Continuous Quality Improvement - advancingstates.org Living Commu… · Continuous Quality...
Transcript of Continuous Quality Improvement - advancingstates.org Living Commu… · Continuous Quality...
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1
Continuous Quality
Improvement
In Assisted Living communities Specializing in Dementia Care
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“Most quality programs fail for one or two reasons. They have system without passion, or passion without system.
You must have both.”
-Tom Peter
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Objectives
• Why CQI in dementia care
• Intent of the project
• CQI Framework
• Contracts and collaboration
• Sample projects
• Lessons learned
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Why CQI in Dementia Care
• Very vulnerable population
– Improves quality of care
– Improves quality of life
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Why CQI in Dementia Care
• Caregiving staff
– Challenging work
– Turnover of staff and leadership
– Promote culture of quality
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Why CQI in Dementia Care
• The process of CQI – Engages those who do the work in improving
quality
– Focuses on processes, not individuals
– Uses data collection and concrete measurements
It’s all about the process not the outcome
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Knowledge
Process Skills
QUALITY
Quality Framework
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Intent of Implementation of CQI
• Promote overall performance
• Share specific, up-to-date knowledge
• Apply knowledge to daily care
• Ensure consistent, ongoing implementation of applied knowledge
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Intent
• Collective work builds a common language to share lessons learned among peers
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Creating and Sustaining Quality means:
• Going beyond minimum standards
• Continually using best practices
• Integrating quality improvement at the facility level
Building a Culture of Quality
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•Most problems are process not people
•Unintended variation leads to unwanted outcomes
• CQI can be achieved through small changes
• Integrate CQI into everyday work
Core CQI Concepts
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Focus of CQI projects • Resident quality of care or life
• Process or systemic client care
Where facilities find ideas • Contract monitoring surveys
• Internal quality audits
• Satisfaction surveys
CQI Framework
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Common Improvement Areas
• Falls prevention
• Nutrition
• Use of psychotropic medications
• Engagement in activities
• Staff turnover
CQI Framework
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• Administrator, Licensed RN, three other staff
– Identify team leader
– Other staff should be topic appropriate
CQI Project Team
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A structured, cyclical process for improving systems and processes in an organization or program
Foundation of CQI
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PLAN
CQI Framework
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Problem Statement
• Problem definition & description:
• Objective
• Benefits
CQI Framework
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Contributing or Potential Causes
• CQI tools used
• Specific potential causes identified
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• Brainstorming
• Fishbone
• 5 whys
• Data collection
Root Cause Analysis Tools
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DO
CQI Framework
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• How will the problem be addressed
• What new practice was used
• Research done
• Resources needed
Intervention
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CHECK
CQI Framework
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• Before and after measures
• Primary Measure
• Additional measurements
Measuring Success
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• Lessons learned
• Unexpected or unmeasurable impacts
• Other desired changes
The process is the key to progress
Results/Outcome
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ACT
CQI Framework
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• Is the project worth continuing?
– If yes, how will it be formalized?
– If no, how will you use what you learned?
Changes-Next Steps
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Collaborative Partnerships
• Incorporated into facility contracts
• Facilities develop CQI projects annually
• Annual Administrator Meeting
– Review results
– Share selected CQI projects
– Share best practices
– Coordinate for similar projects
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Sample Projects
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Sample Project
• Problem:
33.3% of residents were incurring weight loss
• Identified Root Cause:
Residents unable to distinguish food from plate
• Intervention:
Add bright plates that contrasted to food colors
• Outcome:
Reduced weight loss to 10% of residents losing weight
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Sample Project
• Problem:
Increase in challenging resident behaviors
• Identified Root Cause:
Resident boredom and inability to participate in group activities
• Intervention:
• Started a “Sing with Me” music program
• Outcome:
• Decreased challenging behaviors by 80%
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Sample Project
• Problem:
Direct care staff turnover rates high
• Root Cause:
Employee dissatisfaction
• Intervention:
New staff recognition program
• Outcome:
Over one quarter one fewer employee left the facility
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Sample Project
• Problem:
Large number of falls in facility
• Root Cause:
Off-label use of psychotropic medications
• Intervention:
Reduce off-label use of psychotropic medication use
Improve staff training
• Outcome:
10 fewer falls and more resident engagement
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Challenges
• Time and resources
– State
• Trains new administrators on the use of CQI tools
• Reviews all projects and provides feedback
– Facility
• Incorporates CQI and involves staff
• Commits time and resources for meetings and data collection
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Lessons Learned
• Best Practices
oUse CQI projects to help inform best practice
o Share what’s working and what’s not
• Networking
oProvide opportunities to coordinate and share ideas
o Encourage collaboration between facilities
oMake new information and research available
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Resource Website:
https://www.dshs.wa.gov/altsa/home-and-community-services/continuous-
quality-improvement-specialized-dementia-care-program
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Program Manager Contact:
Manipon Manivanh Home and Community Services
Residential Policy and Resources Development Program Manager
360.725.2370
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