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Sponsored by the Sponsored by the National Association of Community Health CentersNational Association of Community Health Centers
Presented By Shoreline Health Solutions, LLCPresented By Shoreline Health Solutions, LLC
Trudy Brown Ripin, MPHTrudy Brown Ripin, MPH President & President & FounderFounderMolly K. Gwisc, MPHMolly K. Gwisc, MPH AssociateAssociate
Performance Improvement in Performance Improvement in Community Health CentersCommunity Health Centers
Presentation GoalsUnderstand Performance Improvement methodology, as
well as practical techniques for quality improvement.
Effectively use the PI model in a new start Community Health Center
Review case studies to demonstrate PI in real scenarios
Understand proactive and reactive performance improvement strategies
Improving Performance
How do we know we are providing high quality care and services?
Do we set and achieve appropriate and realistic goals?
How do we measure improvement?
What is Performance Improvement?
Performance Improvement (PI) is a continuous, systematic process for improving the agency’s care, service and operations.
Why do Performance Improvement?
Methodological way to ensure high quality care & patient safety
Tells you if changes worked
PI model gives you concrete steps to simplify a complex process
BPHC and JCAHO require it
What If We Don’t Measure?
You won’t know if the change WORKED
You won’t know WHICH PART of the change worked
You could make things WORSE
Others may NOT BELIEVE the change worked
Selecting a PI Project
Triggered by a specific incident
Based on existing data trends
Prioritizing: High Risk, High Volume, Problem Prone
Directly impacts patient care or patient satisfaction
Key Elements of a PI Model1. Establish baseline
2. Set benchmark
3. Make change
4. Measure your change
5. Follow-up
FOCUS - PDSA
PDSA is one of many models for PI
Four - step cycle to plan and measure change
FOCUS component maps out Pre-Work to PDSA
FOCUSFind a process to improve
Organize a team
Clarify what is currently happening (baseline data)
Understand where and why problems occur
Select the process improvement and benchmark
PDSAPlan the Performance Improvement strategy
Do a trial run, collect data as you go
Study your resultsWas there a measurable improvement?If not, go back to PLAN until benchmark is achieved
Act! Ongoing monitoring for sustained improvement
Operational PI ExamplesPatient Wait Time
Patient Satisfaction
Staff Satisfaction
Claims Denial
Collections
Operational PI Case StudyImproving Patient Wait Times
F Chose wait times in response to patient demand - patient complaints
O Formulated team involved in areas of wait time – included a clinical provider, medical assistant, registration staff, billing staff, senior management
C Collected baseline data through wait time study
U Understood problem areas by clarifying where delays occur - delays occurred at registration, waiting in exam room, and billing
S Selected to de-centralize intake as first process improvement – benchmark is reducing wait time by 20 minutes.
Operational PI Case StudyImproving Patient Wait Times
P Plan thoroughly developed and outlined by team
D Plan implemented in pediatrics
S Data collected and not at benchmark – repeat cycle
A Benchmark achieved!! Implemented changes in all departments
High Level Integration
An effective PI program incorporates all data sources through a central PI Committee and integrated PI Program infrastructure.
PI Committee StructureSelect Representative MembersIntegrate into all sitesMeet regularlyAppoint PI CoordinatorComplete assignments between meetingsSelect 1-2 PI Priorities AnnuallyAppoint PI TeamsEnsure Ongoing MonitoringReview Key Data Trends From All Sources
Components of PI ProgramProactive Strategies
Peer Review Chart Completeness Review Informed Consent – High Risk
Procedures Patient Satisfaction
Reactive Strategies Incident Tracking Patient Complaint Tracking Sentinel Event Response
Peer Review• Providers Review Each Other’s Charts
• Standardized Audit Tool
• Identify Trends
• Report Results to Staff and Leadership
Peer Review GoalsReview Individual Trends Over Time
Review Clinical Practice Trends
Answer Specific Clinical Questions
Chart Completeness Review
Evaluates Medical Record Documentation
Checklist is Standardized
Usually Done Monthly
Can Be Done By Non-Clinical Staff
High Risk Procedures – Informed Consent
• What is a High-risk Procedure? Risk Of Serious Complications
Examples Include Perforation & Infection
• Informed Consent Needed Understand Benefits & Risks
Be Informed Of Alternatives
Good Clinical Care
Liability Protection/ Risk Management
Patient Satisfaction ProgramComponents of a Comprehensive Pt
Satisfaction Program
Surveys
Staff Training
Patient Suggestion/Comment Box
Patient Complaint Tracking System
Incident TrackingDocumenting the Event
Incident Review
Resolving the Incident
Identifying Trends
Patient Complaint Tracking• Identifies customer service and communication
problems
• Utilizes same process as Incident Tracking
Rapid response to each complaint
Feedback to patient describing agency response
Complaint patterns indicate systemic problems
Structured response to systems problems
Sentinel Event ResponseWhat is a sentinel event?
Near Miss
Do Not Wait for a Trend
Root Cause Analysis
Clinical PI ExamplesTriage:
Child with 104 degree fever scheduled for next day appointment
Walk-in patient left waiting for 2 hours when should have been sent to ER
Evaluation Missed Diagnosis Mis-Diagnosis Labs not ordered
Treatment Wrong medication prescribed Perforation during IUD insertion
Clinical PI ExamplesLab Issues
Patient given wrong person’s test results Lab tests ordered, but never done Results never come back from outside lab
Controlled Substances Stolen prescription pads / forged prescriptions Patient seeing multiple providers / pharmacies to
obtain controlled substances
Clinical PI ExamplesChart Documentation
Illegible handwriting Provider seeing patient without chart
Phone/ Communication Provider never receives patient message Language and cultural barriers
Clinical PI Case StudyFollow-Up for Abnormal Labs
F Identified problem through incident tracking.
O Team included Medical Director, Nurse Coordinator, Medical Assistant, Lab Tech, staff person receiving mail / fax / delivery of lab results.
C Baseline data collected via lab testing log, 3 week period reviewed.
U Problem areas included use of multiple outside labs, high volume, part-time clinicians, no clear person in charge of process.
S Identified responsible person to track all abnormal labs. Benchmark set at 100% follow-up rate within 24 hours of notification.
Clinical PI Case StudyFollow-Up for Abnormal Labs
P Plan thoroughly developed and outlined by team.
D Implemented for three providers
S Data collected: 24-hour follow-up achieved for 95% of cases. Not at benchmark – repeat cycle.
A Benchmark achieved!! Implemented changes for all providers.
Resources NACHC
www.nachc.orgwww.nachc.org
BPHCwww.bphc.hrsa.govwww.bphc.hrsa.gov
JCAHOwww.jcaho.orgwww.jcaho.org
Institute for Healthcare Improvement www.ihi.orgwww.ihi.org
Your State’s Primary Care Association/Organization
Contact us with questions (Trudy or Molly, Shoreline Health Solutions)
[email protected] or (860) 395-5630
