Engaging Front Line Staff in QI - chad.memberclicks.net Quality Improve… · •Set your data strategy •Define your staff engagement needs with your data strategy •Validate and

*All documents are property of CURIS Consulting. Do not duplicate or distribute without written permission.

Changing-Creating-Connecting-Coordinating

Engaging Front Line Staff in QIPrepared by: Shannon Nielson, MHA, PCMH-CCE

Prepared for: CHAD

2.12.19

*All documents are property of CURIS Consulting. Do not duplicate or distribute

without written permission.

www.curis-consulting.com

Meet the Team

Brittany MarkusEngagement

Manager

Shannon Nielson

MHA, PCMH-CCE

Principal Consultant

Jennifer Calohan

RN, TQMP, PCMH-CCE

Principal Consultant

CURIS consultants bring several decades of

experience in the Health Center, PCA/HCCN, and

healthcare industry and provide the expertise

needed to help create clinical, operational and

financial excellence.

• HRSA/FTCA Compliance

• PCMH Recognition/Transformation

• Practice Performance and Operations

• Data Analysis and HIT/HIS Optimization

• Quality Improvement and LEAN-Six

Sigma

• Program Development and

Implementation

• Clinical Integration

• Strategic Organizational Leadership

• Clinical Workflow

• Risk Management

• HCCN/PCA Optimization

[email protected]

*All documents are property of CURIS Consulting. Do not duplicate or distribute


QI01: (CORE): PLAN

A.1 IZ Measure: ______________

B. 1 Prev. Care Measure: ______

C.1 Chronic/Acute Measure:___

D.1 BH Measure:________

QI02: (CORE): PLAN

A.1 Care Coordination Measure:

______________

B. 1 Cost Measure: ______

QI04: (CORE): PLANA. Patient Satisfaction Survey Including (min

3):

A. Access Y N

B. Communication Y N

C. Coordination Y N

D. Whole Person Care Y N

B. Qualitative Feedback (Non-Survey)

Y N

QI03: (CORE): PLAN

Appointment Availability Report

Y N

QI05: (1 CREDIT): PLAN

A.Clinical Quality Disparity (min 1):

______________

B. Pt. Experience Disparity (min. 1):

______

QI108: (CORE): DO

SET GOALS TO ACT TO IMPROVE (min. 3 from

QI01 across 3 diff. categories

A. IZ GOAL: Y N: PDSA: Y N

B. Preventive: Y N: PDSA: Y N

C. Chronic/Acute: Y N: PDSA: Y N

D. BH: Y N: PDSA: Y N

QI109: (CORE): DO

SET GOALS AND ACT TO IMPROVE (Min. 1 from QI02)

Set Goal for: QI02-A QI02-B

PDSA for above: Y N

QI11: (CORE): DO

SET GOALS AND ACT TO IMPROVE (Min. 1 from QI04)

Patient Experience Measure Goal: _______

PDSA from above? Y N

QI109: (CORE): DO

SET GOALS AND ACT TO IMPROVE

Goal for QI03:__________

PDSA for QI03: Y N

QI13: (1 Credit): DOSET GOALS AND ACT TO IMPROVE (Min. 1 from

QI05)

Goal for QI05:__________

PDSA for above: Y N

QI12: (2 Credits): STUDY/ACTAchieved Performance (min. 2

from QI 08, 09, 11)

Demonstrated Improvement

Measure 1 (QI 08, 09, 11):

______________________

%Improved for Measure 1:

__________________________

Demonstrated Improvement

Measure 2 (CI 08. 09, 11):

______________________

% Improved for Measure 2:

___________________________

QI14 (2 Credits): STUDY/ACT

Demonstrated Improvement on Measure

from QI13: __________________

% Improved: _________________________

*All documents are property of Curis Consulting. Do not duplicate or distribute


FMEA Tool – Failure Mode & Effects AnalysisWhat is the process to be examined? QI PROGRAM DESIGN/STRUCTURE

Interventions

to Mitigate

Failure

Current

Process

Anticipated

Failures

What PDSA will you do?



Improve = Do• The Plan-Do-Study-Act (PDSA) cycle is part

of the Institute for Healthcare Improvement(IHI) Model for Improvement

• Simple yet powerful tool for

accelerating improvement

• *By using the PDSA cycle to

incrementally test change in an

effort to improve, we are able to

apply pragmatic steps of Process

Improvement toward reaching the

strategic level goalshttps://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle

https://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle



Key PCMH Criteria

CRITERIA DESCRIPTION Data

Methodology

How to Use Annual Reporting

PCMH?

Alignment

TC07: Staff

Involvement in QI

The documented process

for quality improvement

activities includes a

description of staff roles

and staff involvement in

the performance

evaluation and

improvement process.

PDSA Tracking Staff/Provider

Engagement

In alignment with

monthly staff quality

dashboard

NO HRSA QI

Plan/Program

KM06: Predominant

Conditions and

Concerns

The practice identifies its

patients’ most prevalent

and important conditions

and concerns, through

analysis of diagnosis

codes or problem lists.

UDS Table 6A (if

can run by site)

Billing system;

encounters by

dx and CPT

code

Selection of relevant

interventions to

address clinical

needs

Selection of

community

resources/specialists

NO UDS: Table 6A,

Table 5

Community

Needs Assessment

KM07: Social

Determinant of HealthThe practice collect,

monitors and implements

interventions relative to

SDoH.

UDS

Patient

reporting/Staff

assessment

Community

Resource need

development

Staff Training

NO

KM20: Clinical

Decision Support

The practice has

adopted min. 4

electronic clinical

decision support

mechanisms. This will

insure efficiencies and

standardization of care

EMR

Quarterly

provider/nurse

documentation

auditing

Standardization of

care and create

efficiencies during

patient visit

NO Meaningful Use

KM27: Community

Resource Assessment

Do patients utilize

community resources

they are referred to? Are

they satisfied and do they

work for them?

Patient

Interview

Efficacy of

community

resources;

community building

NO



Key PCMH Criteria

CRITERIA DESCRIPTION Data

Methodology

How to Use Annual Reporting

PCMH?

Alignment

AC11: Patient Visits

with Care Team

Are patients able

to/willing to see currently

designated PCP?

EMR Access. Determine

opportunities for continuity.

In alignment with other

access measures: is access

issue: Scheduling, capacity

or process?

NO

AC13: Panel size

Review and

Management

Have you calculated

realistic panel sizes due to

supply and demand?

EMR Determine utilization based

productivity and capacity.

Measure Actual panel size

vs. Right panel size

NO

CC07: Performance

Information for

Specialists

What are the clinical

outcomes for patients you

share with certain

specialists?

EMR Measure performance and

opportunities for alignment

with specialists based on

shared patient clinical

outcomes

NO

CC14: Identify

unplanned

hospital/ED visits

Who are our patients that

are accessing the

hospital/ED. Is there

appropriate utilization?

EMR/i2i Reduce # inappropriate

utilizersYES

Q01: Clinical Quality

Measures

Monitor and act to

improve 5 clinical

measures

EMR/i2i Improve quality YES Meaningful Use,

UDS, HEDIS

QI02: Resource Use

and Stewardship

Monitor and act to

improve on 2 CC or Cost

measures

EMR/i2i Improve quality YES Meaningful Use,

UDS, HEDIS

QI03: Appointment

Availability

Assessment

Determine if appointment

availability meets the

demand of your patient

population

3NA Report Improve access YES



What we know…

PCMH

UDS

FTCA

Pt. Satisfaction

Surveys

HIE

ACO/APM

EMR

Meaningful Use

HEDIS



What they hear…

PCMH

UDS

FTCA

Pt. Satisfaction

Surveys

HIE

ACO/APM

EMR

Meaningful Use

HEDIS



Meaningful Quality

Efficiency Effectiveness Quality

Quality Impact Value



Patient Staff Engagement

• Importance

• Confidence

• Readiness



Foundations for Engagement in Quality• Importance

• Purpose

• Data

• Confidence• Ownership

• Data

• Reward and Recognition

• Readiness• Responsibility

• Data



First Things First…Importance



We have to do it for UDS…

Reason• We have to do it for UDS

Purpose• Improved documentation gives

us a better understanding of our opportunity to improve quality

• Where should we focus based on how patients utilize us

• We can identify a focused opportunity for growth/access

• Alignment with PCMH and HEDIS



We have to do it for PCMH

Reason• For PCMH we need to huddle

• We need to pick a CM population and you have to document goals

• We need to complete PDSAs to show CQI

Purpose• Improved communication and pre-

visit planning should create efficiencies, improve pt. experience and maximize your skill set

• There is a population that is more at risk and we can provide ongoing care management support to mitigate the risk and reduce risk

• Where is there an opportunity to improve and how do you think we can do it?



We have to do…. We need you to…

• By doing X we can improve Y

Yes, it’s that simple



Importance: Systems Level DataLeadership/Governance

MoneyMission

Mid-level ManagementMoney

Staff SatisfactionEfficiency

Front Line StaffPatient Satisfaction

QualityEfficiency

PatientsQualitySafetyCost



Data Usability

• Actionable• Lists

• Contact Information

• Population Based

• Team Relevant

• Realistic Measurable Outcomes• Process vs. Outcome

• Consistent



Data Visibility

• PLAN without data is a Wish

• DO without data is Simon Says

• STUDY without data is Water Cooler Gossip

• ACT without data is Groundhog’s Day



Systems Level Data Sharing



Confidence

• Ownership

• Data



Confidence: Ownership

• Responsibility vs. Duties• Responsible

• Accountable

• Informed

• Consulted

• Innovation vs. Direction• Quality Teams

• Staff PI teams

• Failure is Fabulous



Confidence: Data

• Test informed data

• Can you really improve A1Cs in 2 weeks

• Qualitative Data

• Patient Feedback

• Staff feedback



Confidence: Reward and Recognition

• Reward Money• Presentation

• Announcements

• Creative incentives

• Competition Drives Engagement• Transparent Data

• Aligned Goals



Readiness: Responsibility

• Scope of Licensure• Team Based Care

• Role purpose

• Expected Outcomes

• Purposeful Process• Skill vs. Availability

• Communication and Access

• Expected Outcome



Readiness: Data

• Data Rules:• Platinum Rule: How will the data be used

• Golden Rule: How are the elements defined

• Silver Rule: When should you see the data change?

• Data Process:• Set your data strategy

• Define your staff engagement needs with your data strategy

• Validate and create your data

• Provide meaningful, actionable, baseline data

• Provide ongoing demonstrative, reactive data



Employee Satisfaction vs. Employee Engagement



Employee Engagement Surveys

• My roles and responsibilities are clearly defined

• My daily activities match my job description

• My skills/licensure/experience is used in my daily activities

• Most of the systems and processes here support us getting our work done effectively and efficiently

• I am given the opportunity to contribute my ideas and opinions on how we can improve

• I am given the opportunity to contribute my ideas and opinions on how we can improve

• Day to day decisions demonstrate that quality and improvement are top priorities

• Our organization promotes non-management employee participation in projects and committees

• What resources, tools or systems are needed to better help you do your job?

• What activities/committees/projects would you like to be involved in or see other staff members involved in?

• What would you like to most see improved upon in the organization that would result in enhanced engagement and satisfaction? (Examples include: EMR optimization, job clarification, communication, team building...)



Motivational interviewing for you

•O: Open ended questions

•A: Affirmations

•R: Reflective listening

•S: Summarize



PCMH: It’s not a 4 letter word

Team Based Care

Knowing and Managing your

Patients

Patient Centered Access and Continuity

Care Management and Support

Performance Management and

Quality Improvement

Care Coordination

and Transitions



Putting Quality into Action

Access is the

opportunity

for care

Quality is the opportunity

for cost

Cost is impacted

by

“appropriateness”

of access

Appropriate

access is driven by

your population’s

care needs

Care needsdrive a

Provider’s adoption of

quality

Adoption of quality

drives your

population health

management

activities

PCMH activities drive

the ability to improve

access beyond your

patients

Spreading your value beyond your patients is VALUE BASED

CARE

Care is the

opportunity

for quality



UDS and PCMH

• PCMH: A Set of Population Health Management strategies that should result in improved outcomes, decreased cost and improved experience

• UDS: A data set and reporting strategy that should provide information to impact the health of the population you serve



How to use UDS for PCMH

• Team Based Care:• No Direct Alignment, BUT…..

• Do we have the appropriate people on the care teams to address the needs identified in Tables 3A, 4, 6A, B, Table 7?




• Knowing and Managing your Population• KM01/KM06: Use Table 6A; identify your top DX for KM06• KM07: Does Table 3, 4 or 7 indicate SDOH? Does Table 5 or Table

6A illustrate appropriate interventions?• KM09, KM10, KM11: Does Table 3B indicate need for other

languages? Does it indicate need for cultural competency or sensitivity training?

• KM13: Are you a HC Quality Leader?• KM20: (Indirect) have you implemented decision support for

primary diagnosis in 6A? Do you see an impact on Table 5A, Table 6B or 7?

• KM21: Does Table 3A&B demonstrate need for community resources?




• Patient Centered Access and Continuity

• AC03: (Do not make extended hours at a site that is far from majority of population—Table 3A)

• AC09: Can you identify trends in utilization by disparities? Table 6A stratified

• AC13: (indirect) does Table 5A align with your panel sizes? Are there provider outliers?




• Care Management and Support• CM01: Does table 6A

indicate overutilization? Does table 6B or 7 indicate a quality of care need? Does table 4 indicate SDOH?




• Care Coordination and Care Transitions• CC10: (Indirect) Use table 5 and Table 6A to identify “shared”

patients and create your integration plan




• Performance Measurement and Quality Improvement• QI01: Don’t just pick the UDS measures because you have

them—use them if they mean something!• QI02: Is your Depression F/U plan a referral to BH? (Table 6B) Use

Table 6A to identify utilization opportunities • QI03: (Indirect) when monitoring patient retention, do you see

similar data in your appt. availability and utilization?• QI08-09, 13-14: Trend your UDS data year to year- OR MORE

OFTEN (6A,6B and 7)• QI15: Do you share your UDS data with your practice (will still

need Pt. Experience data)• QI16: UDS Mapper or UDS Roll up report

Documents

Engaging Front Line Staff in QI - chad.memberclicks.net Quality Improve… · •Set your data strategy •Define your staff engagement needs with your data strategy •Validate and