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TN NHQCC Learning Session 2

health. care. TN NHQCC Learning Session 2. Beth Hercher, CPHQ Fall 2013. tn. TN. Today ’ s Objectives. Overview of Collaborative Review Learning Session 1 Review Performance Improvement Project Review and Engage in QI Approaches During Afternoon Exercise. 2. 3. 4.

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TN NHQCC Learning Session 2

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  1. health. care. TN NHQCC Learning Session 2 Beth Hercher, CPHQ Fall 2013 tn TN

  2. Today’s Objectives • Overview of Collaborative • Review Learning Session 1 • Review Performance Improvement Project • Review and Engage in QI Approaches During Afternoon Exercise 2

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  5. National NH Quality Care Collaborative (NHQCC) Mission Statement: The National NHQCC and its partners seek to ensure that every nursing home resident receives the highest quality of care. Specifically, the collaborative strives to: • Instill quality and performance improvement practices • Eliminate healthcare-acquired conditions • Dramatically improve resident satisfaction by July 31, 2014 5

  6. NHQCC: National Overview • What is the NHQCC Collaborative? • Centers for Medicare & Medicaid Services (CMS) national initiative • CMS Mission Statement: • To ensure that every NH resident receives the highest quality care • To instill quality and performance improvement (QAPI) practices, eliminate healthcare-acquired conditions, and dramatically improve resident satisfaction by July 31, 2014 6

  7. NHQCC: National Overview, cont. • CMS Methodology • Targeted high-performing NHs • Identified systems and processes that contribute to their overall quality • Focused on successful practices of high performers Specific Focus • Healthcare-Acquired Infections (HAIs) • Healthcare-Acquired Conditions (HACs) • Antipsychotics 7

  8. NHQCC: National Overview, cont. QAPI: Identified Problems • Highly variable quality of care and quality of life received across the country (no easy way to measure variance) • NHs operating in emergency (high-stress) mode from survey to survey • Leaders not empowered to make decisions • Cultures not focused on improvement • Difficulty sustaining great improvements over time https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/nhqapibackground.pdf 8

  9. NHQCC: National Overview, cont. • Outcomes • Change Package— A living document to provide a menu of strategies, change concepts and actionable items • QAPI-At-A-Glance Toolkit— A step-by-step guide to implementing a QAPI plan 9

  10. TN NHQCC: Local Initiative • A select group of Tennessee NHs, committed to this national initiative, working together for 18 months to test systems of change. TN 10

  11. TN NHQCC: Local Initiative, cont. How does the national initiative align with the Tennessee collaborative? • Establishes best practices • Identifies gaps between best and current practices • Provides examples of real success stories • Creates common aim (QAPI) 11

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  13. Transformational Change • CMS challenges providers to create an environment that promotes transformational change • Occurs through collaboration, partnership and commitment to shift paradigms to a person-directed care approach for quality improvement 13

  14. Elements of a Successful Collaborative • Be open to new possibilities • Learn from and share with others those practices that improve systems within your organizations • Explore adapting these practices and others in your organizations • Commit to actions and next steps for testing and implementing changes in your organizations 14

  15. Elements of a Successful Collaborative, cont. • Start small, but be fast • Reserve judgment • Share data • Let go of “what’s NOT working,” do more of “what IS working” • Be inclusive • Have FUN! 15

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  17. Blueprints: Breakthrough Collaboration The TN NHQCC collaborative series will follow this plan 17

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  19. Framework: QAPI • QAPI does not refer to a program; it is the way we do our work • The ability to think, make decisions and take action at the system level is a prerequisite for QAPI success 19

  20. Background of QAPI • Legislated in the Affordable Care Act (ACA), enacted March 2010 • ACA requires CMS to establish QAPI program standards and provide technical assistance to NHs • CMS is developing and testing QAPI technical assistance tools and resources before rule promulgation 20

  21. Five Elements of QAPI 1. Design and Scope Clinical care, quality of life, resident choice and care transitions 2. Governance and Leadership Leadership’s working with staff, residents and families on QAPI 3. Feedback, Data Systems and Monitoring • Design, implementation and monitoring of care and services 4. Performance Improvement Projects (PIPs) Specialized projects of focus centered around a particular opportunity for improvement or conducted facility-wide 5. Systematic Analysis and Action A systematic approach to reviewing processes and outcome measures 21

  22. QAPI Building BlocksFacilitators Learning Session 1 Lipscomb School of Transform Aging Beverly Patnaik Charla Long P. Elaine Griffin 22

  23. LS1 Objectives • Understand the first 2 Elements of QAPI— Design and Scope, and Governance and Leadership • Distinguish between a vision statement and a mission statement • Align your vision and mission statement with a PIP • Apply QAPI Elements 1 and 2 to your organizational initiatives and culture 23

  24. Action Period 1 (AP1) • July through September your QAPI team has been… • Participating on monthly sharing calls hosted by the Qsource NH Team • Meeting with your QAPI team to review brief podcasts that will assist you in achieving your goals and QAPI structure • Providing Qsource with an Action Period 1 Progress Report via Survey Monkey • Developing a storyboard • Preparing for LS2 scheduled for Fall 2013 24

  25. Fast Forward to LS2 Action • Review how to implement quality improvement strategies for QAPI steps 7–12 • Review how to document/report process in CARES Report updates (PDSA) • Timeframe • November 2013–July 2014 25

  26. QAPI at a Glance 12 Action Steps to QAPI • Step 1: Leadership • Step 2: Teamwork • Step 3: Self-Assessment • Step 4: Guiding Principles • Step 5: QAPI Plan • Step 6: QAPI Awareness Campaign • Step 7: Collecting and Using QAPI Data • Step 8: Gaps and Opportunities • Step 9: Prioritize Charter PIPs • Step 10: Plan, Conduct and Document PIPs (CARES Report) • Step 11: Root Cause Analysis • Step 12: Systemic Action 26

  27. Laying the QAPI Foundation • Define the role of leadership in implementing QAPI QAPI Steps 1–3 • Define the purpose of developing guiding principles QAPI Steps 4–6 • Use the right tools QAPI Steps 7–9 • Integrate performance improvement into daily operations (CARES Report) QAPI Steps 10–12 27

  28. Resources: NHQCC and CMS • Download at http://www.qsource.org/12-action-steps-qapi/ 36

  29. TN NHQCC Online www.Qsource.org/NHQCC 37

  30. Toolbox Tips 38

  31. Nursing Home Team: • Beth Hercher, CPHQ • bhercher@qsource.org • John Wright, RN, BSN, WCC, BC • jwright@qsource.org • Julie Clark, LPTA • jclark@tnqio.sdps.org This material was prepared by Qsource, the Medicare Quality Improvement Organization (QIO) for Tennessee under contract with the Centers for Medicare & Medicaid Service (CMS), an agency of the U.S. Department of Health and Human Services (DHS). Contents do not necessarily reflect CMS policy. 13.IPC-HAC.09.046

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