1. Assisted Living Enforcement Process Improvement Project Leading Age Assisted Living Enforcement Training October 18, 2013 Oklahoma State Department of Health and Oklahoma University Center for Public Management

2. Agenda 2 Introduction, meeting process, ground rules Ginger Thompson, OUCPM and Performance Solutions Quality Improvement Project Overview – How we got here Henry F. Hartsell Jr., Protective Health Services Swim Lane Steps – Understanding complexity & consequences Mike Cook, Long Term Care Service Plan of Correction Tool -- Reduce or eliminate fines & waste Patty Scott, Long Term Care Service Informal Dispute Process – New law November 1, 2013 Sue Davis, Patty Scott, Long Term Care Service

3. Ground Rules! 3 Know the agenda One person talk at a time Listen Don’t talk over someone Respect Be on time, return from breaks timely Provide session summaries Turn electronics off or vibrate Knock-Knock rule

4. Gain familiarity with: Quality improvement project Swim Lane process map Optional plan of correction template How to participate in pilot Informal dispute resolution Objectives 4

5. Project Overview: How we got here (and where we are going) 5 Henry F. Hartsell Jr., Ph.D. Deputy Commissioner for Protective Health Services

6. Quality Improvement in Public Health 6 Deliberate improvement process - PDCA Plan Do Check Act

7. 7 Achieve measureable improvements Efficiency Effectiveness Performance Accountability Outcomes Quality Improvement in Public Health

8.  Opportunity exists to ensure OSDH implements clear & reasonable enforcement process for assisted living centers to:  Positively impact residents  Reduce need for penalties  Reduce waste for all involved Plan: Identify Opportunities 8

9.  OSDH staff members  Assisted living providers  University of Oklahoma Center for Public Management Plan: Participants 9

10.  Swim Lane map shows:  Steps  Responsibilities  Where delays, mistakes, inefficiency are most likely  See the waste PDCA Plan Phase: Describe Current Process 10

11.  Lanes (responsibilities) are horizontal  Steps are vertical  Time moves left to right  Boxes are steps or tasks  Diamonds are decision points  Lines & arrows are connections  Ovals are start and end points Swim Lane Process Map 11

12.  Surveyors  Enforcement staff  OSDH Long Term Care Leadership  General Counsel  Assisted Living Centers  Administrative Law Judge  Informal Dispute Resolution Panel Swim Lane Lanes 12

13. Building the Swim Lane 13

15. Swim Lane Analysis: Find Causes of Waste 15 Plan of correction incomplete By first revisit, problems not: Corrected Monitored Documented Rework, delays, penalties 40 centers had 2nd revisits in 2012!

16. 16 PLAN: Root Cause Analysis Issue Idea Issue Idea

17. Ensure a complete & acceptable plan of correction 1 st time Optional POC template walks assisted living centers through all required elements Improvement Theory: Increase proportion of POCs accepted 1st time Reduce proportion of 2nd revisits by 15% in three months Plan Phase: Identify Improvements 17

18. Knowledge Test 18

19. PDCA: Where we are go ing 19 Plan: Reduce POC rejections Reduce 2 nd revisits Use Optional Plan of Correction Template Do: Test Optional POC Template in Nov - Jan Check: Adopt, adapt, abandon Act: SOPs, train, track, solve problems, feedback

20. Next Up: Mike Cook and the Swim Lane Process Map 20