Pave Your Path This presenter has nothing to disclose Pave Your Path: How to Improve-Will, Ideas and Execution Cory Sevin, RN, MSN, NP Director, IHI Kate Bones, MSW Director, IHI February 19, 2013 Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW-WV-HH-MMD-032217D
Objectives for Today 2 Identify the current state of home health care quality and why systematic improvement is necessary. Describe set-up for successful improvement work, including leadership actions. Describe the 3 questions for the Model for Improvement. (describe how tracks to LEAN) List key characteristics of a project aim statement Questions for presenters? Send to hhqi@wvmi.org during the presentation
Agenda 3 Current Quality Environment for Home Health care The need for systematic quality improvement Who is the Institute for Health care Improvement (IHI)? What do we know about systematically delivering better care-the science of improvement What do leaders need to do? Homework
Current Home Health Quality Environment 4 Cynthia Pamon, RN, MBA, MSHCAD, CCM Lead, Million Hearts & Disparities Programs GTL, Home Health Quality Improvement National Campaign & Advancing Excellence National Campaigns Center for Clinical Standards and Quality, Quality Improvement Group Centers for Medicare & Medicaid Services
CMS HH Quality Initiatives 5 OASIS C Outcome and Assessment Information Set Required as part of the Conditions of Participation (COPs) for Medicare certified HHAs HHCAHPS Home Health Consumer Assessment of Health Plans and Services Patient experience surveys Home Health Compare Voluntary, public reported subset of measures
CMS HH Quality Initiatives 6 Home Health Quality Improvement National Campaign ACH Oral Medication Management Immunizations Focusing on dual eligible beneficiaries and under-served populations
What May be Missing 7 Need to link the data from quality reporting to science based improvement activities within the agencies. Promote the ability to sustain improvements and/or make the necessary changes in the event improvement does not occur as planned. Embed improvement into day-to-day operations within the agency to include: support to staff/teams; making improvement a priority; supporting internal and external communication and collaboration.
An Introduction to IHI
We Exist Because Between the health care we have and the care we could have lies not just a gap, but a chasm. - Institute of Medicine, Crossing the Quality Chasm, 2001
Our Mission To improve health and health care worldwide. Our Vision Everyone has the best care and health possible. Who We Are IHI is a leading innovator in health and health care improvement worldwide, joining forces with the IHI community to spark bold, inventive ways to improve the health of individuals and populations. What We Want to Accomplish Together with our ever-growing community of visionaries, leaders and frontline practitioners around the world, we seek and achieve vital science-based improvements in health and health care. Where We Work We work globally because countries are interdependent in terms of health and health care, innovations can arise anywhere, and everyone has something to teach and something to learn. How We Work (Will, Ideas, Execution) With the IHI community, we motivate and build the will for change, identify and test innovative models of care, and ensure the broadest possible adoption of proven practices that improve individual and population health.
IHI s Free Online Resources Subscribe to This Week @ IHI, IHI s free weekly e-newsletter Listen to WIHI, a free audio program from IHI Check out the great resources, tools, stories, and contacts available on www.ihi.org Follow @TheIHI IHI Fan Page IHI Group
A Sampling of Upcoming IHI Programs Using the IHI Global Trigger Tool for Measuring Adverse Events virtual program: February 2013 Reducing Avoidable Readmissions seminar: Chicago, IL, March 2013 Frail Elders: Building a Care System seminar: Denver, CO, March 2013 14 th Annual International Summit on Improving Patient Care in the Office Practice and the Community: Scottsdale, AZ, April 2013 We offer many more programs. For a complete listing visit: www.ihi.org/programs
STAAR 13
Pursuing the Triple Aim Population Health Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs By Maureen Bisognano and Charles Kenney Experience of Care Per Capita Cost Jossey-Bass, April 2012
Every system is perfectly designed to achieve the results it gets.
The Model for Improvement 16
Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Improvement Guide, Chapter 1, p.24 Appendix C, p. 454
Fundamental Questions for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? 18
The Sequence for Improvement Test under a variety of conditions Make part of routine operations Implementing a change Sustaining and Spreading a change to other locations Theory and Prediction Developing a change Testing a change Act Plan Study Do
20 What Does This Look Like in Real Life? Aim Measures (aka Dashboard) Change Concepts Change Concepts, Key Changes & Key Activities Change Ideas
Set Up For Improvement-Leadership Responsibility The focus of improvement matter-strategic priority for the organization The home health care agency CEO/director organizes an internal improvement team and officially sponsors the team to engage in the improvement work. Ongoing support for the work of the team-time to meet, support to test changes, removing barriers Ongoing attention and communication with others Support for cross-setting collaboration
Recommended Infrastructure and Strategy to Achieve Results Designate an Executive Leader to set priorities, link quality improvement goals to strategic plan, provide oversight and track progress of QI initiatives Convene an Improvement Team for the initial testing and implementation of new changes and identify a Day-to-Day Leader to drive the improvement work (convening meetings, coordinate testing, collecting data, etc.) Identify opportunities for improvement and establish a workplan for testing changes, implementing successful changes and spreading improvements
Review of baseline data Chart reviews to identify system failures not staff issues Patient and family interviews Staff and clinician interviews Observation Other Identifying Opportunities for Improvement
IHI Diagnostic Review 1. Conduct an in-depth review of the last five rehospitalizations and/or hospitalizations to identify opportunities for improvement. Conduct chart reviews of the last five patients receiving home health care services who were hospitalized or rehospitalized. See IHI How To Guide. Conduct interviews with patients who were recently rehospitalized (ideally, shortly after the rehospitalization) and their family members. 2. Review patient experience data regarding communications and discharge preparations. 3. Review OASIS Data. http://www.ihi.org/knowledge/pages/tools/howtoguid eimprovingtransitionsfromhospitaltohomehealthcar ereduceavoidable Hospitalizations.aspx
What are We Trying To Accomplish? Hope is not a plan The Project AIM is: Not just a vague desire to do better A commitment to achieve measured improvement Some is not a In a specific system With a definite timeline And numeric goals number Soon is not a time
Checklist for Great Aim Statements 26 Important and inspiring yet specific. State the aim clearly. Include numerical goals that require fundamental change to the system. Set stretch goals. Avoid aim drift. Be prepared to refocus the aim. See the following for detailed guidance on Aim Statements: http://www.ihi.org/knowledge/pages/howtoimprove/scienceofimprovementtipsforsettingaims.aspx
Aim Example: Aim Statement 27 The Best Home Health Care Agency will improve the transition between the hospital and their agency by improving the handover and focusing on medication management during the first week of service so that within the next 12 months we will reduce ED visits by 50 percent and acute care hospitalizations within 30 days of discharge by 20 percent. OASIS data will show improvement in medication management and medication stabilization by 15 percent or more.
Aligned Measures Dashboard of Balanced Measures Outcome Measures & Goals Reduce ED visits (Goal: reduce by 50%) Reduce acute care hospitalizations within 30 days of discharge. (Goal: reduce by 20 percent). Process Measures & Goals Improve OASIS medication management data (Goal: improve by 15% or more) Improve OASIS medication stabilization data (Goal: improve by 15 percent or more).
What Changes Can We Make For Best Home Healthcare Agency: Handovers Medication Management
Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Improvement Guide, Chapter 1, p.24 Appendix C, p. 454
Recommended Homework With your team, write an aim statement for an area your agency wants to improve in. Include all the key elements-refer to the Aim s Checklist sent out after the call Post it to the HHQI website Reflect-how was this? What did you learn?
Next Call: The Plan-Do-Study-Act Cycle Act - What changes are to be made? - Next cycle? Study - Complete the analysis of the data - Compare data to predictions - Summarize what was learned Plan - Objective - Questions and predictions (Why?) - Plan to carry out the cycle (who, what, where, when) - Plan for Data collection Do - Carry out the plan - Document problems and unexpected observations - Begin analysis of the data Improvement Guide, Chapter 5, p. 97
Strategic & Sequenced Approach to PDSAs What are the series of PDSA cycles or changes your site potentially will have to make to achieve your AIM?
Readiness Assessment 34 Did you complete the readiness assessment? http://www.surveymonkey.com/s/2x5vkxw Also located at HHQI Discussion Forum: http://www.homehealthquality.org/network/hhqi- Discussion-Forum.aspx?threadid=23 Pave Your Path Forum
Upcoming Calls March 19 at Noon (Eastern) Using the Model for Improvement April 16 at Noon (Eastern) Learning Toward Improvement May 21 at Noon (Eastern) Improvement Science and Helpful Techniques
Thank you 36