Transcript Quality Measurements and Data Reporting

Quality/Performance Improvement
Fundamentals
Making Progress – Skill Building Session
July 24, 2013
Pat Teske, RN,MHA
[email protected]
(661)755-5317
Agenda for Today
• Today
• Discussing common barriers
• Plan how to overcome these barriers
• Describe next webinar
Making progress but…
We still have a way to
go
Raise your hand and chat
Let’s try it
Please don’t put
us on hold
HEN Topics
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ADE
CAUTI
CLABSI
EED
Falls with Injury
HAPUs
OB Adverse events
Readmisions
VAE
VTE
SSI
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Top 10 Improvements
Skill Building Exercise
#10 – Trace the process
• To understand a barrier
trace the actual process
• Find out why it isn’t
working they way you
intended it to
– Observe
– Ask
– Review
Examples
– Barrier staff expect someone else to complete the check
list
– What percentage of the time does the staff member complete the
check list?
– Why do staff members think someone else will fill it out?
– Were staff using the check list involved with testing it?
– What happens when you observe someone filling it out?
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#9 Design to make things easy
• Barriers often come up
when something is too
complicated
• Make the right thing to
do the easy thing to do
or in other words make
it easy to do what is
right
Example
 Follow through on fall prevention
Are there more steps in the process than there
needs to be?
Are the fall prevention items easily accessible?
Is there a process to remove items once pt is
discharged?
Not writing on the white boards
Not enough pens
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#8 Be as clear as possible
• Barriers are sometimes
caused because there is
not a clear procedure or
instructions on how to
follow the process
Example
Falls risk assessment is not being completed
How are staff instructed on the assessment?
What are the specific barriers to completing it?
Is there a written procedure?
Is it clear?
Medication reconciliation is not performed well
These same questions apply?
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#7 Get into the weeds
• It is not enough to say
the barrier is noncompliance we need to
understand why?
Example
• Resistance to change
– What is the change?
– Were staff involved in testing the change?
– Is there a champion?
– What is causing the resistance?
• Patient non-compliance
– Why isn’t the patient taking their medications
once they are discharged?
# 6 Involve patients
Are there opportunities to
involve patients and their
families?
Ask the pt directly:
• What prevented you
from staying out of the
hospital?
• Why do you think you
fell today?
Example
Patient/resident does not have direct input
– Is there a system to obtain pt/family input?
– If input is obtained is it in a place that other care
givers have access to it?
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#5 Dig deeper
• If you think your barrier
is “lack of buy-in” dig
deeper
Example
• Staff Buy-In for consistent use of waiting area
rounding
– Digging deeper it was determined that there was a
perception by the staff that they were unsafe
• Pens not available
– Digging deeper it was determined the unit
coordinator was concerned about spending
money on the unit
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# 5 Simplify
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Understandable
Not too busy
Easy to follow
Balance the need for
specificity with the
benefit of simplicity
Example
• VTE order set
– Can orders be simplified to two or three bucket
approach
• EMR
– Carefully examine key strokes
– Reduce the number of clicks
– Allergy update example
# 4 Design actions to get results
• Think about:
– What can I test now!
– What needs more time
to accomplish
– Focus on actions that
you can test quickly
Example
Barrier
• Staff do not get recognition
when they involve the pt in
managing pain and utilizing
the pt communication
board
Action
• Pass out ‘special” dry eraser
pens to those compliant
staff
• On unit visit and recognition
from CNO and/or CEO
#3 Try multiple ideas
• Is there more than one
idea you can test?
Example
Barrier
• Keeping all staff engaged in
the provision of the
enhanced AM care to
embed and hard-wire this
service hospital-wide
Actions
• Identify AM care Champions on
each unit, to model and drive the
delivery of this service
• Reward and recognize staff
members who embrace the
enhanced AM care service
• Post the HCAHPS OVERALL Rating
scores and positive comments
from patients of each unit to
show their success
#2 Look for bright spots
• Look for things that are
working well and are
highly reliable in your
facility?
• What qualities do they
have?
• How can you replicate
these qualities?
Examples
Barriers
• TBU
• Lack of resources and time
to monitor the patients’
perception of this enhanced
service
Action
• What’s working
• Make a schedule and
sample
• Build monitoring into daily
work flow
#1 Take action
• You will not get over,
under, around or
through barriers by
looking at them
• You need to do
something differently
• The more ideas you test
the more likely you are
to hit on a good one
When Getty was asked
how he became such a
successful oil man he said,
“I drilled more holes”.
Now what?
• Work with your Network Facilitators
– Continue your team efforts
– Look for barriers and ask why?
– Test ideas to overcome barriers
– Keep at it
• Participate in the next webinar
– TUESDAY, July 30th 10:30 -11:30
Testing, spreading & implementing webinar
• Date – TUESDAY 7/30/13
• Time – 10:30 – 11:30
• Topics Covered
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Knowing when testing is necessary
Knowing when to spread
Knowing when to implement
Building a sustainability plan
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Testing, spreading & implementing –
Skill Building
• Skill building due to NF by 8/7/13
• Develop a sustainability plan – Send to network
facilitator
• Skill building post webinar call 8/14/13, 10:3011:30
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Any more questions?