Presentation Transcript

1. Advancing Excellence in Nursing HomesMaking Nursing Homes Great Places to Live, Visit and Work

   Chris Condeelis Senior Director of Quality American Health Care Association ccondeelis@ahca.org Carol Benner, National Director, Advancing Excellence in Nursing Homes Campaign cbenner@aahsa.org Tammy Rolfe, LANEs Field Director, Advancing Excellence In Nursing Homes trolfe@aahsa.org
2. Learning Outcomes Describe the role of Advancing Excellence in Quality First Keeping the Promise. Review the eight goals and targets for improving the performance of nursing homes. Describe the array of comprehensive, customized, evidenced-based resources that are available at no cost. Demonstrate the use of Advancing Excellence website to benchmark and track performance.
3. Quality has evolved 7-5-5 7 Principles – no changes 5 – Goals – refined, consensus, measures sources 5 – Tools -- new
4. Why Update or Even Keep Quality First? Our goals are more refined. We have targeted 3rd- party data sources. We can adjust our goals as our environment changes.
5. QFKTPStrategic Direction Self-initiated – voluntary, proactive Accountability, Transparency Anchor point – across our membership Positioning for the Affordable Care Act Public Reporting Pay for Performance Bundling
6. What is quality ? “Quality is the combination of care and services that meet or exceed customer needs and expectations.” AHCA/NCAL
7. QFKTP -- 7 Principles Continuous Quality Improvement (CQI) – This principle encourages a collaborative approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems, with a primary focus on process, and utilizes objective data to analyze and improve these processes. In long term care CQI incorporates all the components that are necessary for quality care and services.   Public Disclosure and Accountability – This principle seeks to encourage transparency of information that is shared with patients, residents and their families as well as sources of state and federal funding. It also promotes accountability to meeting – and exceeding – patient needs and expectations, while simultaneously exhibiting accountability of government funding for the care provided. Patient/Resident and Family Rights –This principle embodies the critical importance for person-centered care and focus on individual outcomes through services provided. This is exemplified by presenting opportunities to patients and residents to best determine their care and shape the comfort of their environment.
8. QFKTP Principles – continued Workforce Excellence –This principle recognizes that a strong organization empowers leaders and develops and supports a stable, qualified and well-trained workforce that is engaged and committed to excellence.  Public Input and Community Involvement –This principle recognizes the interconnectednessof long term care facilities and the community. Facilities should strive to achieve positive visibility by promotingthemselves as health care providers within the community, becoming involved in issues impacting the community and by sustaining a robust volunteer program that actively engages individuals of all ages. Ethical Practices –This principle embodies the belief that all long term care providers should operate based on a foundation of trust. This includes promoting ethical business standards, corporate integrity and responsible financial stewardship. Financial Stewardship –This principle recognizes that the vast majority of long term care providers rely on government funding (Medicare, Medicaid) to provide quality care and services – and that our profession must operate in a manner that uses these resources responsibly. As a profession, we will endeavor to retain appropriate levels of governmental funding to allow facilities to provide health care and services to those in need.
9. QFKTP – 5 Goals Improve and Sustain: Performance in all CMS quality measures Compliance with the federal survey process High rates of resident and family satisfaction High rates staff satisfaction rates Leadership and staff retention, and reduce turnover rates
10. QFKTP – Data to Measure Goals Improve and sustain performance in all CMS Quality Measures Source: CMS Nursing Home Compare Update: Quarterly Improve and sustain compliance with the federal survey process Source: CMS OSCAR Data Update: Quarterly Improve and sustain high rates of resident and family satisfaction Source: My InnerView – National Survey of Customer and Workforce Satisfaction in Nursing Homes Report Update : Annual Improve and sustain high staff satisfaction rates Source: My InnerView – National Survey of Customer and Workforce Satisfaction in Nursing Homes Report Update: Annual Improve and sustain leadership and staff retention and turnover rates Source :AHCA 2008 Nursing Vacancy, Turnover, and Retention Report Update: Annual
11. CMS Quality Measure Performance(CMS Nursing Home Compare)
12. Federal Survey Process(CMS Nursing Facility OSCAR Standard Health Survey Data)
13. 13 Resident and Staff Satisfaction (My InnerView, Inc.2009) 86% of residents rated their nursing home as “good” to “excellent.” 67% of staff rated their home “good” to “excellent” as a place to work.
14. 14 Retention Rates by Job Category(AHCA, Vacancy and Turnover Study, 2008)
15. Shared Goals Quality First and Advancing Excellence
16. Quality First: Keeping the Promise5 Tools Advancing Excellence Phase II AHCA/NCAL National Quality Award AHCA LTC Trend Tracker® Resident and Family Satisfaction Assessment Staff Satisfaction Assessment
17. Thank-You for What You Do “The leaders who work most effectively, it seems to me, never say “I” They think “we”; they think “team.” “They understand their job to be to make the team function. They accept responsibility and don’t sidestep it, but “we” gets the credit…. This is what creates trust, what enables you to get the task done.” Peter Drucker
18. About the Advancing Excellence in America’s Nursing Homes Campaign
19. Campaign Overview Largest national coalition (30 organizations) of nursing home stakeholders Voluntary for nursing homes (43% registered!) Based on measurement of meaningful goals Initially a two-year campaign started in 2006 Just celebrated our 4th birthday! Incorporated in 2010 And, the data show that it works!!!! www.nhqualitycampaign.org
20. Why Join? Participate in a Quality Improvement method that works Advancing Excellence tools are free, evidence-based and user-friendly Up-to-date information on the website to help nursing homes quality of care and life Robust website Periodic newsletters Participation encouraged for consumers and frontline staff in addition to nursing home leaders www.nhqualitycampaign.org
21. Campaign Benefits Focuses on meaningful issues Drives nursing homes to a culture of data and QI Increases staff retention and focus Improves customer satisfaction Saves money due to improved quality and staff retention Prepares for Pay-for-Performance Brings stakeholders to the table Complements other initiatives Gets nursing homes ready for QAPI www.nhqualitycampaign.org
22. About Quality Improvement
23. Why is Nursing Home QI Important? It’s the right thing to do Affordable Care Act strengthens QA requirements in nursing homes With the shift to MDS 3.0 and the change in quality measures, nursing homes are more accountable than ever for quality. www.nhqualitycampaign.org
24. Quality Assurance/Performance Improvement (QA/PI) The Affordable Care Act, Section 6102 requires CMS to strengthen QA requirements in nursing homes CMS must provide technical assistance to nursing homes in order to meet new requirements. Law requires implementation by December 31, 2011 QAPI Plans must be submitted to HHS Secretary one year later www.nhqualitycampaign.org
25. QA/PI Meaningful problems or issues Measureable Benchmarks/data-driven Evidence-based interventions Evidence of improvement www.nhqualitycampaign.org
26. Quality Improvement Quality Assurance Proactive Aggregate Data Organizational process Improves overall performance Always measureable Concurrent Monitoring is continuous Positive change Reactive Single episode Organizational mistake Prevents something from ever happening again Sometimes anecdotal Retrospective Monitoring based on audit Sometimes punitive www.nhqualitycampaign.org
27. QI Model for ImprovementThree Questions and the PDSA Cycle What are we trying to accomplish? How will we know that we have been successful? What changes can we make to achieve our goal? www.nhqualitycampaign.org
28. QI Model for Improvement Aims are time-specific and measureable Dependent on change Uses P-D-S-A cycle to test small changes www.nhqualitycampaign.org
29. PLAN-DO-STUDY-ACT
30. PDSA
31. PDSA www.nhqualitycampaign.org
32. Example 1 What are we trying to accomplish? I want to lose weight How will we know that we have been successful? Size 6 dress Lost 20 pounds What changes can we make to achieve our goal? (First, have to figure out what process I have to change) Change medicine? Eat less?Eat differently?Exercise? www.nhqualitycampaign.org
33. Example 1
34. Example 2 What are we trying to accomplish? I want to increase profits in my pizza store How will we know that we have been successful? 10% $$$ increase at the end of the 2011 What changes can we make to achieve our goal? First, have to figure out what process I have to change Better marketing? More cooks? Efficient delivery practices? www.nhqualitycampaign.org
35. Example 2 www.nhqualitycampaign.org
36. Example 3 What are we trying to accomplish? Decrease number of in-house acquired pressure ulcers How will we know that we have been successful? No pressure ulcers and no deficiencies What changes can we make to achieve our goal? First, have to figure out what process I have to change Right supplies on hand? Hire wound care nurse?Identification and care of residents at risk for PUs? www.nhqualitycampaign.org
37. Example 3 www.nhqualitycampaign.org
38. Campaign Phase 2 Goals Staff Turnover Consistent Assignment Restraints Pressure Ulcers Pain (long and short-stay) Advance Care Planning Resident/Family Satisfaction Staff Satisfaction www.nhqualitycampaign.org
39. Quality in Nursing Homes To improve care, we need to stabilize the work force. We need to reduce turnover, improve staff retention. We need to improve relationships between staff and staff, staff and residents. www.nhqualitycampaign.org
40. Keep QI Simple Focus on important, meaningful issues. Make sure that your goal is measureable. Figure out what change/process you need to make. Involve the care team Make QI come alive Celebrate your success www.nhqualitycampaign.org
41. About the Advancing Excellence QI Tools
42. Advancing Excellence Tools Staff Turnover Calculator Consistent Assignment Calculator Pressure Ulcer Monitoring Tool Restraint Monitoring Tool Pain Monitoring Tool Advance Care Plan Monitoring Tool Suggested tools for measuring Staff Satisfaction and Resident and Family Satisfaction Find these tools at www.nhqualityCampaign.org
43. The Campaign Tools Evidence-based, tried and tested…they work! Developed by experts Similar to one another and user-friendly Excel worksheets Simple how-to instructions Macros and formulas built-in Monitoring built-in Downloadable and ready to use Free www.nhqualitycampaign.org
44. The Campaign Resources Resources for each Campaign goal include: Implementation Guide Webinar Fact sheet for consumers Fact sheet for CNAs Additional resources include: Videos Research references Resources are regularly updated www.nhqualitycampaign.org
45. Using the AE Tools to improve Staff Turnover, Consistent Assignment and Pressure Ulcers
46. A Major Shift In Thinking It’s ALL about STAFF Enough Competent Caring Compassionate Consistent www.nhqualityCampaign.org
47. Formula for Success Staff Stability + Consistent Assignment = Happier StaffBetter Care and Clinical Outcomes Higher Resident and Family Satisfaction Cost Savings
48. Proving The Link - References A Case For Consistent Assignment: When caregivers get to know their patients more intimately, it opens the way for improved quality and a reduction in staff turnover, Provider Magazine, June 2006 A Keystone For Excellence: Implementing consistent assignment provides a strong foundation for achieving the goals of the Advancing Excellence in America’s Nursing Homes program, Provider Magazine, July, 2007 Predictable scheduling: Nursing homes can boost quality, bottom line with consistent assignment, Modern Healthcare, August 2010 Interventions Table: Staff Retention: An overview of information published between 2004-2009 regarding successful or potentially successful interventions to retain staff
49. What is Staff Stability? Low staff turnover High staff retention Low use of agency staff Rare call-outs, absenteeism High staff satisfaction www.nhqualitycampaign.org
50. Staff Turnover Staff turnover is one component of staff stability www.nhqualitycampaign.org
51. National Nursing Home Turnover Data AHCA’s Staff Vacancy and Turnover Report 2007
52. Staff Turnover – AE Goal Goal 1 - Staff Turnover: Nursing homes will take steps to minimize staff turnover in order to maintain a stable workforce to care for residents. Amazing Resources on the Website: QPRI Staff Stability Toolkit PHI Coaching and Supervision Guide AE Staff Turnover Tracking Tool WEB EX on how to use the tool www.nhqualitycampaign.org
53. QI Process for Staff Turnover PLAN Use the AE tool to calculate what the turnover rate is Decide if this is something that needs to change If yes, ask why? Is it low-pay, too much work, geographical area, lack of leadership? Decide on a plan www.nhqualitycampaign.org
54. QI Process for Consistent Assignment DO Talk with staff and explain what is going on Implement changes in hiring practices Study After two weeks or so, use the AE Tool and see how you are doing Talk to the staff to see how they are doing www.nhqualitycampaign.org
55. QI Process for Consistent Assignment ACT Using the measurement from the AE Tool and the feedback received from the staff, tweak the hiring practices.
56. The Staff Turnover Calculator Tool Only nationally available standardized way to collect turnover data Developed for QIO’s 8th scope of work and modified to make it better over past 6 years Used to collect and analyze monthly data Provides an Annualized Turnover Rate Monitoring on AE website
57. Staff Turnover Calculator
58. Instructions TAB
59. Common Qs & As TAB
60. CNA Calc TAB
61. CNA Trending TAB
62. Data Entry on AE Website Enter staff turnover data on AE website at least monthly Print off a copy of the tool for simplicity and as a record Your data are confidential– others cannot see it Use the provided trend graphs for QI meetings Provide feedback to staff and others through data and graphs www.nhqualitycampaign.org
63. Consistent Assignment www.nhqualityCampaign.org
64. What is Consistent Assignment? The same person takes care of the same resident every time he or she is on duty… www.nhqualitycampaign.org
65. The Case for Consistent Assignment How Would You Feel? To never know who your caregiver might be To always have caregivers that don’t know your preferences or routine To know that you may not see the person who cared for you today again There is a possibility that a single resident could have over 20 different caregivers in a week! www.nhqualitycampaign.org
66. Consistent Assignment Builds positive relationships Increases resident and family satisfaction Quicker awareness of clinical problems Improves staff accountability Improves communication between shifts and with other disciplines Improves staff satisfaction Improves clinical and quality outcomes!!! www.nhqualitycampaign.org
67. A How-To Manual A Step-By-Step Guide to Consistent Assignment Roll-Out This handout is an adaptation from information David Farrell presented during an AHCA webinar held November, 2007 The webinar materials are available for free (See handout for link) www.nhqualitycampaign.org
68. Can Any Nursing Home Do This? Yes !! If the Nursing Director and Administrator are on board with PASSION! If the culture is already open for dialogue If the staff feel empowered and not threatened If everyone realizes that consistent assignment is a different way of thinking and behaving If everyone realizes it is best for the resident www.nhqualitycampaign.org
69. Consistent Assignment – Goal Definition Goal 2 – Consistent Assignment: Being regularly cared for by the same caregiver is essential to quality of care and quality of life. To maximize quality, as well as resident and staff relationships, the majority of nursing homes will employ “consistent assignment” of CNAs. www.nhqualitycampaign.org
70. Consistent Assignment – Objectives The Objectives: The Advancing Excellence Campaign has defined consistent assignment as at least 85% of long stay residents in the nursing home having a maximum of eight CNA caregivers over a four-week period, and at least 85% of short stay residents having a maximum of eight CNA caregivers over a two week period. You may find out that your numbers are higher than 8 and that is OK! If your number is 12, you may want to get it down to 10 Set your goal www.nhqualitycampaign.org
71. QI Process for Consistent Assignment PLAN Use the AE tool to calculate how many CNAs are caring for each resident Decide if this is something that needs to change If yes, ask why and how your staffing patterns contribute to the number of different CNAs taking care of residents. Ask the right questions: Is simply a matter of scheduling? High number of “difficult” residents? Too many call-outs? Educate everyone about consistent assignment See the “How-To Manual” slide and handout www.nhqualitycampaign.org
72. QI Process for Consistent Assignment DO Talk with staff and get buy-in to change Explain value of consistent assignment Use best practices of others to change scheduling practices Pilot consistent assignment on one unit Provide resources www.nhqualitycampaign.org
73. QI Process for Consistent Assignment Study After two weeks or so, use the AE Tool and see how you are doing Talk to the staff to see how they are doing www.nhqualitycampaign.org
74. QI Process for Consistent Assignment ACT Using the measurement from the AE Tool and the feedback received from the staff, tweak the scheduling method.
75. Using the Consistent Assignment Tool ONLY national standardized tool that will allow comparisons Download the Excel-based tool on to your computer and save it with a name Set up the tool by adding names of residents and staff The tool is resident-centered not staff-centered and counts the number of caregivers taking care of residents NOT the number of residents being cared for by the caregiver
76. Using the Consistent Assignment Tool The tool is resident-centered not staff-centered and counts the number of caregivers taking care of residents NOT the number of residents being cared for by the caregiver Tool calculates the average number of unique C.N.A.’s per resident for the past 7 days in weekly increments - ready for data entry into the Campaign website Use the tables from the Excel worksheet to brief your QA Committee and provide feedback to the staff
77. Consistent Assignment Calculator
78. Instructions TAB
79. Common Qs & As TAB
80. CNA Tab
81. Residents TAB
82. Week 1 TAB
83. Summary TAB
84. Pressure Ulcer Tracking Tool www.nhqualityCampaign.org
85. Pressure Ulcers– Goal Definition Goal 4 Pressure Ulcers: Nursing home residents receive appropriate care to prevent and appropriately treat pressure ulcers when they develop www.nhqualitycampaign.org
86. QI Process for Pressure Ulcers Define and Measure Pressure Ulcers Determine current pressure ulcer data in your nursing home, state and nation Identify facility information and tracking Investigate Reasons and Sources of Pressure Ulcers Identify current practices and approaches See Pressure Ulcer Care Process Framework www.nhqualitycampaign.org
87. QI Process for Pressure Ulcers Identify and Implement Solutions to Improve Pressure Ulcer Rates Use interventions that address the specific problem. Use appropriate resources for solutions that are known to work. Monitor and try different interventions if necessary. Re-evaluate performance practices and results Continue internal data collection on results and processes Provide feedback to staff and others No Data Entry Required – Populated from MDS Use trend graphs from 2007 to 2010 www.nhqualitycampaign.org
88. National Pressure Ulcer Data Some Key Campaign Objectives: By December 21, 2011 The national average for high risk pressure ulcers will be below 9% 30% of nursing homes will report rates of high risk pressure ulcers at or below 6% 22,500 fewer residents will have pressure ulcers compared to 6/06 Most Current Quarter 2, 2010 high risk pressure ulcer data 10.8 % www.nhqualitycampaign.org
89. Knowing Pressure Ulcer Data It is important to know your national, state and facility specific data You can find these on the Campaign website Due to MDS 3.0 the Quality Measures are going dark Last QM data expected to be posted Feb 2011 for Q3 2010 www.nhqualitycampaign.org
90. Using the Pressure UlcerTool Internal QI is essential now in the absence of QM’s Use the AE Pressure Ulcer Tool to collect and analyze monthly data Nationally standardized way to collect this data Amazing graphs and trending Go to website, click on goal and tool, download tool – save to PC with an extension such as date or name www.nhqualitycampaign.org
91. Special Tool Features Allows nursing home to monitor in-house acquired and admission acquired by source Shows were pressure ulcers come from Provides multiple graphs for ongoing monitoring There are currently no questions and answers tied to this tool www.nhqualitycampaign.org
92. Pressure Ulcer Tool - Data Entry Section
93. Pressure Ulcer Tool - Graphs and Trends
94. Monthly Notes
95. Thank You!Questions?ccondeelis@ahca.orgcbenner@aahsa.orgtrolfe@aahsa.org www.nhqualityCampaign.org