Resident Councils: Dynamic vs. Grievances Julie Kueker, MBA, BS MT (ASCP)
Objectives Discuss the CMS Final Rule and infusing the resident voice for quality and design of care Review approaches to Resident Councils Grievance session Missed opportunity for improvement Making them dynamic List the solution steps found in the QIO Resident Council Toolkit Learn problem solving techniques that work Describe QIN-QIO role in improvement
Resources from Your QIN-QIO Medicare Quality Improvement Organization QIN-QIO: Quality Innovation Network Free Technical Assistance Webinars on cutting edge topics Free Tools and Resources
Omnibus Reconciliation Act of 1987 (OBRA) A nursing facility must protect and promote the rights of each resident, including the right of the resident to organize and participate in resident groups in the nursing facility Residents have the right to voice grievances with respect to treatment or care that is furnished without discrimination or reprisals Residents have the right to prompt efforts by the nursing facility to resolve grievances the resident may have
The Resident Council Involvement in care planning Facility assist with informing residents of upcoming meetings Resident Council can discuss and offer suggestions about facility policies and procedures affecting residents care, treatment, and quality of life Resident Group or Council work with facility on addressing identified areas for improvement Resident Council and facility support each other Can provide feedback and be involved in QAPI initiatives
Current State of Resident Council Opportunity to build a stronger partnership between the Resident Council and facility It is apparent that a number of existing resident councils are not being cultivated to their fullest potential Issues that may be present: Meeting mainly as a regulatory requirement Lack of participation Unclear agenda Unclear follow-up on suggestions/issues Lack of awareness of the value input from the council can bring to the facility Staff may see this as a complaint session
How Do Your Resident Councils Function Grievances Dynamic
Barriers to an Effective Council Fear of Retaliation Lack of Information and Support Discouraged that Change Won t Happen Low Participation and No Purpose
Effective Resident Councils Can: Communicate Effective way to share information between staff and residents/ families Can help dispel rumors Educate Understand care issues and offer solutions Serve as a sounding board for new ideas Resident Voice Speak out about concerns and overcome fear of retaliation Present ideas, suggestions, and concerns and to work cooperatively towards a solution
Be a Supportive Facility If a council role is too hard for any one resident to handle alone, break it up into bite-size pieces Simplify officer/leader jobs Function as a liaison with staff Help residents access information and resources Set a positive tone Build officers skills with leadership coaching and practice
Adjust Resident Councils to Facility Size In small homes or homes with low resident participation: Informal family-type meetings may work, with non-formal agendas Chairperson and secretary roles may be filled by volunteers or on a rotating basis Time can be taken to canvas everyone s opinions one by one ahead of time Most decisions may be arrived at by consensus In homes where residents are physically frail: A staff advisor may play a more active role if the council permits Work better in smaller groups and one-on-one communication might be required Agendas, minutes and by-laws are short and simple http://www.ciadny.org/documents/adulthomeresidentcounciltoolkit.pdf
Adjust Resident Councils to Facility Size (cont.) In larger homes, with more active members: The general meeting is the centerpiece of council activity Create a formal agenda, strong leadership, and clear rules Agendas, minutes and bylaws are more comprehensive A full slate of officers may be chosen in regularly-held elections Additional committees, advisory boards, and task forces may be formed http://www.ciadny.org/documents/adulthomeresidentcounciltoolkit.pdf
Boost Attendance at Resident Council Meetings Publicize the purpose Admission packet Have current members recruit new members Demonstrate how the Resident Council is meaningful Show successes Build trust List out projects that are ongoing Reach out during dining, or activities Positive attitude Be well organized
Resident Council Bylaws Every resident should be able to fully participate in the council by coming to meetings, voting, and voicing his or her opinion Every resident should have the right to run for office during regularly scheduled free and fair elections Every resident should have equal access to information about how the council is run, and where and when meetings, elections, and activities take place http://www.ciadny.org/documents/adulthomeresidentcounciltoolkit.pdf
A Model Resident Council Residents run the council The council receives support, not interference, from nursing facility staff Residents feel comfortable speaking freely; raising issues and concerns Residents are treated in a dignified manner, and concerns taken seriously Issues and concerns are promptly addressed Residents have access to information as needed Different committees address the issues and concerns raised, and then follow up at the next meeting The council is a vehicle to bring about positive changes http://www.ombuddy.org/nursing-facility-resident-council/
Engagement Outcomes Better Culture Better Care Lower Costs Better Health
Key Points Report Focus on a Culture of Engagement Better Care Personal level: POC Organizational Level: QI or System Changes Effort centers on involvement Skills are needed by staff and patients/families to enable collaboration Teams need: Evaluate current program Speak from a common language (shared purpose) Tools to work collaboratively
Resident Council Toolkit Goal of toolkit is to address issues identified as opportunities for improvement Build collaborative structure for staff/ residents and families Avoid us and them
Steps for a Nursing Home
Steps for a Nursing Home
Steps for a Nursing Home
Steps for a Nursing Home
Resident Involvement Remember Family Members, Ombudsman, staff members, or any guest is by invitation only of the Resident Council
Resident Involvement
Resident Involvement
Resident Involvement
Residents and QAPI
Assessment Start with evaluating current council Current participants and key facility leaders Provide a foundation to prioritize areas for the council to address
Resident Councils and Problem Solving Clearly define the problem Gather all pertinent information and data Discuss the pros and cons, and possible solutions Learning Circles Rose, Bud and Thorn Arrive at a decision or solution, if possible Parking Lot For topics to get discussed later For topics that get too heated to addressed
Learning Circles Open sharing learning circles learning from each other Goal: To devise solutions or develop ideas through mutual respect and understanding, incorporating the nursing home s diverse groups. The circles are to include residents, direct care givers, families, management, all staffing departments and anyone with a willingness to enrich the residents lives.
Learning Circles (cont.) Description: Learning circles provide a structured conversation method that ensures everyone is part of the sharing. In a learning circle, each person can speak once before anyone speaks again. In the first round of speaking, participants share their own experiences and perspectives rather than commenting on what they ve heard from others. Once everyone has had an opportunity to speak and have their ideas heard, the group is free to explore and discuss what they have heard from each other.
The Learning Circle A leveling technique that encourages: Quiet people to speak Talkative people to listen Everyone to share in decision making
Learning Circles Usually organized around a specific need or idea Sit in a circle without tables or obstructions Facilitator introduces topics and gets input from circle members, giving each equal time Facilitator records responses Circle does not respond to the members until circle is completed Facilitator shares all responses and topic discussed fully Team approach for solutions and/or conclusions No Cross Talk
Facilitating a Learning Circle Facilitators are not the teacher Do not need expertise in topic area Do not make decisions for the group Group decides its directions Group sets objectives Encourage good dialogue
Checklist for Facilitators Start the meeting positively and relaxed Be an active listener Discourage the group from treating you as the expert Stay impartial and avoid conflicts Draw out the quiet people, discourage the talkative ones Don t let the group get stuck on improvable facts or assertions Don t be afraid of pauses and silences Close the session with a brief question of what has the group gained from the learning circle, and if there are any suggestions to improve the process
Participating in a Learning Circle Stick to the ground rules Starting and finishing on time All voices are heard All share in ideas and tasks All ideas are welcome Provide helping hands Search for additional resources as needed Arrange guest speakers as needed Prepare the room and refreshments Take turns facilitating Document the groups progress by keeping notes
Suggestions for Learning Circle Participants Listen carefully and actively Maintain an open mind Try to understand alternate points of view Help keep the discussion on track Speak freely, but don t dominate Talk to the group as a whole, not just to the facilitator If you don t understand, say so. Value your own experience and understanding. Be prepared to disagree remember to disagree with the issue, not the person Try not to become angry or defensive
Daily Pleasures How would you feel if you could no longer experience that daily pleasure? Do you think our residents are missing any of their daily pleasures?
Learning Circle Exercise
Rose, Bud and Thorn Problem Solving Technique How to identify the positive, negative or potential for each solution This technique uses a simple method to evaluate potential solutions from all points of view Group analyzes: Proposed solution Data or situation to identify one positive idea (rose), one negative idea (thorn), and one new goal/insights (bud) Techniques helps group stay focused and plan next steps
Rose, Bud and Thorn Problem Solving Technique (cont.) To begin, give each group member three different colored sticky notes and a pen so that they can capture their ideas. For this example, the colors will be pink (positive), blue (negative) and green (potential). Post the problem to be solved on the board, easel or wall. Each person can write his/her thoughts on a colored sticky note and post it for everyone to see. Group together the notes by color/category. Once everyone has posted their ideas, begin a discussion that captures everyone s thoughts, concerns, and plans for a solution.
Rose, Thorne, Bud Quick Guide Identify a topic for consideration Give each person three different color sticky note pads Rose: PINK (things that are positive) Thorn: BLUE (things that are negative) Bud: GREEN (things that have potential) Generate as many ideas as possible in set time frame One item per sticky note Write multiple items per color (minimum of three) Avoid describing solutions
The QIO Makes Things Easy Understand QAPI The Plan The Committee Performance Improvement Projects Where to start What do they look like How to Involve your resident and family in QAPI Performance Improvement Projects Garner input Survey your residents and family
Toolbox The Final Rule and QAPI How can Quality Insights help? We have tools and resources for success Technical assistance for performance improvement projects and the QAPI steps to improvement Root Cause Analysis Setting Goals Action Steps for Quality Improvement Sustainability Customized data reports to choose your QAPI project
My Quality Insights Toolbox QAPI Resources Action Planning Worksheet QAPI at a Glance QAPI Toolkit Fishbone RCA 5-Whys RCA Goal Setting Worksheet Sustainability Guide Topic Example Documents Examples of our Topic Resources Resident Council Toolkit QAPI Toolkit for Residents under development Antipsychotics Trigger Tools, Step-by-Step Guides to reduction Fall Management Care Plans, Risk Assessments Pain Management Audit Tools, Team Tools So much more!
QIN-QIO Quality Improvement Specialist Julie Kueker Email: jkueker@eqhs.org Phone: 318.294.0458
Thank You This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI-LA-C2-020618