Quality Indicators in Residential Aged Care Services (RACS) Overview: Using Quality Indicators to make a positive difference to resident care

The RACS Quality Indicators Online Resource Developed by the Victorian Department of Health and Human Services, Ageing and Aged Care Branch Quality Indicators in RACS Resource: Overview 2 13 Measures

The Overview Module covers the What, Why and How of using QIs for improvement. The module will help you: Quality Indicators in RACS Resource: Overview3 Understand why quality indicators are important Ensure everyone in the organisation has a role in using indicators And – Test your Knowledge! Make indicators part of your quality improvement plan Use the data to identify and make improvements Collect meaningful data

Quality Indicators in RACS Resource: Overview4

Test your ‘pre’ knowledge! 1.True or False: Quality Indicators help identify problems areas only  True  False 2. Effective use of quality indicators for improvement depends on: A.The way you collect the data B.The way you present the data C.The way you use the data D.None of the above Quality Indicators in RACS Resource: Overview5 Pre-Quiz

Test your ‘pre’ knowledge! 3. True or False: All complex systems such as aged care will experience variation in the quality of their care  True  False 4. This group must be involved for Quality Indicators to be most effective: A.Residents and families B.Board C.Both A and B D.Neither A nor B Quality Indicators in RACS Resource: Overview6 Pre-Quiz

How did you go? Quality Indicators in RACS Resource: Overview7 Quiz

The What: What is a QI and What do we want to achieve by monitoring Quality Indicators? Indicators have many names… …but just one goal… To measure, report and improve performance As part of your strategy for creating safe, high quality resident care Quality Indicators in RACS Resource: Overview8 A tool to help us identify performance issues, flag concerns and prompt us to make improvements to care’ (Arora et al. 2007) QIs can:  Describe good care  Set goals  Inform on progress and performance

The Why: Why is monitoring Quality Indicators important? Indicators are a valuable tool for monitoring the safety and quality of our care as part of a broader improvement program. 1. QIs focus us on important and high risk areas of care. 2. QIs can alert us to care problems – that impact on both quality of care AND quality of life – and areas of excellence - we wouldn’t otherwise know about. 3. The most useful QIs also tell us about our broader standard of care. Quality Indicators in RACS Resource: Overview9 It is not possible to measure every aspect of care

The How: How to collect and use indicators to achieve real improvement (1) To make indicators useful, concentrate on getting three things right: 1. The way you collect the data 2. The way you present the data 3. The way you use the data Quality Indicators in RACS Resource: Overview10 Making indicators useful View indicators as bringing you useful information on your progress towards excellence, not as something you have to do, or leading to punishment for substandard care.

The How: How to collect and use indicators to achieve real improvement (2) 1.The way you collect the data  Train staff to collect valid and reliable data:  How the data will be used  Definitions  Data sources and collection rules. Quality Indicators in RACS Resource: Overview11 Making indicators useful It’s better to collect a limited number of indicators, and do it properly so you have data that tells you what’s really going on.

The How: How to collect and use indicators to achieve real improvement (3) 2. The way you present and respond to the data  Numbers by themselves are not very helpful  So we compare the numbers to targets and thresholds  How we analyse this depends on the issue we’re measuring and what we want to achieve The results you get for any indicator may be explained in a number of ways: Quality Indicators in RACS Resource: Overview12 Making indicators useful Remember! Indicators are just indicators. Don’t jump to conclusions! – ask: Is this a real issue? Do we need further information to tell us what’s really happening? What explanations could there be? Inaccurate data One-off event New residents Changes in practice or systems Natural variation

The How: How to collect and use indicators to achieve real improvement (4) 2. The way you present and respond to the data All complex systems have variation in how well and consistently they provide services. So…results will naturally vary. Quality Indicators in RACS Resource: Overview13

The How: How to collect and use indicators to achieve real improvement (5) Quality Indicators in RACS Resource: Overview14

The How: How to collect and use indicators to achieve real improvement (6) 2. The way you present and respond to the data Quality Indicators in RACS Resource: Overview15

The How: How to collect and use indicators to achieve real improvement (7) 2. The way you present and respond to the data RACS currently collect data on 13 measures across 5 key risk areas for aged care residents. Aged Care Services may wish to collect further indicators for internal use. Data are collected and submitted quarterly. Quality Indicators in RACS Resource: Overview16 The Department sends reports back to the health services:  Detailed report for each indicator  Summary report for boards and executives  A report that can be used to communicate results to consumers

The How: How to collect and use indicators to achieve real improvement (8) The results are analysed and presented to help services make considered decisions about responding to the data: Quality Indicators in RACS Resource: Overview17 Raw numbers show the number of events, for example, the total number of falls The rate for each indicator, per 1000 bed days – this enables comparison between facilities The State rate: the mean rate across all facilities Reference ranges: the high and low limits against which you can assess your trends Target – the lower reference range – and you can set your own!

Collecting and reporting data for comparison Quality Indicators in RACS Resource: Overview18 20% 4% 5% 6.67% 10%

The How: How to collect and use indicators to achieve real improvement (9) 2. The way you present and respond to the data Quality Indicators in RACS Resource: Overview19

The How: How to collect and use indicators to achieve real improvement (10) 3. The way you use the data QIs are most useful when they’re used purposefully - as part of your improvement plan. What is our goal?  Reducing the number of things that go wrong?  Making more things go right?  Keeping an eye on something that’s working well?  Helping to inform resident choice of a residential aged care facility? Quality Indicators in RACS Resource: Overview20 Making indicators useful The clearer you are about the purpose of collecting indicators, the more useful they will be.

The How: How to collect and use indicators to achieve real improvement (11) 3. The way you use the data Follow a structured approach to improvement: PDSA Share it with managers and translate it for staff Ask for ideas on improving Use a simple, solid change and improvement strategy Don’t try to improve everything at once Quality Indicators in RACS Resource: Overview21 Making indicators useful When discussing quality indicators, it’s easy to get caught up in the process, and forget the ‘why’. The bottom line should always be ‘Is this indicator helping us to improve care and services for residents?’ Plan Do Study Act cycle

Quality Governance : everyone has a role to play Quality Indicators in RACS Resource: Overview22 Board and Executive: provide leadership, planning, systems, resources and monitoring to support safe, high quality care Managers and quality improvement personnel: understand and apply quality indicators to improve care Residents, families and visitors: ask questions and make suggestions Point of care staff: monitor care and suggest and make improvements

Quality Indicators in RACS Resource: Overview23

Quiz 1.True or False: Quality Indicator results should always be taken at face value:  True  False 2. Quality Indicators are important because they: A.Are developed by the Department of Health and Human Services B.Are reported to the Board C.Produce interesting graphs D.Focus us on important and high risk areas of care. Quality Indicators in RACS Resource: Overview24

3. True or False: These are the three things you must get right for Quality Indicators to be useful:  The way you collect the data  The way you store the data  The way you use the data  True  False 4. Which one of the following is not important in collecting valid and reliable data? A.Clear definitions B.Everyone knowing when you’re collecting the data C.Understanding how the data will be used D.All of these are important. Quality Indicators in RACS Resource: Overview25 Quiz

5. Quality indicators are most useful when they: A.Show consistently poor results B.Are used as part of an improvement plan C.Are posted on your organisation’s website D.Are used to increase the variation of results and practice 6. True or False: Quality Indicators are only useful to managers  True  False Quality Indicators in RACS Resource: Overview26

How did you go? Quality Indicators in RACS Resource: Overview27 Quiz

Using Quality Indicators to make a positive difference to resident care Quality Indicators in RACS Resource: Overview38 End of Overview Module

Quality Indicators in RACS Resource: Overview29 To receive this publication in an accessible format Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, December, 2015 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. ISBN (Online) Available at quality/workforce-training-development/online-training