1. Evercare Quality Improvement Awards Suzanne C. Cryst, RD, CSG, LD

2. Faculty Disclosures: Suzanne Cryst has disclosed that she has no relevant financial relationship(s).

3. Learning Objectives Learning Objectives By the end of the session, participants will be able to: Understand steps to affect interdisciplinary change Identify 5 factors involved in this process improvement project Understand the positive impact of change

4. Facility Demographics Maria Joseph Center Dayton, Ohio 351 beds during Improvement Process 331 Beds Currently Not for Profit Facility Independent Ownership

5. Look Familiar ?

6. Improving Outcomes Unplanned Significant Weight Loss –Exceeding bench mark of less than 10% per month –Based on monthly in-house data collected and Zimmerman Report Objectives –To identify contributing issues –To shift focus and process to implement change –To improve overall outcomes

7. Project Timeline The process began December 2002 –Data gathering began with issues affecting weights –Assess Nutrition Services ( NS ) Department data –Assess factors outside NS Department –Conclusion - this was an interdisciplinary issue

8. Project Timeline, continued Planning & Implementation –Assembled Data and discussed with Medical Director – fourth quarter 2003 –30 minute discussion with Quality Management Committee Outlined problem and concept Identified potential Stakeholders Planned team meeting time and duration Received consensus to start

9. Project Timeline, continued Study ended March 2007 –BUT... Continue to monitor and evaluate –Monthly weights –Benchmarking reviews –Scorecard reporting

10. QI Planning & Implementation Committee Design –Chair- MDS 2.0 RN –Facilitator – Director Nutrition Services/RD,LD –1 RN/DON + 1 RN Assessment Nurse –4 STNA’s –2 DTR’s –Ad hoc – Medical Director, 2 CDM’s + 1 NS Coordinator

11. QI Planning & Implementation, continued Team meetings Start with IDT issues Initial – 3 – 45 minute sessions Subsequent team meetings – 30 minutes – planned for 4 months to implement this IDT segment Plan education sessions as issues arise Monitor and Evaluate throughout the process

12. QI Planning & Implementation, continued Communication of Plan and Results via –Staff Development –Nursing Leadership –Staff Meetings –Work Group Members to Peers –Care Plan Meetings –Facility Newsletter to Employees –Resident Council Meetings –Food Committee Meetings- new, increased frequency

13. Issues Encountered –December 2002 - 17% unplanned significant weight loss –38% supplementation usage –Historical Food Satisfaction Scores- low 60’s –Accuracy of meal intakes being recorded inconsistent

14. Issues Encountered, continued –2 different Weight Policies in writing –No standard policy for process on the 7 units –Nutrition not involved in process until after recorded in the Medical Record –Interdisciplinary team not involved

15. Issues Encountered, continued –Lack of consistent vehicle to communication Acute Resident Issues to the IDT –Lack of process for implementing interdisciplinary change –Lack of framework to be Proactive vs Reactive

16. Tools Used to Affect Change Education session for Work Group on Facilitating Change Charter Development –Purpose –Current issues & measures –Team members –Timeline –Focus –Documentation reported to:

17. Tools Used to Affect Change, continued Development of ground rules Consensus building focus Reporting document format Subject Discussion Recommendations Responsible Party Time Frame

18. Tools Used to Affect Change, continued Weight Tracking Tool Development of One Weight Policy Development of Weight Procedures Development of Weight Reporting Process

19. Tools Used to Affect Change, continued Report and Celebrate the Victories Recognition of Staff that went “Above and Beyond” Staff teaching Staff

20. Facility Expenses 942 Employee Hours over 39 months $300.00 – Gift Cards to “Thank” the Work Group Members

21. Outcomes A Great Work Group –Improved working relationships/ communication Consensus for One Interdisciplinary Weight Policy Consensus for Facility Weight Procedure –Less rework, Consistent MDS 2.0 reporting

22. Outcomes, continued Unplanned Significant Weight Loss % –Dec.2002- 17% –May 2004 – 9.8% –Second Quarter Average 2005 – 8.3% –March 2007 – 4% Supplementation usage reduced –From 38% to average of 15% = $1600/month savings

23. Outcomes, continued Customer Satisfaction Scores –Steady improvement 2005- 76% First Quarter 2007 – 81.18% Accuracy of Meal Intakes Improved –32% improvement in recording after education session Nutrition Service “Food First” Focus

24. Outcomes, continued Proactive vs Reactive - everyone has a voice in Morning “Stand-up” or Care Conferences or 1:1 meetings Created a framework for future projects –Templates and strategies used via the QMC and CQI Committee

25. Closing Thoughts This project can be implemented in other facilities because it was based on a purpose, related to current issues that were not acceptable, related to benchmarking measures. The process to move forward is consistent with any other problem solving task.

26. Closing Thoughts, continued Lessons Learned- –Consensus is KEY –Patience & Flexibility & Focus –Revisit issues – reinforce positive outcomes –Monitor –Re-educate as necessary

27. Closing Thoughts, continued Helpful Tips/Insights- –Seek out those in your organization who have the qualities of a change agent and get them involved. This person is not always in leadership position. –Be open to change. A process may not appear to be broken, but it could be better.

28. Closing Thoughts, continued Questions