultural competency or sensitivity training?
• KM13: Are you a HC Quality Leader?• KM20: (Indirect) have you implemented decision support for
primary diagnosis in 6A? Do you see an impact on Table 5A, Table 6B or 7?
• KM21: Does Table 3A&B demonstrate need for community resources?
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How to use UDS for PCMH
• Patient Centered Access and Continuity
• AC03: (Do not make extended hours at a site that is far from majority of population—Table 3A)
• AC09: Can you identify trends in utilization by disparities? Table 6A stratified
• AC13: (indirect) does Table 5A align with your panel sizes? Are there provider outliers?
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How to use UDS for PCMH
• Care Management and Support• CM01: Does table 6A
indicate overutilization? Does table 6B or 7 indicate a quality of care need? Does table 4 indicate SDOH?
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How to use UDS for PCMH
• Care Coordination and Care Transitions• CC10: (Indirect) Use table 5 and Table 6A to identify “shared”
patients and create your integration plan
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How to use UDS for PCMH
• Performance Measurement and Quality Improvement• QI01: Don’t just pick the UDS measures because you have
them—use them if they mean something!• QI02: Is your Depression F/U plan a referral to BH? (Table 6B) Use
Table 6A to identify utilization opportunities • QI03: (Indirect) when monitoring patient retention, do you see
similar data in your appt. availability and utilization?• QI08-09, 13-14: Trend your UDS data year to year- OR MORE
OFTEN (6A,6B and 7)• QI15: Do you share your UDS data with your practice (will still
need Pt. Experience data)• QI16: UDS Mapper or UDS Roll up report