Mary Tess Crotty VP, Quality – Genesis HealthCare Northeast Division

 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.

 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

 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

 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?

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

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

 The Unit/Neighborhood Model Steering Committee Neighborhood/ Unit

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

 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

 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?

QAPI The Regulation

 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

 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

 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)

 CMS Site ◦  AHCA Site ◦

 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

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

 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

 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.