1. Michigan Community Dental Clinics Quality Improvement with a Patient Centered Perspective August 5, 2014

2. Discussion Questions  What, if any, barriers does MCDC face when instituting quality improvement in its dental clinics?  How is baseline quality data obtained?  How is clinical quality measured?  How is administrative quality measured?  How does peer review have a place in clinical quality improvement?  How is clinical quality improvement performed without animosity among clinical staff?  How is quality improvement information shared with staff?

3. Discussion Questions con’t  How does MCDC include productivity as a part of quality improvement?  Does MCDC use quality improvement processes such as Six Sigma or LEAN? If so, how are staff trained?  How often are formal quality improvement reviews performed?  Does MCDC partner with universities or other community partners to expand its quality improvement capacity and expertise?  Could MCDC share any patient satisfaction surveys that have been used in its quality improvement process?  Could MCDC share any staff satisfaction surveys that have been used in its quality improvement process?

4. Presented by: Nicole Murray RN BSN

5.  Our Mission: ◦ to create and expand access to ever improving quality dental care for Medicaid recipients and low income, uninsured individuals.  Our Vision: ◦ to have a healthy Michigan population who assume responsibility for their own wellness, with our staff’s guidance and proper intervention.

8.  2013 ◦ 179,068 Total Office Visits ◦ 65,269 Patients received care in our clinics  51% Adults 21-60  40% Children 1-20  9% Senior Adults over 60

10.  In an effort of transparency, the primary objective of the QI Department is to assess, develop, and implement MCDC community standards.  These efforts support our organization’s quest to provide oral health care services with a patient centered perspective.

11.  Director(s) of Quality Improvement & Patient Safety ◦ Amanda Desjardins DDS ◦ Rebekah Sheppard DDS  Quality Improvement Coordinator ◦ Nicole Murray RN BSN

12. Assess Develop Implement

13.  MCDC entered into a partnership with Press Ganey in 2012.  This collaborative relationship has ultimately improved the MCDC patient experience by creating continuous, sustainable improvement.

14.  Patients are selected through a randomized process.  PG operators contact our patients by phone to complete survey.  Survey Questions have been modified for our organization and unique patient population.  In 2014: 5 surveys completed per clinic each month  Their sophisticated analytics help MCDC discover and prioritize key performance improvement efforts with real time Survey data.

15.  Each Quarter in 2014: ◦ new priority indexes will be calculated – providing each clinic their best opportunities for improvement  Top 3 OFI – Action Plans ◦ Clinic receives each quarter via email ◦ Action plans developed at the clinic level

16. NEW Add Clinic Specific Info REVISED

17.  2014 Press Ganey Score Board – Team Approach  Goals and achievements are reviewed at daily huddles and staff meetings

18.  Quality Assurance begins with a set of standards and accountability to one another.  Clinical and Administrative Policies & Procedures for the Dental Office were written in an effort to establish the MCDC community standard of oral health care delivery for our providers.  A Provider Evaluation (OPPE) will be conducted on each provider annually. The QI Department will be responsible for completing and communicating findings with providers, administration, and board of directors.

19.  Provider Evaluation process begins in June.  Approximately 6-10 charts will be randomly selected for review within 30 days of provider’s scheduled evaluation.  QI department is responsible for reviewing charts and completing assessments together

21.  Was a Dental Diagnosis documented or completed prior to rendering treatment?  Was the treatment reviewed with the patient prior to initiating and was an appropriate consent obtained?  Were radiographs taken per MCDC guidelines?  Was the procedure properly documented in the patient’s clinical note?  Was the next appointment needs documented and scheduled with the patient?

22.  Is the treatment plan consistent with the patient’s desire, in relation to their exam, diagnosis, and prognosis?  If anesthetic was required, was the type and dosage used appropriate?  Did the radiograph’s quality meet the MCDC community standard of care?

23.  Restorative  Endodontic  Oral Surgery  Prosthodontics

24.  Attendance at Spring Doctor Meeting  Does provider actively participate with Doctor’s Corner?  Does Provider engage with MCDC administration via email communications?  Does Provider participate in any MCDC adjunct committees?

25.  If a specific concern is identified, a focused evaluation may be warranted.  A new hire will be clinically evaluated within 90 days of their employment.  An FPPE may also be completed on a case by case basis and initiated by the DQIPS.

27.  An interactive resource to share information with other providers  Cases are posted for DDS review & comment

30.  Quality Concerns – Case Submission ◦ MCDC staff members are required to alert the DQIPS or QI department of any quality or patient safety concerns.  Email  Phone call ◦ Patient Safety Hotline – (January 2014)  Accessible from IES Exchange  Anonymous  All staff have access ◦ Concerns will be reviewed by the QI Department. If appropriate, the concern may be forwarded on to the committee for review.

31. Access from IES Exchange

32.  Committee Duties ◦ Care rendered by provider will be reviewed by the committee upon the request of the DQIPS. ◦ The members are tasked with validating the issue of quality and safety in question and presenting a recommendation to the Chief Dental Officer.  Key Points ◦ The anonymity of the provider, patient, & clinic will be maintained throughout the entire review process. ◦ All pertinent information will be presented to members in a confidential format in order to preserve objectivity. ◦ The preferred venue for improvements is the MCDC Performance Improvement Program.

33.  Performance Improvement Program ◦ Designed to provide assistance for providers who may have challenges practicing within the MCDC Community standard of practice. ◦ Upon recommendation, active participation is presumed.  Program Initiation ◦ Self-Reporting by the dentist to senior management team. ◦ A recommendation from the Quality Improvement & Patient Safety Committee following a review of provider’s delivery of care.

34.  Option 1- Internal Mentorship ◦ Consists of an employed dentist that has been identified as one who has demonstrated competency in the specified area of concern needing improvement by participating dentist. ◦ The specific improvement opportunities will be discussed with the mentoring dentist and participating dentist. A clinical competency checklist will be created specifically for those needs that have been identified.

35.  Option II – External Membership ◦ The selection of the external mentor will be a collaborative effort between the DQIPS and participating dentist. ◦ The specific improvement opportunities will be discussed with the external mentoring dentist and participating dentist. ◦ A clinical Competency checklist will be created specifically for needs identified. ◦ Formal written feedback will be provided to DQIPS regarding final impression and any improvement identified for the participating dentist.

36.  Option III – CE Instructional Program ◦ Upon recommendation of committee, the dentist may be directed to participate in a CE Instructional Program with specific course content to facilitate improvement for an area of identified concern. ◦ The selection of the CE Course will be a collaborative effort between the DQIPS and participating dentist. ◦ The costs associate with the selected CE Program will be the responsibility of the participating dentist.

37.  Questions?