move to improve program process and results

Move to Improve ProgramProcess and Results

Gina Mazza RN, BSNPartner, Fazzi Associates

Marian StillwellDirector of Clinical Services

Heritage Health Care

October 2012

To identify best practice strategies for reducing avoidable hospitalizations of the home care patient.

Objective

76 Agencies

Size of agencies by Average Daily Census:

Mean: 230

Median: 157

# agencies less than 100: 19

# between 100 and 300: 39

# agencies greater that 300: 20

Move To Improve Project Statistics

For comparative analysis, agencies were divided into three categories:

Move To Improve Project Statistics

 Home Health

Compare Rate Number of Agencies

Low Hospitalization Rate

(Best)16% - 27% 23

Moderate Rate Hospitalization 28% - 32% 28

High Hospitalization Rate (Poorest) 33% or greater 25

The Program…

• Initiated collection of baseline OASIS data

• Agency practice survey

• Focus Group

• Developed Tracker and Hospitalization Management Dashboard

• Training

Revised Structure

• Audit tool revised

• Dashboard revised

• Monthly Accountability/Planning Meeting

SafeSide™ Structure

ActivityReal Time Tracking

Real Time Audits

Monthly

Targeted Trend

Improvement Effort

SafeSide Components

Hosp. Dashboard

48-Hour SafeSide

Audit

SafeSide Monthly

Accountability Meetings (MAP)

No More Than 1 New Improvement per Quarter

Lead QI/PIClinical Director/

SupervisorSafeSide Lead

Clinical Director

Input ProcessOutcomes:

Improvement Efforts

Zealous Accountability ● Data-Driven ● Goal-OrientedMeasurable Targets and Outcomes

Project Leader

Project Leader

Planning and Improvement

Meeting

Planning and Improvement

Meeting

Fazzi’s SafeSide Outcomes ModelThe Outcome Oriented Change Model

Process Improvements

Process Improvements

Practice Refinements

Practice Refinements

New StrategiesNew Strategies

Education and Competency

Education and Competency

Data Monitoring

and Tracking

Data Monitoring

and Tracking

Real-Time Audits

Real-Time Audits

Leadership of Program

Lead

CEO SeniorClinical

Dir.Mid

LevelQuality

AverageOverall Reduction

-6.0% -5.0% -2.2% 0.2% -4.2%

Frequency of Monitoring Hospitalization Rates

How often monitor scores

Often Somewhat

moreIn-

FrequentHave not

monitored

Average Overall

Reduction-6.7% -3.2% 0.8% 0.0%

Results of Agencies Performing Audits

Hospitalization Grouping at

Initiation

Change in HHC Hospitalization

Rate

% Reduction of the HHC

Rate

High Rate-11 percentage

points21.5%

Moderate Rate-5.3 percentage

points15.6%

Low Rate-2.8 percentage

points10.1%

Total-6.6 percentage

points15.7%

Overall Results

Hospitalization Grouping at

Initiation

Change in HHC Hospitalization

Rate:First 6 Months vs.

Last 6 Months

% Reductionof their HHC

Rate

High Rate -11 percentage points 19.9%

Moderate Rate -4percentage points 13.9%

Low Rate -3 percentage points 8.2%

Total Average -6 percentage points 14.8%

Recommendations

1. Audit charts of hospitalized patients

●Critical to identifying core issues related to hospitalization

●Create teachable moments

2. Set clear and measureable goals and share with team

●Set stretch goals and publicize and celebrate wins

Recommendations

3. Accountability● Have a leader that has authority, accountability and

respect of clinicians.

4. Develop a plan for change and operationalize

● Plan, Do, Check, Act

● Don’t let daily fires distract from the focus.

Recommendations

• Act with purpose

• Make decisions based on data

• Set clear goals

• Have clear outcomes

Heritage Health Care

Move to Improve Project Participant

Marian Stillwell Director of Clinical Services