2019 CDPH PPT Sacramento

11/18/2019

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New Direction for CDPH’s Center for Health Care Quality SeminarNovember 19, Sacramento

Access seminar materials by visiting www.calhospital.org/cdph-district-updates-resources

Ask questions online at www.menti.comUse code 11 63 86

California Department of Public Health

Transforming CDPH’s Center for Health Care

Quality


Improving the Management of Regulation Packages

Chelsea DriscollActing Chief of Policy and Planning

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Project Goals

Streamline regulation development and approval process• Decrease redundancy • Increase the ease of package movement• Decrease timeframe to complete regulation

packages Quality product in less time Increase stakeholder engagement Future: regulations are kept consistent with

current standards of practice


October Kickoff Meeting

Performance Improvement Management (PIM) Team

CHCQ Regulations Unit Office of Regulations Office of Legal Services Department of Finance Health and Human Services Agency


Action

1. Understand the process and identify time lags2. Develop solutions that address root causes of delays3. Map out future state and develop implementation4. PIM Operations Committee approval of future state

map5. Complete implementation plan6. PIM Operations Committee and Executive Steering

Committee implementation plan approval7. Execute implementation plan

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GACH Packages

• Adverse Events• Medical Information Breach• GACH - Clinical Laboratories,

Pharmaceutical, and Dietetic Services Regulations

• GACH – Infection Control and Physical Plant

• GACH – Emergency/Specialized Services/ Medical Imaging Regulations


GACH Packages Continued

• GACH – Administration/ Records and Reporting

• GACH – Rehab, Outpatient, and Supportive Services Regulations

• GACH – Nursing/Surgery/Anesthesia/Cardiac Cath Lab

• Change of Ownership Regulations


Stakeholder Engagement

We will be hosting stakeholder meetings for regulation package

Stakeholder Meeting Date Regulation PackageAugust 30, 2019 Clinical Laboratories,

Pharmaceutical, and Dietetic Services Regulations

September 10, 2019 GACH - Diagnostic Medical Imaging and Interventional Radiology Services Regulations

October 10, 2019 GACH - Dialysis and Organ Transplant Center Services Regulations

October 15, 2019 GACH - Rehab, Outpatient, and Supportive Services Regulations

November 1, 2019 Change of Ownership RegulationsDecember 6, 2019 GACH Pediatric Services

Regulations

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Stakeholder Engagement (cont.)

Please join our stakeholder distribution list to keep informed about upcoming opportunities to participate in regulation development.

[email protected]


SB 227 Hospital Staffing Penalties

SB 227 - Hospital Inspections and Penalties• Specifies that L&C must verify

compliance with mandatory nurse-to-patient staffing ratios during periodic, unannounced inspections of GACHs.

• Establishes administrative penalties for violations of nurse-to-patient staffing ratios.


Performance Improvement Management Office:

Governance, Accountability, and Workstreams

Michelle Vinnicombe Bell, MBAPerformance Improvement Manager

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Project Proposal



Complaint & FRI Backlog Reduction

Blessilda CanlasProject Manager

Performance Improvement Management Team

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Complaint/Facility-Reported Incident (FRI) Backlog Reduction

CDPH’s Center for Health Care Quality (CHCQ) statewide backlog of open complaints/FRI:

22,919(July 1, 2019)


Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)

“Backlog” is defined as:



Work group of representatives from all CHCQregional offices and central officedeveloped backlog reduction strategies:

Preliminary steps –

1. Clean up database to determine “true backlog universe” (mid-Oct. through mid-Nov. 2019)

2. Conduct comprehensive inventory of open intakes(1st week of Nov. 2019)

3. Prioritize open intakes (2nd week of Nov. 2019)

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OPTION A OPTION BReassign backlogged open cases equitably among all surveyors in each regional office to even out the workload.

Keep cases with current surveyor.

Limit number of backlogged cases on each surveyor’s desk (4-10 at a time)

Focus on 4-5 cases at a time, based on order of priority.

Supervisor assigns target date for completion of each case.

Backlog reduction strategies:(Starting Dec. 1, 2019)




Prioritize investigations –

1. Starting with the oldest year:• Offsites/admin closures first, then simpler FRIs, then

simpler complaints, then more difficult FRIs, then more difficult complaints.

2. Proceed to next oldest year, in the order listed above.

3. Continue moving on to the next oldest year, and the next, until all backlogged open cases have been assigned and completed.




• Streamline investigations using decision trees developed based on guidance from CMS.

• Administrative review for simpler cases.• Post-investigation: Utilize more efficient, standardized method

to review, approve, and process cases.• Streamline investigation packets to include only the essential,

relevant documents to substantiate allegations.• Prevent future backlog by utilizing short-term future state

decision trees for streamlined investigations.

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Eliminate backlog by December 2021.


Centralized Applications Branch

Kelly Abel, Branch ChiefRose McDowall, GACH/APH Unit Chief

Kelly Abel, Branch ChiefRose McDowall, GACH/APH Manager

Centralized Applications Branch (CAB)9


• CAB Data Metrics

• Online Application

Agenda

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Open GACH & APH Applications


Open GACH & APH Applications

82 59 71 73 56 50 51 43 35 38 35 58 63

334314 278 278 294 308 306 337

320285

261 219 200

416

373349 351 350 358 357

380355

323296

277 263

0

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100

150

200

250

300

350

400

450

Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

Open with CAB Open with Applicant Total Open


0

20

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60

80

100

120

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

2018 2019

Received Completed

Monthly Count of GACH & APH ApplicationsReceived vs. Completed

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Online Application


Online Application Processing (Coming Soon)


Adobe Experience Manager (AEM) online application for GACH/APH• Purpose: HS 1272 mandated that CAB create an

automated application system to process GACH/APHapplications by December 31, 2019.

• Kickoff: online project in February 2019.• Status: Sprint 10 is underway. CAB is working on final

user stories for backend integration, • User Acceptance Testing: First round of UAT was done

with members of CHA in October. Second round of UAT in progress with CHA, stakeholders and internal users.

• The project is on target to be completed by December 31, 2019.

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Online Application Benefits

• Application checklist• Visual Application

Progress

Initial Application

• Facility detail display

• Pre-populate facility data

• Online dashboard status

• Reduce/eliminate back and forth with CAB analysts

• Faster corrections turnaround

Application Corrections

GACH/APH Online Application

• Easy navigation • Data entry validation • Streamlined process • Upload and attach

documents • Help text and guidance • Save and exit feature • ADA compliant

GACH/APH Online Application Benefits

Report of Change Applications

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Online Application Preview

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Contact Information

Please send questions to:

[email protected]@[email protected]@[email protected]


Transforming…The Center for Health Care Quality

CHA 2019Heidi W. Steinecker

Deputy Director

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Why I Am Here


Why We Are Here


Culture

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How We Serve


Who We Are

Regu

lato

ry F

ield

Ope

ratio

ns • State Licensing• Federal

Certification

Licen

sure

& C

ertif

icatio

n Fu

nctio

ns

• Central Applications

• Provider Certifications

• CNA Oversight• Criminal

Investigations• Medical

Breach• Staff Audits• Emergency

Preparedness

Publ

ic Po

licy

and

Prev

entio

n • Legislative Analysis• Regulation

Development• Policy Governance• Healthcare

Associated Infections

• Research Data and Informatics

• External Communications

Inte

rnal

Ope

ratio

ns • Fiscal• Contracts and

Grants• Personnel • Training• Capital Asset

Management

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Overall Scope and Severity RetentionAdmin ProcessesCulture of DistrustHierarchy StructureManual Processes

RecruitmentOld RegulationsUneven WorkloadLack of standardization

Missing Functions-PIM-LGA/OPA -Internal Com-LAC Manager


Performance Improvement Management Governance Structure

Project Proposal

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Performance Improvement Achievements

Enterprise-wide automated

systems

Stakeholder Customer Service

Portal system and Web based

Automated Processes

Electronic Roadmap

Packets

Website upgrades

Online

Applications

Myfi Wireless Routers

Smart Phones

Tablets

Mobile Technology

Re-Organization of the Center

Performance Improvement Management

(PIM) Office

External Communications

Manager & Internal

Communications Manager

Operation Structure


Performance Improvement Initiatives

Phase 1: Adoption/Training Existing Resources

•Scanning, PDFs, Hardware

Phase 2: Robotic Process Automation

(RPA)

Phase 3: Survey/Investigation

Pilots

Paperless

Diversify the Workforce

Telework

Internal Communication

Recruitment and Retention

Re-engineer State-wide Survey Training

Center- wide Training and

Onboarding Program

High Tech/High Touch Approach

Training

Debt Free 2021

State-wide Triage System

Strategic Surveyor Usage

Complaint/FRI Backlog

Regulatory Interpretation

Section

Policy and Procedure

Governance

Centralized Program Flexes

Standardization


Former Organizational Structure

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The Proof is in the Process


Proposed Organizational Structure


Former District Based Workload

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Current Workload in the Field


Future Regional Workload


Vacancy Rate

3.9%

2.7%

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Debt Free 2021 Campaign


The Blue Line Lesson


Fees

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Emergencies and Unusual Occurrences

Update Emergency Contacts

Program Flexes & 1135 Waivers

Communicate Data & Impacts

Evacuations & Re-populating

Top Tips

Surveyor InteractionDo… remember you have mutual goal of safety and quality

Do not… make them wait for 30+ minutes- make sure your staff know where to navigate the team

Do… provide a confidential area to work and discuss


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Questions?

Raise your hand or submit a question at www.menti.com and enter code 11 63 86

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Thank You

Hosted Luncheon

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CDPH District Office Breakouts with Hospital Members1:00 – 2:30 p.m.

Wrap Up

Thank You

BJ Bartleson, RN, MS, NEA-BCVice President, Nursing & Clinical ServicesCalifornia Hospital [email protected]

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2019 CDPH PPT Sacramento

Documents

Transcript of 2019 CDPH PPT Sacramento