Oklahoma Health Care Authority February, 2005 MANAGEMENT INTELLIGENCE FOR HEALTH CARE

My InnerView Today

Customers in 37 states

15 state LTC association endorsements

Alliance for Quality Nursing Home Care » MyInnerView selected as provider of family satisfaction surveys for member multifacility companies with 2100 locations.

Evidence-based management calls for a paradigm shift in the approach to quality improvement: An appreciation of data, the ability to turn data into information and knowledge, and to use that information and knowledge to improve quality. Evidence-based Management Philosophy

Outcomes: Continued improvement in compliance with state/federal regulations 2. Promotion of financial integrity and fraud prevention 3. Progress in prevention of confirmed abuse and neglect 4. High rates on consumer satisfaction surveys 5. Improvement in retention and turnover 1. Continued improvement in compliance with state/federal regulations 2. Promotion of financial integrity and fraud prevention 3. Progress in prevention of confirmed abuse and neglect 4. High rates on consumer satisfaction surveys 5. Improvement in retention and turnover

The Georgia Experience Making Quality First Work

My InnerView’s evidence- based path to quality and risk management Turn plan into action: improve process Turn knowledge into plan: apply new wisdom to process Turn information into knowledge: study current process Collect data: ensure validity, organize Turn data into information: benchmark, study variation Evaluate outcomes: measure variation © My InnerView Inc.™

Quality of Data-GA

Family response by council © 1/1/05, My InnerView Inc.™ +2% +1% -4% +3% +6% +5% +2% +4%

Employee response by council © 1/1/05, My InnerView Inc.™ +16% +14% +8% +18% +21% +20% +17% +16% +19%

© 1/1/05, My InnerView Inc.™ Quality Profile participation rate

© 1/1/05, My InnerView Inc.™ Data submission Submitted dataSubmitted on time (by 10th of month)

Oscar vs. My InnerView data © 1/1/05, My InnerView Inc.™

2004 Special Focus: Leadership Skills

Number of Attendees at AARP Sponsored Training Sessions

Many Attendees Statewide

The Voice of Employees 2003 vs. 2004

p =.02 SUPERVISION Overall “Supervision” scale

p =.13 CARE/CONCERN OF SUPERVISOR How your supervisor cares about you as a person

p =.13 COMMUNICATION BY SUPERVISOR How supervisor regularly gives work-related information

p =.000 APPRECIATION OF SUPERVISOR How supervisor regularly shows appreciation for job well done

p =.000 FAIRNESS OF EVALUATIONS How fair your performance evaluations are

How the facility helps you deal with job stress or burnout p =.000

p =.008 RESPECTFULNESS OF STAFF How the staff treats the resident with respect

Facility Case Study

GOOD TOTAL EXCELLENT Family surveys Overall satisfaction 33%38%43%60%76%98% Recommendation of facility 39%48%41%45%80%93% Quality of care from nurses 33%30%56%64%89%94% Quality of care from CNAs 33%34%48%55%81%89% IMPROVEMENTDECREASE

GOOD TOTAL EXCELLENT Employee surveys Overall satisfaction 6%17%39%44%45%61% Recommendation of facility as place to work 18%26%32%39%50%65% Recommendation of facility as place to receive care 15%31%42%43%57%74% IMPROVEMENTDECREASE

© 1/1/05, My InnerView Inc.™ RNs/LVNs/LPNs without absenteeism State AverageFacility

© 1/1/05, My InnerView Inc.™ CNAs/NAs without absenteeism State AverageFacility

© 1/1/05, My InnerView Inc.™ Residents without pressure ulcers State AverageFacility

Key points » Data are absolutely critical to benchmark performance statewide or within individual facilities. » Without data you have no “beef”. » Data are absolutely critical to benchmark performance statewide or within individual facilities. » Without data you have no “beef”.

Statewide Clinical GA Metrics: July 2003 to Dec 2004

Residents without falls PERCENT

Residents without falls by geographic region PERCENT A B C Rural Suburban Urban

Residents without anti-psychotic medications PERCENT

Residents without anti- psychotic medications by size of organization. PERCENT A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

Residents without acquired catheters PERCENT

Residents without acquired catheters by ownership type PERCENT A B C Government owned (state, county or city) Not-for-profit (with religious affiliation) Not-for-profit (without religious affiliation) D E For-profit (privately owned) For-profit (publicly traded)

Residents without acquired physical restraints PERCENT

Residents without acquired physical restraints by ownership type PERCENT A B C Government owned (state, county or city) Not-for-profit (with religious affiliation) Not-for-profit (without religious affiliation) D E For-profit (privately owned) For-profit (publicly traded)

Residents without unplanned weight loss/gain PERCENT

Residents without unplanned weight loss/gain by size of organization PERCENT A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

Residents without unplanned weight loss/gain by geographic region PERCENT A B C Rural Suburban Urban

Residents without acquired pressure ulcers PERCENT

Residents without acquired pressure ulcers by size of organization PERCENT A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

Employee Commitment: Statewide 2003 and 2004

% CNAs/NAs without turnover PERCENT

% CNAs/NAs without turnover by geographic region PERCENT A B C Rural Suburban Urban

% RNs/LVNs/LPNs without turnover PERCENT

% RNs/LVNs/LPNs without turnover by geographic region PERCENT A B C Rural Suburban Urban

CNAs/NAs: Stability PERCENT

CNAs/NAs: Stability by Geographic Region PERCENT A B C Rural Suburban Urban

RNs/LVNs/LPNs: Stability PERCENT

RNs/LVNs/LPNs: Stability by Geographic Region PERCENT A B C Rural Suburban Urban

RNs/LVNs/LPNs: Stability by Size of Organization PERCENT A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

The Voice of Families 2003 vs. 2004

© 1/1/05, My InnerView Inc.™ Recommendation to others Overall satisfaction 85% 84% 85% 84%

p =.005 CHOICES/PRFERENCES How resident’s choices and preferences are met

p =.07 RESIDENT-TO-RESIDENT FRIENDSHIPS How … offered opportunities for friendships with other residents

p =.03 MEANINGFULNESS OF ACTIVITIES How the resident is offered meaningful activities

p =.001 RELIGIOUS/SPIRITUAL OPPORTUNITIES How resident’s religious and spiritual needs are met

Organizational Systems Model Family Satisfaction Employee Satisfaction Organizational Factors: Size Ownership Chain Affiliation Geographic Location

Correlations between Employee Satisfaction and Family Satisfaction Sub-scales Employee Satisfaction Sub-scales Pearson Correlation Coefficient Sample Size (N) Training.415**305 Supervision.921**314 Management.904**314 Work Environment.988**314 Global Satisfaction.530**305

Scatter Plot of Family Satisfaction and Work Environment

Facilities with higher family satisfaction have better work environments < 54%54% to 58%58% to 64%> 64% Mean = 68.0 EMPLOYEE ENVIRONMENT SCORE (%) FAMILY SATISFACTION

Facilities with higher family satisfaction have better supervision < 54%54% to 58%58% to 64%> 64% Mean = 72.2 EMPLOYEE SUPERVISION SCORE (%) FAMILY SATISFACTION

Predictors of Family Satisfaction Independent Variable Standardized Beta Significance Facility Size Ownership Type Chain Type Geographic Region Employee Satisfaction Score R 2 =.327 (F=27.8; p <.000)

Creating a Culture of Quality

Quality Improvement Model Feedback Loop (Performance Measurement System) Leadership Core Systems Information Human Resource Clinical Operations Environmental Design Performance Outcomes Quality of Life Quality of Care Quality of Workplace Staff Turnover Customer Satisfaction Regulatory Compliance

Evidence-based Management Evidence-based Management Leadership Excellence Culture Change Three-legged Platform for Excellence

Key Opportunities » Leadership development for culture change » Enhancing quality of life and quality of the workplace through culture change » Adopting the philosophy of evidence-based management » Leadership development for culture change » Enhancing quality of life and quality of the workplace through culture change » Adopting the philosophy of evidence-based management

Key opportunities, cont’d. » Policy assessment and development. » Resource allocation. » Pay for performance. » Incentivize best practices. » Reduce liability costs. » Data customization. » Benchmarking in Oklahoma and outside. » Policy assessment and development. » Resource allocation. » Pay for performance. » Incentivize best practices. » Reduce liability costs. » Data customization. » Benchmarking in Oklahoma and outside.

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