1. Mary Tess Crotty VP, Quality – Genesis HealthCare Northeast Division

2.  The survey team finds no surprises on your annual survey.  The state receives no family complaints about your facility.  Your staff love their jobs and don’t want to move.  Your residents and family don’t blame you for any problems.  You have a waiting list for new residents.

3.  Is a comprehensive system to manage all your strategic and operational areas.  Balances the auditing and monitoring activities with a continual focus on making large scale improvements across your facility.  Involves all your staff and encourages involvement of patients, residents and families

4.  More than existing QA&A  Aligns with the AHCA Quality Award Criteria at Silver and Gold levels  Easily incorporates most common quality systems, such as Lean and Six Sigma  Provides a full operational focus – no need to compartmentalize  An action planning system for achieving all your organizational goals

5.  What is your Performance Improvement model now? ◦ Self-assess and reorganize as needed  How engaged are your leaders, all your staff, and your patients, residents and families? ◦ Introduce new approaches or commit to existing ones  How do you plan and prioritize?  How do you monitor?  How do you support improvement activities?

6. The Team Model Culture Change Excellence Team Clinical Excellence Team Staff Excellence Team Customer Excellence Team Business Excellence Team Performance Improvement Committee & Excellence Teams Safety Excellence Team

7.  The Committee Model Chair Nursing DietaryRehab Physical Plant Med DirSoc Svcs Rec/Activiti es Bus OfficeCNAs

8.  The Unit/Neighborhood Model Steering Committee Neighborhood/ Unit

10.  Audits for other units?  Audits for other departments?  Routine audits built into care processes?  Process measures?  Where are goals displayed?  Where are results displayed?

11.  Small changes, n=1  Neighborhood/Unit huddles  Teams respond to missed targets  Resident/Family involvement  Large change/improvement projects – using PDCA, DMAIC, Lean methodologies  Projects pursuing strengths vs. deficiencies  Visual participation – inviting everyone to participate in improvement process

12.  Who can identify an area to assess or improve?  What data and processes do you use to prioritize and set targets?  What performance levels trigger a response?  What tools do staff use to respond to misses and near-misses?  How does everyone know where you’re going and how you’re doing?

13. QAPI The Regulation

14.  Included as statutory language in the Accountable Care Act (ACA) for all CMS providers: regulation and technical assistance  Will be located at Tag 520, QA&A  LTC is the last provider to write the regulation- providers will have a year to implement from the regulation publication date  Technical assistance began over three years ago, including a two-year pilot with about 30 nursing facilities

15.  Five Elements 1. Design & Scope 2. Governance & Leadership 3. Feedback, Data Systems, and Analysis 4. PIPs – Performance Improvement Projects 5. Systematic Analysis and Systemic Action

16.  Guides and worksheets for every component  Self-assessment  Training modules for each Element, including scripts, powerpoints and handouts  Newsletters from pilot facility activities  Video and public relations campaign featuring AHCA and LeadingAge Quality Leaders (both geriatricians)

17.  CMS Site ◦ http://go.cms.gov/Nhqapi http://go.cms.gov/Nhqapi  AHCA Site ◦ http://www.achancal.org

18.  Think INPUT versus meeting attendance  Use large visual displays to get input – such as the multivoting example  Develop a “P.I. huddle” style meeting for staff, residents and family – a stand-up meeting, in a private area, to generate ideas for improving targeted issues. Keep the huddle to 5-10 minutes.  Establish Learning Circles on prioritized topics or solutions you are considering – include a mix of staff, residents and family

19. Prioritized Ideas Make lunch more affordable for staff Have mini fridges available on each wing for staff lunches Offer PB&J in break room if someone needs some food Be respectful, don’t take it if it’s not yours

20.  Action Initiated Payroll deductions for meals from the kitchen – all shifts. Weekly offerings include a salad, sandwich or hot item. Mini Fridges in the LNA charting rooms for closer monitoring Free popcorn always available in the break room, made hot each day in the popcorn maker

21.  Focus on the areas where residents, families and staff will find the most benefit  Get cross-department involvement in auditing for compliance  Make sure your “quality assurance” is built into staff’s daily routines  Have fun and celebrate with your PI Projects.  Share the success with everyone.