1. PEAL: Assisted Living/PEAL Quality Improvement Process:
Operationalizing your Quality Committee Approach to
Resident Satisfaction and Facility Compliance

2. Presenters Brian R. Purtell, WiCAL Executive Director
Lori Koeppel, Koeppel HSC, LLC

3. Goals
Continue and increase appreciation of significance of quality committee
Value, not another “task”
Foundational elements to operationalize
Review structure
Operating agreement
Committee elements checklist
Goal to make process familiar, routine, efficient/effective

4. PEAL Quality Committee
"Quality Committee"- by any other name...
Organization and structure
Who, what, when, and why
Operating document/"bylaws"
Minutes and Agendas
Effective and Efficient meetings
Prepare
Keep it moving
Document and follow up

5. PEAL Quality Committee
Reactive and Proactive
No major changes without review and input from committee
Clinical efforts
Sentinel events
Citations
Resident satisfaction
Quality of life
HR/workforce

6. Foundation to Operationalize
Leader verse in structure, process, and purpose
PEAL page as source for resources
Independent learning (and sharing)
Staff buy-in crucial, but that begins at the top
Structure in place-2 primary resources
Template for operating document/bylaws
Quality Committee Checklist
As leader, you need to first understand. Would not want a educator that is learning along with students, would not want a nurse training on infection control that does not wash their hands (or get their flu shot)
PEAL page has foundational information, but don’t hesitate to learn more (how many times have you seen that episode of Modern Family); as important, share resources you find that you have found useful.
No “we have to do this…”

7. Foundation to Operationalize
Structure in place-
Develop template rather than having to start fresh every time
Agendas
Minutes
RCA materials
Action Plan
Checklists
Communication forms-who, what, where, when (not why)
Create familiarity and consistency to allow energy focused on task at hand
Goal to get to a point where staff can huddle and conduct micro-process on issues not arising to committee level.

8. Foundation to Operationalize
Meeting preparation: Keep it focused, tight, and on task.
Review meeting preparation session
Hone and practice techniques to effective meeting management
Establish consistent and specific timing
Keep to agenda/schedule
Right people involved (be prepared to make changes if necessary)

9. Foundation to Operationalize
Participant, then staff buy-in.
Committee members need to understand purpose and goals
Engage them in development or review, and approval throughout
Why, not just what-otherwise just another meeting or task
Members should carry this through to staff when changes, additional actions and efforts, are communicated, e.g. why we are asking you do x, y, or z
Which would you rather:
“Starting today, I need you all to do the following…please check off that you have read this”
“As part of an effort to address an area for improvement, as part of a action plan developed with input from several dedicated individuals, including some of you, we are going to put in place the following…the goal we have set is…your feedback is welcome and appreciated if you have thoughts on how to achieve our goal…”

10. Foundation to Operationalize
Once formalized and in place, incorporate explanation as part of orientation and in-service.
Familiarize all with process
Explain how to advance concerns to committee
Familiarize personnel with terminology: problem statement, goal setting, action plan, RCA, monitoring, etc.
Opportunities for involvement (advancement)

11. Putting into Action-Satisfaction Survey Results
Results of survey coming out, what perfect time to engage.
Schedule meeting following survey results
Consider sharing with committee shortly in advance to allow individual review to cut down on meeting time.
Timing of session not coincidence. Next week results of satisfaction survey.

12. Putting into Action-Satisfaction Survey Results
Leader: Develop and distribute agenda
Will depend on facility, may need to begin with “old business”
Review survey results
Identify strengths
Discussion
Action steps?
Depending: Celebrate, recognize, reaffirm, thanks
Identify opportunities for improvement
Discussion of observations
Identification of priorities
Note response rate, as few can impact results
Not excuse to disregard, but may direct action.
Note, low/red numbers are obvious focus, but is there relatedness, trends, decreases over prior surveys (early warning); significant “strongly disagree, with otherwise majority “strongly agree” or “agree”
REMEMBER: Keep the group focused!!! Do not let discussion stray off topic. First opportunity for stray:
Tips:
Ok, we are getting ahead of ourselves trying to explain or solve this issue. Let’s remember we are simply looking at establishing priority items.
Thanks for that thought, but lets come back to the task before us, which is [current task]
That is an important issue, and if time today we can add that to the agenda, otherwise, let me make a note to have either a follow up with those critical to this immediatelty after, or possibly add to the next meeting’s agenda.

13. Putting into Action-Satisfaction Survey Results
Everyone should be afforded opportunity to provide input.
Leader should not “state” the answer:
Not: “well its clear where we need to work”
Rather: “I certainly have some ideas as to priorities, but I really want to hear from everyone else so that we can reach a consensus of focus”
“Mary, you certainly have identified some good points, but let’s hear from _____”

14. Putting into Action-Satisfaction Survey Results
Committee selects priorities, based on input and consensus
Keep it limited and realistic
Develop and agree upon Problem Statement per item
Identify possible measure
Define goal
RCA
Action Plan
Implement
Monitor
Note: all may not be possible in single meeting. More information may be necessary to gather, additional personnel may need to be brought in (or subcommittee assigned).

15. Performance Improvement Process
Case example:
Results received
Committee review
Consensus that “Activity programs are offered daily that interest me” is a priority item suitable for PIP.
Problem statement developed
Benchmarks identified
2017 survey result
Attendance at activities
Goals identified
RCA
5 why’s yield: “Facility does not have a suitable assessment/information gathering process to identify the individual needs/preferences/interests”

16. Performance Improvement Process
Case example:
Action Plan
Gather what we currently use
Research better tools from authoritative sources
Consensus reached on better version to use based on above
Current residents complete new version
Report information gained
Need to modify form/tool based on use?
Implement final version for all future admissions
Develop activities programming based on new information gained
Monitor participation
Report back to committee
Action needed?
Results returned from 2018
Celebrate or modify?