Developing Physician and Staff Engagement to Improve Performance Outcomes

Transcription

1 Developing Physician and Staff Engagement to Improve Performance Outcomes Matthew Cusano, MD Brandi Damron, OTR/L, MBA FIM, UDS-PRO, and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

2 Objectives Identify the medical director (MD) /rehabilitation physician s medical and administrative functions to increase the efficiency and effectiveness of the program Identify the medical director/rehabilitation physician s responsibilities in improving staff engagement and performance outcomes Identify common practices with the program director (PD) and rehabilitation team to improve physician engagement and performance outcomes

3 Norton Community Hospital Inpatient Rehabilitation Unit Opened in 1998 MD and PD accepted leadership roles in acute care beds 11 bed rehab unit Member of Mountain States Health Alliance (15 hospital healthcare system) One of two IRFs within MSHA

4 Our Case Mix Stroke 18% Brain injury 9% Orthopaedic 32% Amputation 2% Trauma 5% Neurological 5% Other (debility, cardiac, pulmonary, etc.) 29%

5 Our Program s Progression NCH Outcomes FIM gain % to acute 18% 10% % to community 76% 82% LOS efficiency CMI % tiered comorbidities 44% 67%

6 Physician Struggles Can your physicians relate to any of the following? Not having enough time to evaluate the program regularly Not talking regularly to the program director to see how the program is performing financially Not feeling as though staff is engaged in patient outcomes Struggling to keep up census based on newer regulations Liaison and/or program director feel they are admitting not enough candidates or poor candidates Feeling burnout with documentation requirements and spending less time at bedside

7 Key Components for a Successful Program Highly engaged rehabilitation physician Interdisciplinary team conference with input from all Accountability and transparency by all team members on patient outcomes/performance measures A program director who frequently reviews/trends performance outcomes (UDS-PRO reports) and communicates findings to the team MD and PD have a good working relationship Regularly scheduled MD/PD meetings

8 Medical Director Leads team in providing rehab care to the most challenging rehab patients Patient advocate Assist with performance improvement efforts Outcomes, financial planning Attends/leads interdisciplinary department meetings with educational opportunities Supports PD in program development efforts With administrative team Program Director Serves as ally and resource Provides updates on regulatory changes Develops templates and communication tools to improve physicians efficiency Works to make everyone s job easier Provides regular updates on outcomes DC disposition, CMI, LOS, % tier, etc. with national and regional comparisons Defining the Roles of the MD and the PD

9 Performance Outcomes: What Every Rehab Physician Should Know CMI % of tiered comorbid conditions DC to acute LOS and LOS efficiency (FIM gain LOS) FIM gain ADC (actual and budgeted) Patient satisfaction Team member satisfaction

10 Solution: MD and PD Weekly Meeting(s) Review performance outcome data FIM data (gain, admission, and discharge) Discharge disposition UDSMR PEM Report and Program Management Report

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13 Solution: MD and PD Weekly Meeting(s) Review compliance PD audits charts for compliance with CMS standards and provides feedback Medical record requests/denials (e.g., RAC) 60% rule UDS-PRO Presumptive Eligibility Estimation Report

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15 Solution: MD and PD Weekly Meeting(s) Patient safety Patient safety reports (falls, med errors) CMS quality measures (pressure ulcers, CAUTIs) Identifying potential trends Isolation needs C. diff. cases, norovirus outbreak (2012), shingles

16 Solution: MD and PD Weekly Meeting(s) Financial review CMI Payment (expected payment, transfer reduction) LOS efficiency (FIM gain LOS) ADC and discharges Referral log/denial analysis UDS-PRO Medicare FPP Potential Payment Reduction Report

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18 Team Engagement: Team Conference Regulations Per CMS, team conference must Be led by a rehabilitation physician Include all treating professionals Include a review of following Assessment of progress toward goals Consideration of possible resolutions to any problems Reassessment of validity of the rehabilitation goals Revision of treatment plan, as needed

19 Team Conference: Key Components Engaged, prepared team ready to discuss Accountability by all disciplines on progression of patients Develop team ownership of lack of progress Physician assist with patient limitations and barriers Depression, pain, bowel regimen, level of alertness, infection, motivational issues, etc. LOS management: set and adjusted by team under direction of physician Review and adjust at each team conference Discuss comorbid conditions and medical management

20 Team Conference: Patient Satisfaction/Outcomes Barrier identification Improved communication and discharge planning No longer keeping patients extra days for: Family education/trainings Medication/DME issues Personal issues (home not ready, caregivers not arranged, etc.) Improved LOS efficiency (patients go home sooner) Team working toward common goals discussed in conferences Improved FIM gains (patients perform at higher level) Scheduled communication among team members

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22 Staff Struggles/Concerns Not enough staff (therapy and nursing) Acuity of patients (more medically complex and more functionally impaired than ever) but less staff to take care of them Three-hour rule, weekend work, and holiday work Therapy versus nursing ( not my job attitude) 9-to-5 mentality Disconnect with patient outcomes

23 Improving Staff Satisfaction and Engagement Communication: Seek input! Open-door policy by rehab leadership (MD and PD) Concerns about patient acuity Concerns about staffing Concerns about patient and/or staff safety Survey your team and develop action plans

24 Listen to Your Team Seek Input! Strengths

25 Listen to Your Team Seek Input! Concerns

26 Improving Staff Engagement Communication by rehab leadership team Interdisciplinary rehab department meetings Ongoing education provided by peers Physicians, OTs, PTs, STs, SWs, and RNs are all responsible for selecting in-service topics and teaching the team

27 Interdisciplinary Department Meetings Performance improvement Patient satisfaction Critical incidents (med errors, falls, etc.) Environmental issues and safety issues Industry updates Team member engagement and action plans In-services/competencies

28 Improving Staff Satisfaction and Engagement Develop a sense of ownership Seek input from all levels of the staff in making decisions, and include them in data collection Performance improvement Strategic business planning Program development opportunities Environment of care Nursing and therapy team function with one goal in mind: achieving the highest level of independence Work to eliminate the not my job attitude

29 Improving Staff Engagement Provide timely feedback Patient satisfaction (use patient comments) Team member satisfaction Patient outcomes/success stories UDS-PRO Patient Profile Report Have fun, and celebrate even the smallest successes Become the shining star of your facility Host annual Christmas parties Provide lunches, cakes, etc. Start annual patient reunion on anniversary month Start rehab unit newsletter

30 Improving Staff Engagement Always link patient successes and positive outcomes to the team Provide recognition in all forms Written At scheduled meetings (board meetings, dept. meetings, huddles, etc.) Recognize accomplishments and achievements in healthcare system, in community, etc.

31 Recognition From: BRANDI DAMRON Date: 10/16/2014 Just wanting to acknowledge that I know we have had a tough group of patients over the last several months... I appreciate all you guys do!!! The outcomes that we see in our patients are because of your dedication. Thanks!!! Brandi Just wanting to wish each of you a Happy New Year!!! I honestly believe we have the BEST rehab program, and it is all because of the great work each of you do!!! I have been reviewing our December discharges, and seeing the outcomes of some really difficult patients makes me prouder to be a part of this team!!! Thanks again for all you do!!! Brandi As we just wrapped up FY 14, I would like to thank each of you for your hard work and dedication to our rehab unit. FY 14 was our busiest year in over five years... (I am sure you guys are aware of that.) And with that being said, our patient outcomes continue to be great!!! Thanks for all you do!!! I am working to plan a celebration soon!!! Brandi Congratulations!!! I just received notification that we are again ranked in the top ten percentile for This is the 8 th consecutive year we have received this recognition. This year, our ranking was in the 98 th percentile, which is the highest ranking we have received. I know I tell you guys often, but we have the best rehab team in the country, and this recognition supports that. We have therapists and nurses who are willing to go above and beyond their traditional responsibilities to provide individualized care to achieve the highest level of independence. I will plan a celebration soon!!! Thanks for your hard work and dedication to our patients!!! Brandi To: SHARON NIXON From: BRANDI DAMRON Date: 12/16/2013 Reason for Recognition: Service Excellence Hi, Sharon. Great job on the referrals and admissions in December! It has been one of our busiest months, and this can be credited to your hard work in getting the patients here. Thanks for always being willing to go the extra mile in admitting our patients! Brandi

32 Thank You! ANY QUESTIONS?