Transcript Quality Improvement in the Non-Clinical

Housing
Housing
Authority
Authority
Quality
Improvement in
the Non-Clinical
Community
Employment
Employment
Medical
Medical
Benefits
Benefits
October 15, 2015
Emergency
Emergency
Assistance
Assistance
FoodFood
BankBank
Case Managers Making A Difference
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AGENDA
1. Quality improvement is…….
2. Quality improvement is not……
3. Why do Case Managers do quality improvement activities?
4. What roles do Case Managers play and how does quality
improvement fit into our programs?
5. Deciding what to do!
6. Real World Experiences
7. Open discussion / questions
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What is Quality Improvement?
• More than simply comparing yourself against a national
standard (Quality Assurance)
• Process / systems oriented, not person oriented
• Data driven, not measured by gut reactions!
• Based on activities designed to make specific
improvements
• Involves recurring measuring and assessing and
adjusting…..in other words, it’s CONTINUOUS!
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Quality Improvement is NOT:
• Judgmental – No program is perfect, no program performs at 100% for
every activity
• Critical – No one is belittled chastised because they perform poorly at
any given activity
• Punitive – Programs and staff are not punished if they make attempts
to improve and fail!
Note: The only time you would experience negative feedback or actions from
federal authorities is if you do nothing!! We expect that there will be challenges,
barriers and slip backs, but we MUST show that we are trying something!
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Why Do We Do It?
1. Federal legislative mandates
• Ryan White Care Act
• National HIV/AIDS Strategy
• July 2013 White House Executive Care Continuum Order
2. Creating your RW grant application to HRSA
3. Every support service that is improved, just nudges that patient
a few steps closer to medical engagement
4. It improves the lives of the people we serve.
5. It’s just the right thing to do!
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Continuum of Care and the Cascade
Quantum Leap of Faith!
IF we can diagnose more
people, we can get more
people into care.
IF we engage them in care,
we can retain them in care
IF we retain them, we can
get them routinely on HIV
medications.
IF we can keep them on
HIV medications, we can
lower the amount of virus
in their bodies.
IF we suppress viral loads
we can prevent new
transmissions.
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http://www.cdc.gov/nchhstp/newsroom/2012/Continuum-of-Care-Graphics.html
Where do we see the biggest
drop in this Cascade?
Case Managers,
Social Workers
Medical Case Managers,
Nurse Case Managers
Doctors and Nurse
Practitioners
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Diagnosis
Transportation
Housing
Emergency
Services
Food/Nutrition
services
Mental
Health
Substance
Abuse
Jobs
Engagement
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School &
Education
How Does CQI Fit Into My Position?
Empower
Every
improvement
you make in
your service,
contributes to
the patient’s
ability to become
actively engaged
in their medical
care.
Support
Prepare
Enable
Assess
Readiness
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Let’s think about
how we can help
move patients
from the left side
of the continuum
to the right side!
How Do I Know What To Work On?
Listen to Patients and Staff
Consumer
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Case Manager/Agency
• I had to wait over an hour for my
or
ride home!!
• Patients call for a ride the day
before their appointment!
• I hate green beans and they keep
or
putting them in my meals!
• They just don’t want to eat what’s
good for them!
• I can’t keep the MH
appointments, I have no child
care and no transportation.
• I am constantly trying to get several
of the patients in here…..they just
don’t come!.
or
How Do I Get That Information?
Surveys:
• Satisfaction or Needs Assessment
• Electronic, Paper, Patient Completed,
Peer or Staff Facilitated
• Suggestion Boxes
• Focus Groups
Patient Satisfaction
• With the services
•
•
•
With the facility
With the staff
With their outcomes
Data:
• Chart reviews
• EMR/Database queries
• Trend charts
• Project-specific data collection
Needs Assessment
•
•
•
•
Ancillary services
Access
Health literacy / numeracy
Other support services
OR……Walk thru the service agency in your patient’s shoes. (Fake
appointment/visit/phone call)…. How long did you wait, how were you
treated, did you get what you came for?
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How Do I Decide Which Issue To Choose?
• How many patients will be impacted?
• What will the impact for the patient be?
• Will it cost my agency any money?
• How much staff and time will it take?
• Will I get buy-in from other staff?
• Is it something I am able to measure?
• What are the chances of success?
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ACT: Act on
what you
learned. Do
you need to
tweak your
plan or test it
in on a larger
scale?
STUDY:
Document what
happened and
decide if your
plan produced
the results you
hoped for.
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PLAN:
Brainstorm for a
strategy and
then make the
plan. Decide
who will do
what, when,
where, and
how.
DO: Carry out
your plan in a
sample
population or in
a specific
designated time
slot. Just test it
on a small
scale!
What Does The
Improvement Process
Look Like?
First ID a problem,
then just PDSA it!
Example of the “PDSA” Process
PROBLEM: Patients
are provided five
healthy, frozen meals
at the food bank each
week to take home.
However, patients do
not make healthy
eating choices outside
of those meals.
GOAL: Ninety percent
of all registered HIV+
food bank recipients
will have a quarterly
nutrition consult.
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ACT: Did everyone or
most everyone stay for
their consult? If so,
expand and continue
to monitor. If not, ID
the reason and
readjust the Plan. Start
the cycle again!
STUDY: Document
the number of
patients staying for
their scheduled
consult. Was it
what you
anticipated? Check
with nutritionist for
any challenges on
her part.
PLAN: Assure that
each patient has a
meeting with the food
bank nutritionist at
least quarterly to
assess weight &
reinforce good food
choices.
DO: For one week,
each time a patient
signs in to pick up
meals, check their
most recent chat
with the nutritionist.
Alert patient if they
need to stay for a
nutrition consult at
next week’s pick up.
Did I Make A Difference?
• What was the OUTPUT? This measures what your activity
produced: How many patients had a quarterly visit with the
food bank nutritionist?
• What was the OUTCOME? This is result of your outputs:
What percentage of patients now enjoy an appropriate body
weight?
• What was the IMPACT? This is a long term change and will be
harder to measure and assess: Are patients reporting that they
feel better or healthier? Are they better prepared to maintain
their HIV treatment protocols or participate in school or hold
a job? Have better eating habits impacted other aspects of their
lives?
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When Does It End?
Hint: CQI is a “continuous” process and does
not have an “end”!
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I have reached my goal, what next?
 Decide if there is still room for more improvement and
goal should be reset higher.
 Decide if another project might now have higher priority
 Maintain measurements….possibly less frequently, to
make sure you don’t slide backwards and your gains are
maintained!
 Every attained goal deserves a celebration!
Real World Experiences!
Let’s listen to the experiences of our fellow grantees!
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Vulnerability Index for
Housing
A QI collaborative among Ryan White and Supportive
Housing Services
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How it all began…
Problem:
• Tension over how housing voucher openings were filled
• Some clients had a higher need; waited longer
• Sense of the current system being “not fair”
Plan:
• Devise a new selection process for voucher openings
• Assemble a team (Housing agency representatives; Quality Manager;
Medical Case Managers)
• Examine current approach
Our Plan Stage led to…
• Examining a number of assessment tools
• Using these resources as models
• Developing our own assessment and naming it Vulnerability Index
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Testing the Theory
The “Do” stage:
• Develop the assessment electronically in the database
• Provide introduction and training
• Launch pilot program
Checking the Results
• Expanded use of index to a second agency
• Extending the length of the pilot program due to a low
number of housing openings
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Potential Future Uses
Measuring Performance
• Getting feedback from those who use the index
• Analyzing the efficiency of the process
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Multnomah County
Health Department
Portland OR TGA
HIV Care Services Program
Margy Robinson,
HIV Care Services Manager
Marisa McLaughlin,
Quality Improvement Specialist
Line of Sight
• A QI Plan where providers use, “So that”….to understand
the continuum from social service support to medical care.
Three providers/agencies focus on different social
service/support needs: housing, food, community building.
• Grantee provides the QI training, providers choose and
implement two projects relevant to the population they
serve. Grantee monitors progress and assists with challenges.
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Food
• Goal – Home delivery of meals to patients unable to
leave home.
• Feed the people who are injured or too sick to
otherwise secure food.
• Use food delivery as a way to check on patients and
report back any obvious issues.
• Track the patients receiving food and see if they
have had a recent medical visit.
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Housing
• Goal – Move more people from transitional RW
supported housing, to patient-supported stable
housing.
• Component 1 – Develop an “income sustainability
plan” that evaluates patient income, employment
potential.
• Component 2 – Develop and Acuity Scale that
would standard the priority process across all case
managers. Who needs what the most?
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Building Community
• Goal – Engage more patients in group activities to
promote peer support.
• Bring patients into group activities by offering
topics of interest (holistic health, Raki, crafting).
• Build a safe place for patients to interact, and
develop trust.
• Hypothesis: Confident, empowered patients will
engage more fully in medical care.
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Lesson of the Day:
The ultimate outcome,
Viral Load Suppression,
is a TEAM effort. Case
Managers are the initial
impetus and provide the
potential for the
healthiest of outcomes.
Any improvement made
by a Case Manager is an
improvement in a
patient’s life.
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Questions later?
Jane Caruso, NQC Consultant
[email protected]
Kevin Garrett, NQC Senior Manager [email protected]
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Recording Link
To hear the recording of this webinar, please go to:
https://meetny.webex.com/meetny/lsr.php?RCID=7
0269e1c25e143ae903f969bbcd48ba2
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