The Culture of Poverty

Michigan Community Dental Clinics Quality Improvement with a Patient Centered Perspective

August 5, 2014Discussion QuestionsWhat, if any, barriers does MCDC face when instituting quality improvement in its dental clinics?How is baseline quality data obtained?How is clinical quality measured?How is administrative quality measured?How does peer review have a place in clinical quality improvement?How is clinical quality improvement performed without animosity among clinical staff?How is quality improvement information shared with staff?Discussion Questions contHow does MCDC include productivity as a part of quality improvement?Does MCDC use quality improvement processes such as Six Sigma or LEAN? If so, how are staff trained?How often are formal quality improvement reviews performed?Does MCDC partner with universities or other community partners to expand its quality improvement capacity and expertise?Could MCDC share any patient satisfaction surveys that have been used in its quality improvement process?Could MCDC share any staff satisfaction surveys that have been used in its quality improvement process?Quality ImprovementPresented by:Nicole Murray RN BSN

4Our Mission: to create and expand access to ever improving quality dental care for Medicaid recipients and low income, uninsured individuals.

Our Vision: to have a healthy Michigan population who assume responsibility for their own wellness, with our staffs guidance and proper intervention.

Changing Lives One Smile at a Time

Oral Healthcare Network

A Strong Infrastructure- to support our Clinic System

2013

179,068 Total Office Visits

65,269 Patients received care in our clinics51% Adults 21-6040% Children 1-209% Senior Adults over 60Having an Impact

Relentless Pursuit of Excellence

In an effort of transparency, the primary objective of the QI Department is to assess, develop, and implement MCDC community standards.

These efforts support our organizations quest to provide oral health care services with a patient centered perspective.

Quality Improvement Initiatives

Quality Improvement Department was created in September 2013. 10Director(s) of Quality Improvement & Patient SafetyAmanda Desjardins DDSRebekah Sheppard DDS

Quality Improvement CoordinatorNicole Murray RN BSN

QI Team Members

Continuous ImprovementQI initiatives create a cycle of continuous improvement as we assess needs for improvement develop policies and procedures and implement them within the organization.12MCDC entered into a partnership with Press Ganey in 2012.

This collaborative relationship has ultimately improved the MCDC patient experience by creating continuous, sustainable improvement.

Quality Initiatives

One of the ways we assess our ability as an organization to meet our patients needs is utilizing Press Ganey - For nearly 30 years, Press Ganeys mission has been to support health care providers in understanding and improving the entire patient experience.

13A Patients VoicePatients are selected through a randomized process.

PG operators contact our patients by phone to complete survey.

Survey Questions have been modified for our organization and unique patient population.

In 2014: 5 surveys completed per clinic each month

Their sophisticated analytics help MCDC discover and prioritize key performance improvement efforts with real time Survey data.

Each Quarter in 2014: new priority indexes will be calculated providing each clinic their best opportunities for improvement

Top 3 OFI Action PlansClinic receives each quarter via email Action plans developed at the clinic levelOpportunities for Improvement

Press Ganey Action Plans

NEWNEWNEWAdd Clinic Specific InfoREVISEDProvide example - 162014 Press Ganey Score Board Team ApproachGoals and achievements are reviewed at daily huddles and staff meetings

Press Ganey Tools

17Quality Assurance begins with a set of standards and accountability to one another.

Clinical and Administrative Policies & Procedures for the Dental Office were written in an effort to establish the MCDC community standard of oral health care delivery for our providers.

A Provider Evaluation (OPPE) will be conducted on each provider annually. The QI Department will be responsible for completing and communicating findings with providers, administration, and board of directors.

Quality Assurance

Provider Evaluation process begins in June.

Approximately 6-10 charts will be randomly selected for review within 30 days of providers scheduled evaluation.

QI department is responsible for reviewing charts and completing assessments together

Annual OPPE Evaluations

Ongoing Professional Practice Evaluation (OPPE)

Was a Dental Diagnosis documented or completed prior to rendering treatment?

Was the treatment reviewed with the patient prior to initiating and was an appropriate consent obtained?

Were radiographs taken per MCDC guidelines?

Was the procedure properly documented in the patients clinical note?

Was the next appointment needs documented and scheduled with the patient?

Documentation Section

Is the treatment plan consistent with the patients desire, in relation to their exam, diagnosis, and prognosis?

If anesthetic was required, was the type and dosage used appropriate?

Did the radiographs quality meet the MCDC community standard of care?

Clinical Quality Section

Restorative

Endodontic

Oral Surgery

ProsthodonticsClinical Elements

RESTORATIVE: Restorative material used appropriate for tooth/surface? Was dental dam used and validated with radiograph and clinical note documentation? Decay removed? Snoop caries indicator utilized? Surface restoration appropriate for diagnosed decay? Margins acceptable? (Overhang/Over contoured) Contact with adjacent tooth?

ENDODONTIC: Length of Fill appropriate? ( +/- 2mm from Apex? Density of Fill appropriate? Was a dental dam used and validated with radiograph and clinical note documentation? Tooth restored appropriately? Appropriate perioperative radiographs taken?

ORAL SURGERY: Was the use of irrigation documented? Was a surgical hand piece utilized and documented? Were sutures utilized? Was a post op phone call completed within 24 hours of surgical extractions? If dentures TP? Was an alveoloplasty completed at time of extractions?

PROSTHODONTICS: Were there any voids > 3 mm captured in the impression? Were the vestibules fully captured in the impression? Was the appropriate size tray utilized to capture a final impression? Did the impression correctly capture the Frenum Attachment? Did the impression adequately capture the Hamular Notch?Did the impression adequately capture the Retromolar Pad?

23Attendance at Spring Doctor Meeting

Does provider actively participate with Doctors Corner?

Does Provider engage with MCDC administration via email communications?

Does Provider participate in any MCDC adjunct committees?

Engagement Section

If a specific concern is identified, a focused evaluation may be warranted.

A new hire will be clinically evaluated within 90 days of their employment.

An FPPE may also be completed on a case by case basis and initiated by the DQIPS.Focused Professional Practice Evaluation (FPPE)

Focused Professional Practice Evaluation (FPPE)An interactive resource to share information with other providersCases are posted for DDS review & comment

Doctors Corner

Example - Case Study

Example - Question

Quality Concerns Case SubmissionMCDC staff members are required to alert the DQIPS or QI department of any quality or patient safety concerns.Email Phone call

Patient Safety Hotline (January 2014) Accessible from IES ExchangeAnonymousAll staff have access

Concerns will be reviewed by the QI Department. If appropriate, the concern may be forwarded on to the committee for review.

Quality Improvement & Patient Safety Committee

Access from IES ExchangeHotline View

Committee DutiesCare rendered by provider will be reviewed by the committee upon the request of the DQIPS.

The members are tasked with validating the issue of quality and safety in question and presenting a recommendation to the Chief Dental Officer.

Key PointsThe anonymity of the provider, patient, & clinic will be maintained throughout the entire review process.

All pertinent information will be presented to members in a confidential format in order to preserve objectivity.

The preferred venue for improvements is the MCDC Performance Improvement Program.

Quality Improvement & Patient Safety Committee

Performance Improvement ProgramDesigned to provide assistance for providers who may have challenges practicing within the MCDC Community standard of practice.Upon recommendation, active participation is presumed.

Program InitiationSelf-Reporting by the dentist to senior management team.A recommendation from the Quality Improvement & Patient Safety Committee following a review of providers delivery of care.

Quality Improvement Initiative

Provider Annual Evaluation (OPPE)

33Option 1- Internal MentorshipConsists of an employed dentist that has been identified as one who has demonstrated competency in the specified area of concern needing improvement by participating dentist.

The specific improvement opportunities will be discussed with the mentoring dentist and participating dentist. A clinical competency checklist will be created specifically for those needs that have been identified.

Performance Improvement Program

Option II External MembershipThe selection of the external mentor will be a collaborative effort between the DQIPS and participating dentist.

The specific improvement opportunities will be discussed with the external mentoring dentist and participating dentist.

A clinical Competency checklist will be created specifically for needs identified.

Formal written feedback will be provided to DQIPS regarding final impression and any improvement identified for the participating dentist.Performance Improvement Program

Option III CE Instructional ProgramUpon recommendation of committee, the dentist may be directed to participate in a CE Instructional Program with specific course content to facilitate improvement for an area of identified concern.

The selection of the CE Course will be a collaborative effort between the DQIPS and participating dentist.

The costs associate with the selected CE Program will be the responsibility of the participating dentist.

Performance Improvement Program

36Questions?In Summary