1. C C Q Creating a Culture of Quality How to Change and Sustain Improvement Pam Havermann Director of Quality Mgt/Education 3/16/2011A renal community collaboration

2. C C Q Creating a Culture of Quality Plan of Correction Once a clinic has been identified and audited- WE WRITE THE PLAN OF CORRECTION with specific timelines for completion If the clinic knew how to fix it, they would have already done it They learn by following the plan and staying on target with timelines Graded by severity- Amount of oversight related to grade – Use level 1, 2 or 3 3/16/2011A renal community collaboration

3. C C Q Creating a Culture of Quality Plan of Correction Severity of Deficiency determines how plan is presented Set clear expectations and consequences when plan is presented They understand that it is supported from the top of the corporate office Depending on severity- we may require weekly Governing Body meetings 3/16/2011A renal community collaboration

4. C C Q Creating a Culture of Quality Make the message clear “Beating around the bush increases confusion not clarity” Lee Cockerell 3/16/2011A renal community collaboration

5. C C Q Creating a Culture of Quality 3/16/2011A renal community collaboration

6. C C Q Creating a Culture of Quality Plan of Correction Typical timelines- 10 days/30 days/90 days and 120 days Clinic is responsible for sending in completion dates without prompting from Corporate Timely response is a measurement of Manager effectiveness and seriousness of commitment to improvement 3/16/2011A renal community collaboration

7. C C Q Creating a Culture of Quality Plan of Correction Takes 4-5 months to start seeing real improvement Plan of Correction is followed through QAPI- Corporate Nurse either attends monthly mtgs or calls in to QAPI at the clinic level Corporate Nurse is there as a resource and helps facilitate the process 3/16/2011A renal community collaboration

8. C C Q Creating a Culture of Quality 3/16/2011A renal community collaboration

9. C C Q Creating a Culture of Quality 3/16/2011A renal community collaboration

10. C C Q Creating a Culture of Quality Clinic has responsibility for improvement and is accountable to corporate for results How do we monitor them? 3/16/2011A renal community collaboration

11. C C Q Creating a Culture of Quality Monthly Meeting at Corporate Office Attended by: Dr. Keith Johnson Dr. Doug Johnson Director of Operations Director of Quality Mgt/Education Corporate Administrators Corporate Nurses Each clinic reviewed 3/16/2011A renal community collaboration

12. C C Q Creating a Culture of Quality Because of the people at the meeting, the Plan of Correction has teeth SUPPORT IS KEY They are willing to stand behind us to improve patient care 3/16/2011A renal community collaboration

13. C C Q Creating a Culture of Quality Monthly Meeting Review timeliness of correction plan Involvement of managers in the process Improvement of indicators- Outcomes/ Operational and Soft Problems encountered: – e.g. Refusal of Medical Director to change, staffing barriers, manager barriers discussed 3/16/2011A renal community collaboration

14. C C Q Creating a Culture of Quality Decisions are made to solve problems Do we need follow-up with a Medical Director by Dr. Keith or Doug Johnson? Do we need to increase their staffing? Bring in agency nurses? Does the manager need support from the administrator? 3/16/2011A renal community collaboration

15. C C Q Creating a Culture of Quality DCI Progress Audited and put 19 clinics under review over the past year 5 clinics have been moved off the list due to completion and improvement in outcomes 4 remaining clinics have been downgraded to less oversight and are improving 3/16/2011A renal community collaboration

16. C C Q Creating a Culture of Quality DCI Progress 8 Nurse Managers replaced and new managers doing well- Appreciate the plan of correction already being in place 1 Administrator on probation 1 Administrator/3 nurses we thought we would need to replace have stepped up and become good managers 3/16/2011A renal community collaboration

17. C C Q Creating a Culture of Quality DCI Progress 1 Nurse Manager still being evaluated 1 Administrator Terminated 1 Medical Director removed Other managers doing well with plan 3/16/2011A renal community collaboration

18. C C Q Creating a Culture of Quality Critical Step 1 Support from the top of your organization 3/16/2011A renal community collaboration

19. C C Q Creating a Culture of Quality Critical Step 2 Clinic has to do the work We can’t do it for them We can be a resource and give them a blueprint If you teach them the correct way to do QAPI, problem solve in QAPI and follow through in QAPI, they learn to solve their own problems 3/16/2011A renal community collaboration

20. C C Q Creating a Culture of Quality Critical Step 3 Evaluate the manager honestly Have they been trained? Do they have the resources they need? Do they have the personality for management? 3/16/2011A renal community collaboration

21. C C Q Creating a Culture of Quality Don’t assume you know who will make it as a manager It’s hard to be patient with an inexperienced manager We were surprised by some and disappointed in others 3/16/2011A renal community collaboration

22. C C Q Creating a Culture of Quality Monthly Meeting If no progress in 4-5 months, start looking at the effectiveness of the managers Are they able to do the job? Some improve and become better managers Some aren’t able to make the tough changes Separates the good managers from the bad 3/16/2011A renal community collaboration

23. C C Q Creating a Culture of Quality What does it all boil down to? Manager is Key You have to bring them along quickly or you have to be willing to remove them Don’t wait too long- patient care will suffer 3/16/2011A renal community collaboration