1 skills competency education for new pi directors & coordinators session fivemarch 14, 2007...
TRANSCRIPT
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Skills Competency Education for
New PI Directors & Coordinators
Session Five March 14, 2007
Quality Management Team Meetings
Sponsored by: The MT Rural Healthcare PI NetworkCo-Sponsored by: Mountain Pacific Quality Health
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Today’s Session Recap Session 4: Performance reporting
Session 5: QMT Meetings Purpose Members and mechanics Managing team conflict Evaluating team effectiveness Evaluating PI program effectiveness
CAH Annual Evaluation and Work Plan
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QMT Meeting Purpose
Improve organization performance by…
Integrating PI program components Data collected
Building stakeholder collaboration
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Why Integrate Components
Share knowledge, information, data
Clarify complex, inter-related issues Example: safety, patient safety
Reduce duplication of effort Minimize waste, staff frustration
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Integrate Components
Improve Performance
Strategy
Clinical Quality
Customer
Satisfaction
Hospital
Operations
Community Relations, PR
Staff, Medical Staff
Regulators
Mission, vision, values
Strategic initiatives
All services
MS Committees
Patient Safety, Risk M
Finance
Human Resources
Building, Environment
Annual work plans
Purchasing, Materials Management
Information Management
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Integrate Component Data
Improve Performance
Strategy
Clinical Quality
Customer
Satisfaction
Hospital
Operations
Satisfaction surveys
Grievances, complaints
Regulatory surveys
Strategic plan measures
Dept PI reports
Inf Control, P&T, others
Incident/occurrence rpts
PIN Benchmark data
Staff Competencies
Med Records, HIT
Safety, Life Safety Data
QIO & PIN CIS data
Financials
Work plan measures
Incident/occurrence rpts
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Build Stakeholder Collaboration
Team Membership and RolesAn Improvement Cycle
Meeting MechanicsManaging Team Conflict
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Team Members: Stakeholders Stakeholders are:
Individuals who have a vested interest in the outcome of the meeting discussion
Can be internal, staff members
Can be external, community and/or Board members
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Team Membership
Improve Performance
Strategy
Clinical Quality
Customer
Satisfaction
Hospital
Operations
Community member
Staff member
PR Director
CEO
Clinical Service Leaders
Inf Control
Pt Safety Officer/RManager
Purchasing, MM
HR Director
Med Records, HIT, HIPAA
Safety Cmtee rep, Engineer
Quality/PI Coord, Dir
CFO
Board member
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Team Membership Balance membership, 7-9 ideal
System and front-line perspectives Decision-makers and process-
performers Personalities
Drivers Cheerleaders Interpersonal facilitators Data, process junkies
Rotating membership is acceptable
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Team Member Role Responsible for independent assessment of
objective evidence concerning the hospital’s overall quality management system
Proactive, prevention-oriented, proactive Objective evidence, fact and data-based decisions Engage in continuous assessment and
improvement cycles Holds other team members accountable Makes decisions about how to move forward
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Team Member Role Eliminates barriers to improvement
Educates the organization about PI
Coordinates resource utilization and allocation for PI activities
Objectively evaluates the soundness of the organization’s approach to performance measurement, assessment, and improvement
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Team Leader Role Calls meetings
Location, time, notification, agenda
Ensures the needed information available
Identifies current & future opportunities
Identifies current, needed and new resources
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Team Leader Role
Maintains and follows up on action plan
Documents meetings or delegates this
Helps move team through improvement cycle Plan, Do, Study, Act (PDSA)
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Plan, Do, Study, Act Plan
Opportunity for improvement identified All aspects of the opportunity clarified
and understood Plan for improvement is developed
Do Test the plan for improvement Collect data about the impact of change
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Plan, Do, Study, Act Study
Aggregate and assess data from “Do” Decide if improvement was made
Return to Plan if not; try again until succeed Proceed to Act if it did
Act Formalize the change (policies,
procedures) Monitor to ensure improvement
maintained Spread the change as appropriate
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Before the Meeting Give a heads-up to reporting members
Distribute the agenda and attachments
Distribute minutes from last meeting
Room availability and set up
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Traditional Team Agenda Review, approve
minutes
Review, revise agenda
Old Business
New Business
“Other”
Next Meeting
Attachments
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Sample Traditional Agenda
1. Review minutes, agenda2. Follow ups3. Quarter reports
a. Acute careb. Swing bedsc. Ambulatory care
4. PI Team reportsa. CAP, pneumoniab. Heart Failure
5. Other6. Next meeting
Kathy 5 minnoneKip 10 minCarol 10 minKathy 10 min
Kirsten 5 minKim 5 min
5 minMarch 10 1 pm
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Traditional AgendaAdvantages
Template for clear meeting record
Clear order of discussion; flexible
Effective follow up of pending issues
Disadvantages
Easily run out of time
Lots of attachments
Easy not to be data, objective evidence focused
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Traditional Agenda Tricks List pending and critical discussion issues first
Assign discussion time for each item Assign time keeper for the meeting
Identify the “owner” of the item; accountability
Learn to facilitate data-based discussion discourage team rushing to decisions; wasting time
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Consensus Agenda
Like the traditional agenda, except…
Reports to be given are listed A motion is made to accept as presented Members must request discussion on
reports they want to discuss Discussion items are noted and addressed
in order requested
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Consensus Agenda
Advantages
Move through standing items quickly
Increased time for new discussion items
Disadvantages
Members have to request discussion
Assumes members have reviewed reports & data prior to meeting
Easy to bypass important pending items
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Work Plan Agenda Last meeting’s work
plan is this meeting’s agenda
Current, pending and in-progress activities listed
Task ‘owner’ clearly identified
Individual activity steps identified
Target completion dates clearly identified
Attachments
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Work Plan AgendaFocus Who Will Do
WhatWhen Follow
up
Quarter Reports
Kip Q4 06 AcuteQ4 06 Swing
Jan 07Feb 07
Next meeting
Staff PI Ed
Carol In-service managers
Feb 07 March
Heart Failure PI
Kim - Revise DC instruct form-MS approval
Jan
Feb
March
CAH Ann Eval
Kathy Prep and lead meeting
Dec 07 Fall 2007
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Work Plan AgendaAdvantages
Activity focus
Clear accountabilities
Effective follow up of pending issues
Future activities identified
Easy to track progress
Disadvantages
Less documentation of discussion
Easy to get stuck in operational details
Easy to overlook data
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Team Meeting Minutes
List items in same order as agenda Date, time of meeting; members present Agenda items Assessment of relevant data presented Brief summary of discussion Specific actions to be taken
who, what, when date of next report
Next meeting date, time, location
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Team Work¹
Team Task Function: what we are doing
Inte
rper
son
al F
un
ctio
n:
how
w
e ar
e w
orki
ng
with
eac
h ot
her
Team Effectiveness
Maximized when we perform both task and interpersonal functions well
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4 Stages of Team Development² Forming: orientation to group and
task Safe, “best” behavior put on Need approval; avoid controversy, conflict Opinions about each other forming
Storming: conflict over control Competition and conflict emerge as
attempt to organize task functions Leadership, structure, responsibilities,
power, authority are all at stake
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4 Stages of Team Development
Norming: group solidifies Interpersonal cohesiveness develops Acknowledge each other’s contributions Ideas, opinions can change based on facts Leadership shared; questions OK
Performing: maximum productivity Rare to reach this stage Interdependence in personal relations and
problem solving; roles and authority adjust as needed; group identity and loyalty high
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Team Conflict
Conflict is inherent in the team process
Different points of view borne out of different perspective, personality, experience
Different personal, organization “agendas”
Has been described as “functional” or “dysfunctional”
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Functional Conflict Enlarges mutual understanding through
the constructive expression of… Different points of view, passionate beliefs Competing goals Unique, creative solutions to problems
For the purpose of respectfully working together to achieve consensus Win-win outcomes; “I can live with that…”
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Dysfunctional Conflict Undermines collaboration, trust &
quality because members…
Compete for control of the process, outcomes
Express aggressive, manipulative behaviors Fail to share information and listen
Prevents team achieving effectiveness Win-lose outcomes; “Live with it…”
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Techniques forManaging Team Conflict Team roles clarified (see previous section)
Team rules established
Team facilitator
Team and program effectiveness evaluations group members mature to manage
themselves
One on one interventions
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Team Rules How the team will work together
Process or system, not people
“Each process/system is perfectly designed to produce its current outcome.”
Mutual respect; all contribute, all listen
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Team Rules Differences of opinion, perspective, passion
are desirable and must be expressed freely Members come to share information
What we say here stays here
Titles are left at the door
Data-based, objective decision-making
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Team Rules Primary decision-making method is consensus
Meeting value, importance: “100 mile Rule”
Will respect each other’s time
complete between-meeting work start the meeting on time end on time minutes and reports reviewed prior to meeting
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Team Facilitator Sole interest is getting to the best decisions
No vested interest in a particular decision
Keeps discussion focused on current topic
Tactfully stops side conversations
Tactfully prevents domination of discussion by one or a few members and that all participate
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Team Facilitator Stops task discussion when dysfunctional
interpersonal conflict is building
Aggressive verbal or non-verbal behaviors Discussion is shutdown, members
withdraw
Encourages members to deal honestly, respectfully with interpersonal conflict
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Team Effectiveness Evaluation
At the end of the team meeting, ask…
What did we do well; what didn’t we do well Did we pay attention to interpersonal
functions as well as the task function What barriers to effectiveness did we
encounter What do we need to do differently to
improve Did we orient new members to the team
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PI Program Effectiveness Eval
For the CMS/Regulatory perspective…
See SOM tags C-0336 through C-0343
Session 1: Leadership and Provider roles and responsibilities; PI Program policy and purpose statements
Session 2: data to be collected
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PI Program Effectiveness Eval
Ask: “In our organization culture…”
Do our leaders demonstrate commitment to improving performance and patient safety
Are our mission, vision, values, objectives aligned with improving customer satisfaction and patient safety
Do we value the uniqueness and contribution of all members of the organization
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PI Program Effectiveness Eval
Ask: “In our PI Program…”
Do we use an understandable approach to improving performance
Do we clearly define our goals in terms of achievable, measurable objectives that stretch us
Are there clear lines of communication through all organization levels and services
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PI Program Effectiveness Eval
Ask: “As a result of our PI Program…”
Can all staff articulate our mission, values
Can staff describe the PI process we use
Has my own professional practice improved
Have patient safety and customer satisfaction increased
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One on One Interventions Always attempt to let people “save face”
Minimal Risk Interventions as a Facilitator Outside the meeting, ask a disruptive member
what would increase his/her satisfaction with the meetings; give constructive feedback about specific behaviors
Within the meeting, ask in very general terms about any group process concerns identified in team evaluations; avoid identifying individuals unless they volunteer themselves
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One on One Interventions Moderate Risk Interventions as a
Facilitator After lower risk attempts have failed, outside
the meeting, tell the disruptive member what specific behavior improvement you are looking for
Add humor; offer to help correct a bad habit CEO may need to do this
High Risk Interventions as a Facilitator As a last resort and only in a mature team,
address the undesirable behavior in the group
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CAH Annual Program Eval
C-0331 “The CAH carries out or arranges for a periodic evaluation of its total program. The evaluation is done at least once a year and includes review of…”
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CAH Annual Program Eval The utilization of CAH services, including
at least the number of patients served and the volume of services (C-0332)
Acute care, including outpatient & emergency
Surgery, anesthesia, OB if provided
Swing beds
Ancillary clinical services
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CAH Annual Program Eval
A representative sample of both active and closed clinical records (C-0333)
“means not less than 10% of both active and closed patient records”
Can be conducted throughout the year Includes records reviewed for CART/CMS,
PIN studies, other PI projects, etc Includes records sent for external peer
review
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CAH Annual Program Eval
The CAH’s health care policies (C-0334)
“evidence demonstrates that the health care policies are evaluated, reviewed and/or revised”
Policies developed by a team of professionals that includes one or more physicians, mid-level providers, and individuals not members of the staff (C-0272, C-0258, C-0263)
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CAH Annual Program Eval “The purpose of the evaluation is to
determine…
whether the utilization of services was appropriate
the established policies were followed
any changes that are needed (C-0335)” Work plan generated, approved for the next 12
months
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CAH Program Annual Work Plan
Focus Who Will Do What
When Follow up
Quarter Reports
Kip Q4 06 AcuteQ4 06 Swing
Jan 07Feb 07
Next meeting
Staff PI Ed
Carol In-service managers
Feb 07 March
Heart Failure PI
Kim - Revise DC instruct form-MS approval
Jan
Feb
March
CAH Ann Eval
Kathy Prep and lead meeting
Dec 07 Fall 2007
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Footnotes and References
¹ Structured Experience Kit, University Associates, Inc.; ©1980 International Authors B.V.; San Diego, CA.
² Team Building: Blueprints for Productivity and Satisfaction, W. Brendan Reddy. ©1988 NTL Institute for Applied Behavioral Science, Alexandrian, VA and University Associates, Inc., San Diego, CA.
The Team Handbook; Peter R. Scholtes et al; ©1988 Joiner Associates, Inc.; Madison, WI.
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Addendum: from the SOM, aQA Program is effective if it…
Evaluates the quality and appropriateness of diagnosis and treatment (C-0336) including:
Ongoing monitoring and data collection Problem prevention, identification and data
analysis Identification of corrective actions Implementation of corrective actions Evaluation of corrective actions Measures to improve quality of a continuous basis
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Addendum: from the SOM, aQA Program is effective if…
All patient care services and other services affecting patient health and safety are evaluated (C-0337)
RT, therapeutic gases and lab testing (C-0200) Drugs and biologicals use (C-0203, C-0276, C-0227) Blood utilization (C-0205) Emergency Preparedness and Life Safety (C-0227 through C-0231) Dietary, Nutrition (C-0279), Rehab (C-0281), Radiology (C-0283) Medical records quality (C-0300 through C-0310)
Nosocomial infections and medication therapy are evaluated (C-0338, C-0276 through C-0278)
Diagnosis and treatment provided by both mid-levels and physician providers are evaluated (C-0339, C-0340, C-0259, C-0264)
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Addendum: from the SOM, aQA Program is effective if…
CAH considers findings and recommendations from the QIO and takes corrective action is necessary (C-0339, 0341)
The CAH takes appropriate remedial actions to address deficiencies found through the QA program (C-0342). Note, this includes survey deficiencies.
Outcomes of all remedial action documented (C-0343)