4/26/2017. I ll Do It My Way, Thank You Performance Improvement Strategies for Home Care. Session Objectives. Session Agenda

Transcription

1 I ll Do It My Way, Thank You Performance Improvement Strategies for Home Care Barbara Katz, RN, MSN President, BK Health Care Consulting, LLC Session Objectives Explain the role of evidence based best practices(ebp) in achieving Triple Aim Goals and COPS compliance Identify barriers to evidence based best practices use Describe performance management strategies that improve consistent staff use of best practices Utilize population health techniques to improve team adherence to best practices Diagnose and manage individual staff performance deficiencies bkhealthconsulting.com 2 Session Agenda Why Evidence Based Best Practices are vital Understanding variation and EBP Barriers to best practices implementation Individual performance management Analyzing performance deficiencies Population health techniques bkhealthconsulting.com 3 1

2 Reducing Variation Improves Results Today, healthcare is increasingly recognizing the relationship between reducing variation and improving outcomes. Interventions to reduce variation for a targeted process can improve care by establishing consistency based on best practices. J. Ferguson, Health Catalyst bkhealthconsulting.com 4 Evidence Based Best Practices Defined Evidence based best practices (EBP) are the integration of the best research evidence with clinical expertise and patient values* Research evidence Good quality research that shows what actually works to achieve good outcomes Clinical expertise Clinicians know when and how to apply EBP and they integrate EBP into their daily clinical practice Individualization of EBP to agency and patients *Sackett, 2000 bkhealthconsulting.com 5 Heart Failure Best Practices Example Front load visits (home visits and phone calls) Install telemonitor or develop a plan for self monitoring Refer to OT, PT, Social work and HHA Elicit patient goals, assess health literacy and learning style Teach self-management skills using Heart Failure teaching packet and teachback MD follow-up within 7 days of start of care bkhealthconsulting.com 6 2

3 Why Best Practices? -New and Old Challenges COPS - Implementing and clearly communicating patient centered care plans and implementing improvements generated by QAPI Value based payment - Achieving Triple Aim goals, especially readmission reduction Consistent adherence to regulatory requirements - The old and ongoing challenge It is the right thing to do - Best practices produce better clinical results and higher levels of patient satisfaction bkhealthconsulting.com 7 Your Best Practices Story 1. How many types of best practices does your agency have? 2. Do you have best practices for all disciplines (including home health aides)? Yes or No 3. On a scale of (low) 1-5 (high), how consistently do agency staff use your best practices? 4. What techniques have worked well for implementing consistent best practices in your agency? bkhealthconsulting.com 8 Is a Home Care Nurse More Like a..? or a bkhealthconsulting.com 9 3

4 Barrier - Variation is Baked In to the Culture of Home Care Independence is prized. Cookbook care is despised. Independence is necessary in home care BUT Uncontrolled variation = poor outcomes SO Adapting best practices to local conditions and using thoughtful variation preserves independence and produces the best results. bkhealthconsulting.com 10 Barrier - In Home Care It s All About The One Home care mindset = one nurse, one patient, one home Home care leaders tend to focus on individual clinician accountability For better results focus on: the individual + population + the environment bkhealthconsulting.com 11 Other Barriers to Using EBP Institutional and cultural barriers- The organization does not resource the use of EBP - i.e. frontloading mandated, but no time in the schedule The overwhelm - Too many demands, too many patients, not enough staff, little clerical support Personal - Don t confuse me with the facts i.e. A secondary diagnosis of CHF doesn t warrant use of best practices if there are no current symptoms Inadequate performance support systems - Training, reference material, clinical coaching, etc. bkhealthconsulting.com 12 4

5 Best Practices Barriers in Your Agency Which barriers have you identified? Attitudes Skill Deficiencies Performance Support How have you worked to overcome them? Competing demands Resources What do you wish you had done differently in implementation? Culture bkhealthconsulting.com 13 What Staff Need to Succeed with Best Practices The Will Consequences The Skill Feedback Supportive Environment bkhealthconsulting.com 14 Popular Methods of Implementing Best Practices Tell them Remind them Lecture, cajole, threaten Tell them again Reeducate Reeducate Tell them again Lecture, cajole, threaten Lecture, cajole, threaten Remind them bkhealthconsulting.com 15 5

6 A Better Way Manage Performance at Two Levels Individual clinician Clinician population bkhealthconsulting.com 16 Steps to Individual Performance Management 1. Set clear expectations 2. Develop competence 3. Remove obstacles 4. Check performance 5. Institute consequences bkhealthconsulting.com 17 Stratify Clinicians by Level of Performance High performers Engage as mentors and experts, tell stories, public recognition Competent performers Identify gaps, communicate, involve in improvement, clinical coaching Low performers Intensive individual performance management bkhealthconsulting.com 18 6

7 A Hugely Helpful (and low cost) Resource bkhealthconsulting.com 19 Analyzing Performance Deficiencies 1 Management Barriers Before you Reeducate look for Fast Fix Opportunities Invisible expectations Inadequate resources Obvious obstacles No feedback Source: Analyzing Performance Deficiencies by Robert Mager and Peter Pipe 20 Analyzing Performance Deficiencies 2 - Consequences Is desired performance punishing? Is undesired performance rewarding? Are there any consequences at all? Source: Analyzing Performance Deficiencies by Robert Mager and Peter Pipe bkhealthconsulting.com 21 7

8 Analyzing Performance Deficiencies 3 - Skills Could they do it if their life depended on it? Do they use the skill often? Does anyone tell them how they are doing? Could the task be simplified? Source: Analyzing Performance Deficiencies by Robert Mager and Peter Pipe bkhealthconsulting.com 22 Analyzing Performance Deficiencies 4 Do they have what it takes? Are there personal obstacles? Do they lack the will? bkhealthconsulting.com 23 What s Your Diagnosis? 1. I didn t know I was supposed to follow all those steps. 2. I can t do it. I have a caseload of 35 and I am seeing 8 pts a day. 3. I don t buy these best practices. My personal best practices have always worked just fine. 4. I can never find the patient teaching booklets and we don t have enough telemonitors or enough slots in the schedule. 5. Haley is so good at these best practices, we are going to give her all the high risk CHF patients. 6. You marked me down for best practices on my appraisal. That s the first time I ever heard there was a problem. bkhealthconsulting.com 24 8

9 Managing the Tough Stuff Do they have what it takes? If yes, go back to the checklist and fix obstacles If no, change the job or get the person out of it Do they have temporary personal obstacles? Assess current capability Consider job modification Provide reduced hours or more flexibility Consider EAP referral FMLA Do they lack the will? Show the data Try motivational interviewing Apply peer pressure Include best practice use in performance appraisal Use progressive discipline bkhealthconsulting.com 25 Population Techniques for Performance Improvement Communicate and engage Customize EBP to your agency s needs Restructure work processes Track and communicate group performance Stratify staff by performance level Apply performance management best practices Keep researching and innovating bkhealthconsulting.com 26 Tools and Techniques Build the WILL Paint a clear and public picture of expectations Provide vital resources (time, tools, training) Align EBP with staff values and goals Develop champions Involve staff in customizing EBP Listen and respond to problems Use visible measures and competition bkhealthconsulting.com 27 9

10 Case Study Reducing Unnecessary Lab Tests House staff committee project Committee members introduce the project Follow-up with resources and lab test costs to patients Teams compete against each other Weekly s on real time results Monthly report identifies the winner Report describes benefits to patients Grass roots strategy - keep the dialogue going Results - unnecessary testing declined by 23% Choosing Wisely Medical Resident Team at Vanderbilt U. Medical Center bkhealthconsulting.com 28 Telling Isn t Training Build the SKILL Set clear expectations and describe expected results Provide interactive, skill based training Embed training in context and workflow Do in-context competency testing Create a mentoring system Coach for improvement Use case conferences to reinforce learning bkhealthconsulting.com 29 Create Performance Support Systems Easy access to cheat sheets, tools Lean workflows that support EBP Time in the schedule Articles, videos, success stories Templates, reminder systems Interdisciplinary case conferences Mentor program Data on individual performance bkhealthconsulting.com 30 10

11 Case Study - Which Population Techniques Were Used? A large independent agency was not meeting it s readmission reduction goals Data analysis and reviews of high risk patients demonstrated inconsistent use of best practices Agency best practices had had not been reviewed or revised in 5 years Senior clinical managers collected data on outcomes and best practices by team and by individual nurse Managers stratified employees by performance level and created strategies for each group Managers assessed their own level of support and resource allocation for EBP They held focus groups with clinicians to understand perceptions, what was going well and barriers Managers recruited high performers to be trainers, champions and mentors Managers involved clinicians in restructuring best practices Outcome results and audits of best practices use were published monthly The agency started a competition between teams for highest level of best practice use bkhealthconsulting.com 31 NOW Let s Get Started on Using Performance Management to Improve Outcomes! bkhealthconsulting.com 32 11