1. Quality/Performance Improvement Fundamentals Making Progress – Skill Building Session July 24, 2013 Pat Teske, RN,MHA pteske@cynosurehealth.org (661)755-5317

2. Agenda for Today Today Discussing common barriers Plan how to overcome these barriers Describe next webinar

4. Making progress but… We still have a way to go

5. Let’s try it Raise your hand and chat

6. Please don’t put us on hold

7. HEN Topics ADE CAUTI CLABSI EED Falls with Injury HAPUs OB Adverse events Readmisions VAE VTE SSI 7

8. Top 10 Improvements

9. Skill Building Exercise

10. #10 – Trace the process To understand a barrier trace the actual process Find out why it isn’t working they way you intended it to – Observe – Ask – Review To understand a barrier trace the actual process Find out why it isn’t working they way you intended it to – Observe – Ask – Review

11. Examples – Barrier staff expect someone else to complete the check list – What percentage of the time does the staff member complete the check list? – Why do staff members think someone else will fill it out? – Were staff using the check list involved with testing it? – What happens when you observe someone filling it out? 11

12. #9 Design to make things easy

13. Example  Follow through on fall prevention  Are there more steps in the process than there needs to be?  Are the fall prevention items easily accessible?  Is there a process to remove items once pt is discharged?  Not writing on the white boards  Not enough pens 13

14. #8 Be as clear as possible Barriers are sometimes caused because there is not a clear procedure or instructions on how to follow the process

15. Example Falls risk assessment is not being completed How are staff instructed on the assessment? What are the specific barriers to completing it? Is there a written procedure? Is it clear? Medication reconciliation is not performed well These same questions apply? 15

16. #7 Get into the weeds It is not enough to say the barrier is non- compliance we need to understand why?

17. Example Resistance to change – What is the change? – Were staff involved in testing the change? – Is there a champion? – What is causing the resistance? Patient non-compliance – Why isn’t the patient taking their medications once they are discharged?

18. # 6 Involve patients Are there opportunities to involve patients and their families? Ask the pt directly: What prevented you from staying out of the hospital? Why do you think you fell today? Are there opportunities to involve patients and their families? Ask the pt directly: What prevented you from staying out of the hospital? Why do you think you fell today?

19. Example Patient/resident does not have direct input – Is there a system to obtain pt/family input? – If input is obtained is it in a place that other care givers have access to it? 19

20. #5 Dig deeper If you think your barrier is “lack of buy-in” dig deeper

21. Example Staff Buy-In for consistent use of waiting area rounding – Digging deeper it was determined that there was a perception by the staff that they were unsafe Pens not available – Digging deeper it was determined the unit coordinator was concerned about spending money on the unit 21

22. # 5 Simplify Understandable Not too busy Easy to follow Balance the need for specificity with the benefit of simplicity Understandable Not too busy Easy to follow Balance the need for specificity with the benefit of simplicity

23. Example VTE order set – Can orders be simplified to two or three bucket approach EMR – Carefully examine key strokes – Reduce the number of clicks – Allergy update example

24. # 4 Design actions to get results Think about: – What can I test now! – What needs more time to accomplish – Focus on actions that you can test quickly

25. Example Barrier Staff do not get recognition when they involve the pt in managing pain and utilizing the pt communication board Action Pass out ‘special” dry eraser pens to those compliant staff On unit visit and recognition from CNO and/or CEO

26. #3 Try multiple ideas Is there more than one idea you can test?

27. Example Barrier Keeping all staff engaged in the provision of the enhanced AM care to embed and hard-wire this service hospital-wide Actions Identify AM care Champions on each unit, to model and drive the delivery of this service Reward and recognize staff members who embrace the enhanced AM care service Post the HCAHPS OVERALL Rating scores and positive comments from patients of each unit to show their success

28. #2 Look for bright spots Look for things that are working well and are highly reliable in your facility? What qualities do they have? How can you replicate these qualities? Look for things that are working well and are highly reliable in your facility? What qualities do they have? How can you replicate these qualities?

29. Examples Barriers TBU Lack of resources and time to monitor the patients’ perception of this enhanced service Action What’s working Make a schedule and sample Build monitoring into daily work flow

30. #1 Take action You will not get over, under, around or through barriers by looking at them You need to do something differently The more ideas you test the more likely you are to hit on a good one You will not get over, under, around or through barriers by looking at them You need to do something differently The more ideas you test the more likely you are to hit on a good one

31. When Getty was asked how he became such a successful oil man he said, “I drilled more holes”.

32. Next Steps

33. Now what? Work with your Network Facilitators – Continue your team efforts – Look for barriers and ask why? – Test ideas to overcome barriers – Keep at it Participate in the next webinar – TUESDAY, July 30 th 10:30 -11:30

34. Testing, spreading & implementing - webinar 34 Date – TUESDAY 7/30/13 Time – 10:30 – 11:30 Topics Covered Knowing when testing is necessary Knowing when to spread Knowing when to implement Building a sustainability plan Date – TUESDAY 7/30/13 Time – 10:30 – 11:30 Topics Covered Knowing when testing is necessary Knowing when to spread Knowing when to implement Building a sustainability plan

35. Testing, spreading & implementing – Skill Building 35 Skill building due to NF by 8/7/13 Develop a sustainability plan – Send to network facilitator Skill building post webinar call 8/14/13, 10:30- 11:30 Skill building due to NF by 8/7/13 Develop a sustainability plan – Send to network facilitator Skill building post webinar call 8/14/13, 10:30- 11:30

36. Any more questions?