Michigan Community Dental Clinics Quality Improvement with a Patient Centered Perspective

1. Michigan Community Dental Clinics Quality Improvement with a Patient Centered Perspective August 5, 2014

2. Discussion Questions • What, if any, barriers does MCDC face when instituting quality improvement in its dental clinics? • How is baseline quality data obtained? • How is clinical quality measured? • How is administrative quality measured? • How does peer review have a place in clinical quality improvement? • How is clinical quality improvement performed without animosity among clinical staff? • How is quality improvement information shared with staff?

3. Discussion Questions con’t • How does MCDC include productivity as a part of quality improvement? • Does MCDC use quality improvement processes such as Six Sigma or LEAN? If so, how are staff trained? • How often are formal quality improvement reviews performed? • Does MCDC partner with universities or other community partners to expand its quality improvement capacity and expertise? • Could MCDC share any patient satisfaction surveys that have been used in its quality improvement process? • Could MCDC share any staff satisfaction surveys that have been used in its quality improvement process?

4. Quality Improvement Presented by: Nicole Murray RN BSN

5. Changing Lives One Smile at a Time • Our Mission: • to create and expand access to ever improving quality dental care for Medicaid recipients and low income, uninsured individuals. • Our Vision: • to have a healthy Michigan population who assume responsibility for their own wellness, with our staff’s guidance and proper intervention.

6. Oral Healthcare Network

7. A Strong Infrastructure- to support our Clinic System

8. Having an Impact • 2013 • 179,068 Total Office Visits • 65,269 Patients received care in our clinics • 51% Adults 21-60 • 40% Children 1-20 • 9% Senior Adults over 60

9. Relentless Pursuit of Excellence

10. Quality Improvement Initiatives • In an effort of transparency, the primary objective of the QI Department is to assess, develop, and implement MCDC community standards. • These efforts support our organization’s quest to provide oral health care services with a patient centered perspective. 

11. QI Team Members • Director(s) of Quality Improvement & Patient Safety • Amanda Desjardins DDS • Rebekah Sheppard DDS • Quality Improvement Coordinator • Nicole Murray RN BSN

12. Continuous Improvement

13. Quality Initiatives • MCDC entered into a partnership with Press Ganey in 2012. • This collaborative relationship has ultimately improved the MCDC patient experience by creating continuous, sustainable improvement.

14. A Patient’s Voice • Patients are selected through a randomized process. • PG operators contact our patients by phone to complete survey. • Survey Questions have been modified for our organization and unique patient population. • In 2014: 5 surveys completed per clinic each month • Their sophisticated analytics help MCDC discover and prioritize key performance improvement efforts with real time Survey data.

15. Opportunities for Improvement • Each Quarter in 2014: • new priority indexes will be calculated – providing each clinic their best opportunities for improvement • Top 3 OFI – Action Plans • Clinic receives each quarter via email • Action plans developed at the clinic level

16. Press Ganey Action Plans Add Clinic Specific Info REVISED NEW NEW NEW

17. Press Ganey Tools • 2014 Press Ganey Score Board – Team Approach • Goals and achievements are reviewed at daily huddles and staff meetings

18. Quality Assurance • Quality Assurance begins with a set of standards and accountability to one another. • Clinical and Administrative Policies & Procedures for the Dental Office were written in an effort to establish the MCDC community standard of oral health care delivery for our providers. • A Provider Evaluation (OPPE) will be conducted on each provider annually. The QI Department will be responsible for completing and communicating findings with providers, administration, and board of directors.

19. Annual OPPE Evaluations • Provider Evaluation process begins in June. • Approximately 6-10 charts will be randomly selected for review within 30 days of provider’s scheduled evaluation. • QI department is responsible for reviewing charts and completing assessments together

20. Ongoing Professional Practice Evaluation (OPPE)

21. Documentation Section • Was a Dental Diagnosis documented or completed prior to rendering treatment? • Was the treatment reviewed with the patient prior to initiating and was an appropriate consent obtained? • Were radiographs taken per MCDC guidelines? • Was the procedure properly documented in the patient’s clinical note? • Was the next appointment needs documented and scheduled with the patient?

22. Clinical Quality Section • Is the treatment plan consistent with the patient’s desire, in relation to their exam, diagnosis, and prognosis? • If anesthetic was required, was the type and dosage used appropriate? • Did the radiograph’s quality meet the MCDC community standard of care?

23. Clinical Elements • Restorative • Endodontic • Oral Surgery • Prosthodontics

24. Engagement Section • Attendance at Spring Doctor Meeting • Does provider actively participate with Doctor’s Corner? • Does Provider engage with MCDC administration via email communications? • Does Provider participate in any MCDC adjunct committees?

25. Focused Professional Practice Evaluation (FPPE) • If a specific concern is identified, a focused evaluation may be warranted. • A new hire will be clinically evaluated within 90 days of their employment. • An FPPE may also be completed on a case by case basis and initiated by the DQIPS.

26. Focused Professional Practice Evaluation (FPPE)

27. Doctor’s Corner • An interactive resource to share information with other providers • Cases are posted for DDS review & comment

28. Example - Case Study

29. Example - Question

30. Quality Improvement & Patient Safety Committee • Quality Concerns – Case Submission • MCDC staff members are required to alert the DQIPS or QI department of any quality or patient safety concerns. • Email • Phone call • Patient Safety Hotline – (January 2014) • Accessible from IES Exchange • Anonymous • All staff have access • Concerns will be reviewed by the QI Department. If appropriate, the concern may be forwarded on to the committee for review.

31. Hotline View Access from IES Exchange

32. Quality Improvement & Patient Safety Committee • Committee Duties • Care rendered by provider will be reviewed by the committee upon the request of the DQIPS. • The members are tasked with validating the issue of quality and safety in question and presenting a recommendation to the Chief Dental Officer. • Key Points • The anonymity of the provider, patient, & clinic will be maintained throughout the entire review process. • All pertinent information will be presented to members in a confidential format in order to preserve objectivity. • The preferred venue for improvements is the MCDC Performance Improvement Program.

33. Quality Improvement Initiative • Performance Improvement Program • Designed to provide assistance for providers who may have challenges practicing within the MCDC Community standard of practice. • Upon recommendation, active participation is presumed. • Program Initiation • Self-Reporting by the dentist to senior management team. • A recommendation from the Quality Improvement & Patient Safety Committee following a review of provider’s delivery of care.

34. Performance Improvement Program • Option 1- Internal Mentorship • Consists of an employed dentist that has been identified as one who has demonstrated competency in the specified area of concern needing improvement by participating dentist. • The specific improvement opportunities will be discussed with the mentoring dentist and participating dentist. A clinical competency checklist will be created specifically for those needs that have been identified.

35. Performance Improvement Program • Option II – External Membership • The selection of the external mentor will be a collaborative effort between the DQIPS and participating dentist. • The specific improvement opportunities will be discussed with the external mentoring dentist and participating dentist. • A clinical Competency checklist will be created specifically for needs identified. • Formal written feedback will be provided to DQIPS regarding final impression and any improvement identified for the participating dentist.

36. Performance Improvement Program • Option III – CE Instructional Program • Upon recommendation of committee, the dentist may be directed to participate in a CE Instructional Program with specific course content to facilitate improvement for an area of identified concern. • The selection of the CE Course will be a collaborative effort between the DQIPS and participating dentist. • The costs associate with the selected CE Program will be the responsibility of the participating dentist.

37. In Summary • Questions?