Quality/Performance Improvement Fundamentals Making Progress – Skill Building Session July 24, 2013 Pat Teske, RN,MHA [email protected] (661)755-5317.

Quality/Performance Improvement Fundamentals

Making Progress – Skill Building SessionJuly 24, 2013

Pat Teske, RN,MHA

[email protected]

(661)755-5317

Agenda for Today• Today

• Discussing common barriers• Plan how to overcome these barriers• Describe next webinar

Making progress but…We still have a way to

go

Let’s try itRaise your hand and chat

Please don’t put us on hold

HEN Topics

• ADE• CAUTI• CLABSI• EED• Falls with Injury• HAPUs• OB Adverse events• Readmisions• VAE• VTE• SSI

7

HARM

Top 10 Improvements

Skill Building Exercise

1)Identify your barriers2)Develop an action plan to overcome them

#10 – Trace the process

• To understand a barrier trace the actual process

• Find out why it isn’t working they way you intended it to– Observe– Ask– Review

Examples

– Barrier staff expect someone else to complete the check list– What percentage of the time does the staff member complete the

check list?– Why do staff members think someone else will fill it out?– Were staff using the check list involved with testing it?– What happens when you observe someone filling it out?

11

#9 Design to make things easy

• Barriers often come up when something is too complicated

• Make the right thing to do the easy thing to do or in other words make it easy to do what is right

Example

Follow through on fall preventionAre there more steps in the process than there

needs to be?Are the fall prevention items easily accessible?Is there a process to remove items once pt is

discharged?Not writing on the white boards

Not enough pens

13

#8 Be as clear as possible

• Barriers are sometimes caused because there is not a clear procedure or instructions on how to follow the process

Example

Falls risk assessment is not being completedHow are staff instructed on the assessment?What are the specific barriers to completing it?Is there a written procedure?Is it clear?

Medication reconciliation is not performed wellThese same questions apply?

15

#7 Get into the weeds

• It is not enough to say the barrier is non-compliance we need to understand why?

Example

• Resistance to change– What is the change?– Were staff involved in testing the change?– Is there a champion?– What is causing the resistance?

• Patient non-compliance– Why isn’t the patient taking their medications

once they are discharged?

# 6 Involve patients

Are there opportunities to involve patients and their families?Ask the pt directly:• What prevented you

from staying out of the hospital?

• Why do you think you fell today?

Example

Patient/resident does not have direct input – Is there a system to obtain pt/family input?– If input is obtained is it in a place that other care

givers have access to it?

19

#5 Dig deeper

• If you think your barrier is “lack of buy-in” dig deeper

Example

• Staff Buy-In for consistent use of waiting area rounding– Digging deeper it was determined that there was a

perception by the staff that they were unsafe• Pens not available

– Digging deeper it was determined the unit coordinator was concerned about spending money on the unit

21

# 5 Simplify

• Understandable• Not too busy• Easy to follow• Balance the need for

specificity with the benefit of simplicity

Example

• VTE order set– Can orders be simplified to two or three bucket

approach• EMR

– Carefully examine key strokes– Reduce the number of clicks– Allergy update example

# 4 Design actions to get results

• Think about:– What can I test now!– What needs more time

to accomplish– Focus on actions that

you can test quickly

Example

Barrier• Staff do not get recognition

when they involve the pt in managing pain and utilizing the pt communication board

Action• Pass out ‘special” dry eraser

pens to those compliant staff

• On unit visit and recognition from CNO and/or CEO

#3 Try multiple ideas

• Is there more than one idea you can test?

Example

Barrier• Keeping all staff engaged in

the provision of the enhanced AM care to embed and hard-wire this service hospital-wide

Actions

• Identify AM care Champions on each unit, to model and drive the delivery of this service

• Reward and recognize staff members who embrace the enhanced AM care service

• Post the HCAHPS OVERALL Rating scores and positive comments from patients of each unit to show their success

#2 Look for bright spots

• Look for things that are working well and are highly reliable in your facility?

• What qualities do they have?

• How can you replicate these qualities?

Examples

Barriers• TBU• Lack of resources and time

to monitor the patients’ perception of this enhanced service

Action• What’s working• Make a schedule and

sample• Build monitoring into daily

work flow

#1 Take action

• You will not get over, under, around or through barriers by looking at them

• You need to do something differently

• The more ideas you test the more likely you are to hit on a good one

When Getty was asked how he became such a successful oil man he said, “I drilled more holes”.

Next Steps

Now what?

• Work with your Network Facilitators– Continue your team efforts– Look for barriers and ask why?– Test ideas to overcome barriers– Keep at it

• Participate in the next webinar – TUESDAY, July 30th 10:30 -11:30

Testing, spreading & implementing - webinar

34

• Date – TUESDAY 7/30/13• Time – 10:30 – 11:30• Topics Covered

• Knowing when testing is necessary• Knowing when to spread• Knowing when to implement• Building a sustainability plan

Testing, spreading & implementing – Skill Building

35

• Skill building due to NF by 8/7/13• Develop a sustainability plan – Send to network facilitator

• Skill building post webinar call 8/14/13, 10:30-11:30

Any more questions?