Long Term Care Administration

1. Long Term Care Administration Thursday, April 2, 2009 Week 13 - Chapters 11 & 14 Quality and Governance Home and Community Care

2. The Quality Factor in LTC W. Edwards Deming • Deming is widely credited with improving production in the United States during World War II, although he is perhaps best known for his work in Japan. • There, from 1950 onward he taught top management how to improve design, service, product quality, testing and sales, markets through various methods, including statistical methods. William Edwards Deming was an Home and Community Care

3. The Quality Factor in LTC Deming's philosophy 'a'-versus-'b' comparison: (a) When people and organizations focus primarily on quality, quality defined by the following ratio: then quality tends to increase and costs fall over time. (b) However, when people and organizations focus primarily on cost, then costs tend to rise and quality declines over time. Home and Community Care

4. The Quality Factor in LTC • Dr. W. Edwards Deming taught that by adopting appropriate principles of management, organizations can increase quality and simultaneously reduce costs. • By reducing waste, rework, staff attrition and litigation while increasing customer loyalty. • The key is to practice continual improvement and think of manufacturing as a system, not as bits and pieces. Home and Community Care

5. The Quality Factor in LTC Home and Community Care

6. The Quality Factor in LTC Three main Quality Processes: • Quality Assurance (QA) • Continuous Quality Improvement (CQI) • Total Quality Management (TQM) Home and Community Care

7. The Quality Factor in LTC Quality Assurance (QA) • The emphasis in traditional quality assurance is on monitoring whether the appropriate things are being done correctly. • Actions are taken to correct the problem with the focus on individual performance. • Focus on departmental level and reactive. Home and Community Care

8. The Quality Factor in LTC Continuous Quality Improvement (CQI) • Improving processes with full staff involvement, integrated organization wide. • Client focused, process, performance. • Working teams to identify and prioritize areas for improvement and measure the results of improvements. • Proactive, goal to become even better. Home and Community Care

9. The Quality Factor in LTC Total Quality Management (TQM) • Process for meeting and exceeding customer requirements. • Concept includes employees within the organization as a critical customer group. • Philosophy and new way of doing business. Home and Community Care

10. The Quality Factor in LTC Risk Management (RM) • Identification of risk factors. • Elimination of risk. • Minimization of the effects created by incidents that do occur with the facility. • Change or possibility of danger, loss, or injury. Home and Community Care

11. The Quality Factor in LTC Risk Management (RM) • Well being of staff and public • Property • Reputation • Environment • Organizational functioning • Financial stability • Market Share • Other things of value Home and Community Care

12. The Quality Factor in LTC Canadian Council on Health Services Accreditation (CCHSA) – 4 Principles Establish culture of quality care & service. • Leadership, organizational teamwork. • Improve processes, achieve results. • Meet needs and exceed expectations of clients. Home and Community Care

13. The Quality Factor in LTC Defining Quality… What is Quality? Home and Community Care

14. The Quality Factor in LTC CCHSA Definition of Quality • The degree of excellence, extent to which the organization meets clients’ needs and exceeds their expectations. Four Quality Dimensions. • Responsiveness, effectiveness, work life and client/community focus. Home and Community Care

15. The Quality Factor in LTC John Carver • Quality never stands still. • Degree client’s expectations are met or exceeded. • Inspire leaders, changing concept of excellence. • Clients of today and tomorrow. Home and Community Care

16. The Quality Factor in LTC Defining Standards “Desired and achievable level of performance against which actual performance can be compared.” Home and Community Care

17. The Quality Factor in LTC Standards of Practice • Authoritative statements that describes the level of service, or performance common to all members of a profession. • Focus on the behaviour of the provider, and give direction to address the legal and professional basis of practice. Home and Community Care

18. The Quality Factor in LTC Municipal Bylaws and Codes • Set fire and safety standards and building codes. • Building codes help prevent accidents. • Fire codes help prevent death from fires. Home and Community Care

19. The Quality Factor in LTC Provincial Standards • BC – Adult Care Regulations • Grant Licenses to operate LTC. • Compliance with minimal standards. • Reviewed by inspection process. • Annual onsite inpection. Home and Community Care

20. The Quality Factor in LTC Health Professional Bodies • Set standards for professional practice. • RNs, MDs, PT, OT, SW. • Set codes of ethics. • License professionals. • Monitor practices. • Regulate the profdession. Home and Community Care

21. The Quality Factor in LTC Performance Measures (CCHSA) There are three types of performance measures: • accreditation requirements (standards) • indicators • instruments (e.g. survey tool or audit) Home and Community Care

22. The Quality Factor in LTC Quality Indicators • Performance measurement tool, screen, or flag that is used as a guide to monitor, evaluate, and improve the quality of client service delivery, support services, leadership and partnerships. • Indicators relate to structure, processes and outcomes. Home and Community Care

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24. The Quality Factor in LTC Benchmarking (Goldwasser) • Assess current performance relative to other organizations. • Discover and understand new ideas and methods to improve processes and practices. • Identify aggressive, yet achievable, future performance targets. Home and Community Care

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26. The Quality Factor in LTC Quality of Life for Residents • Promotion of individuality and choice. • Mission, values, vision - statements. • Resident-centred programs and services. • Standards of Quality of Life. • Clients perspective on Quality of Life. Home and Community Care

27. The Quality Factor in LTC Use of Restraints • Restraint free environment. • Minimal restraint. • No restraint. • Better quality of life for residents. Home and Community Care

28. Quality Factor in LTC Freedom of Choice Family Decision Making • Challenging situations evolve where staff weigh the risks to the resident against the resident’s right to choose versus the family members who may contradict the resident’s requests. Home and Community Care

29. Quality Factor in LTC Cultural Aspects of Care and Service • Education of staff. • Develop an awareness of the cultural sensitivities in ethnic and native population groups. • Diversity programs. • How do the needs of groups get met? Home and Community Care

30. The Quality Factor in LTC Elder Abuse • Free from any fear of abuse from staff or other residents. • Policies and procedure must be in place to report abuse, deal with it quickly, ensure compliance to the policies is upheld. • Responsibility of the governing body to set policies. Home and Community Care

31. The Quality Factor in LTC Sexuality • Provide an environment that enables residents to express their sexuality. • Staff attitudes toward sexuality. • Privacy and space for this essential human need to be expressed, especially in a long term care facility. Home and Community Care

32. The Quality Factor in LTC Environmental Considerations • Literature reviews to learn what is happening in the field. • Discussing new theories of care delivery. • Bring residents and families into the discussion. • Explore better opportunities. Home and Community Care

33. The Quality Factor in LTC Improving Communication • Open lines of communication is best. • Investigate ways for residents to interact with the community. • Involve residents on committees. • Rights of residents. Home and Community Care

34. The Quality Factor in LTC Challenges • Quality is a living organism. • Pursuit of quality is a courtship. • Ever changing face of quality. • Client change, definition of satisfaction care and service changes. • Demand for quality will increase. Home and Community Care

35. Governance and Advocacy Governance Effectiveness • Ultimate responsibility is to ensure the well-being of the clients the facility serves. • Ability to govern. • Level of operational understanding. • Impact of decisions. • Measure effectiveness of their actions. Home and Community Care

36. Governance and Advocacy Governance Effectiveness Questionnaire • The goals, expectations and concerns of individual Board members are appropriately communicated to the Chair of the Board and CEO.    • Our Board has the appropriate mix of members, skills, experience and other characteristics to be effective. • All Directors attend at least 75% of Board meetings or have a valid excuse for non-attendance. • Meeting agendas include all relevant and high-priority issues and allocate time appropriately. • Directors study and understand relevant information in order to utilize their meeting time effectively and make informed decisions. Home and Community Care

37. Governance and Advocacy Elected Versus Appointed Board Members • Representative of the community. • Avoid single issue or fixed ideological position – irresponsible governance. • Expertise in specific areas – law, medicine • Extended orientation to fully contribute. • Number one priority enhance organization. Home and Community Care

38. Governance and Advocacy Governance Rules and Practices • Vancouver Coastal Health is committed to being open and accountable to the public we serve. • Increasingly, in both the public and private sector, there is a growing trend towards enhancing corporate governance practices. • We have responded by significantly reviewing these practices and improving our level of disclosure. We are committed to taking part in a continual review and updating process following the Board Resourcing and Development Office (BRDO) provincial best practice guidelines. Home and Community Care

39. Governance and Advocacy • The governance rules and practices of VCH are set out in the Board Manual that explains how the Board of VCH conducts business. • It includes a Code of Conduct for Directors, VCH By Laws and Terms of Reference for the Board, the Chair, the CEO and Board Committees. Home and Community Care

40. Governance and Advocacy BC Board Resourcing and Development Office • Establishes guidelines for all provincial appointments to agencies • Ensures that all provincial appointments are made on the basis of merit following an open, transparent and consistent appointment process • Ensures that appointees receive appropriate orientation and ongoing professional development with respect to agency governance issues Home and Community Care

41. Governance and Advocacy Integration with Regional Authorities What are the pros and cons for acute care, long term care and community care under one governance structure? Home and Community Care

42. Governance and Advocacy Roles and Responsibilities of the Board • Set strategic direction. • Develops operational policies. • Makes critical decisions about the type of organization it governs. • Ensures sufficient resources are in place. • Accountable for its actions and decisions. Home and Community Care

43. Governance and Advocacy Roles and Responsibility of the Board, cont.. • Selection and evaluates the CEO. • Achievement of goals and objectives. • Advocate for the client. • Ensures all interactions, services, programs are high quality and maintain the dignity of the individual client. • Role as evaluator and critic. Home and Community Care

44. Governance and Advocacy Roles and Responsibility of the Board, cont.. • Decision on model of governance. • Decision on philosophy of care. Home and Community Care

45. Governance and Advocacy Mission as the Central Focus • Single most influential document. • Primary source that guides a governing board, management and staff. • Complements and gives direction to the organization’s strategic plan and sets the framework for its annual goals and objectives. Home and Community Care

46. Sample Mission Statement • To provide quality of life and quality of care to residents who come to us for long-term residential or short-term rehabilitative care. • We assist residents to achieve their highest possible level of physical, psychosocial and spiritual potential, always working to protect and enhance their dignity. • We seek to continually improve the services we provide. Home and Community Care

47. Sample Mission Statement To be a thriving healthcare community in which the individual needs and desires of the residents direct and shape daily life. Home and Community Care

48. Governance and Advocacy Carver Model - Policy Governance • Board is the stewards of the organization. • Focus on making high level policy. Four key policy areas: • Restriction or limitations of the CEO. • Development of outcomes. • Process of governance, board effectiveness. • Accountability of staff. Home and Community Care

49. Governance and Advocacy Philosophy of Care • Client-centredness critically evaluates the organization’s processes so that resources are assigned based on client needs. • Individual needs of the resident take precedence over the needs of the delivers of the service. Home and Community Care

50. Governance and Advocacy Governance and Accountability • Trusteeship - honour trust placed on them by the public. • Leadership – make difficult decisions in a time of uncertainty and change. • Accountability – clear policy direction. • Responsibility – efficiently and effectively. Home and Community Care