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1
Telligen
Making BIG Changes Attainable with Affinity Group Outreach
June 3, 2016
2
Telligen QIN-QIO
3
For today
• Assess the landscape – Evaluate how your projects align with affinity group interests
• Tell the story – Learn how to present data to compel action
• Make it happen – Identify, enlist and motivate your partners
4
SBAR
• Situation – What’s happening right now? What needs attention first?
• Back ground – What’s the context? What else happened to bring us to this
point?
• Assessment – From your perspective, what’s the problem? What do you see
happening?
• Recommendation – What should happen next?
5
Situation - C Task Team
• Recruit 25 hospitals – Follow for CAUTI, CLABSI, CDI
• Recruit 75% of Iowa nursing homes – 330 nursing homes
– Overall improvement - Composite score, Antipsychotics
• Recruit 60% of Medicare population – 276,636 Medicare beneficiaries
– Improve admission, readmission and community tenure rates
AND
• New!! CDI in LTC – Recruit 66 nursing homes to report into NHSN
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Situation
• Recruit AND
• Maintain engagement AND
• Create sustainability AND
• Show improvement AND…
• Staffing for C team – Sheryl and Kate
– October 2015 added Kari
7
Background
• FTEs are limited
• Skill set – Who is really good at what? Who is the best person to do the
task?
– What kind of backgrounds does your team have?
• Scrum for daily work** – Huddle at least 3x a week, more prn
– Schedules, what has been done, what needs to be done, what is holding up the work, PDSA review
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Work space
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Background
• Quality Improvement for everything QIO – Use data to drive decisions
– Write PDSA, follow up, track
– RCA – why didn’t that work?
AND
• Quality improvement for everything – Different needs in different settings
– Don’t need to be a subject matter expert in infection, readmission, nursing home – just in QI
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Assessment
• Efficient and Effective
• QI 101 for all – How to collect data
– Using and understanding what you have
– Make it super easy
– PDSA and RCA
• Follow up and accountability
• Leadership and Organizing in Action principles
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Recommendation – how we did it – for LTC
• Created affinity group for decreasing antipsychotics in LTC – Used data to ID at risk performers
– QI 101
– PDSA and RCA to dig into the problem
– Easy wins
– Follow up and follow through
– Success Stories and Barriers
• Many other affinity groups developing as a result – UTI, unplanned transfers, pain, alarm reduction, corporations
12
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NNHQCC Evaluation Measures
RIR antipsychotic long stay measure to current:
Iowa Statewide = 15%
Contract goal for July 2016 = 3%
RIR composite score measure to current:
Iowa Collaborative 8.01%
Iowa Non-Collaborative = 3.01%
National Collaborative = 2.90%
14
Recommendation – how we did it - Communities
• Bridging the gap between ACO and LTC – Used data to ID at risk performers
– QI 101
– PDSA and RCA to dig into the problem
– Easy wins
– Follow up and follow through
– Success Stories and Barriers
15
Community Intervention
-10.0%
-5.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Percent of Reports without Orders (trend line added due to missing Sept data point)
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Recommendation – how we did it - Hospitals
• Connecting Infection Prevention and Quality Improvment – Used data to ID at risk performers
– QI 101
– PDSA and RCA to dig into the problem
– Easy wins
– Follow up and follow through
– Success Stories and Barriers
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Hospital Intervention
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Recommendation – how we did it - Stakeholders
• Nursing home trade associations – Understanding what their goals are
• Hospital Engagement Network (HEN) – Collaboration to avoid duplication
• Iowa Department of Public Health – State Innovation Model (SIM) grants for communities
19
Recommendation – how we did it – Motivation
• Leave in action – Everyone needs an action item or ‘to-do’ every time
• Collect data – There is always data to be collected
– Remember to share the data back with the group
• Meet regularly – Quarterly meetings = 10 year improvement plan
– Monthly meetings = 1 -2 year improvement plan
– Monthly meetings AND calls between = 90 or 100 day improvement plan
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Recommendation – how we did it – Sustainment
• Creating a strong mission and vision statement
• Celebrate wins
• Share the story
• Shared leadership
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What we learned - QIO
• Write your own PDSA and document on it regularly – What went well, what didn’t go well, any changes
• Relationships
• Team – No one left behind
– Continuous communication
– Win together, lose together
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What we learned – Success stories are powerful!
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What we learned – Affinity Groups
• Need more family and resident/patient involvement
• Share the joy – Use your super star staff to share the work
• Most problems can be solved through QI
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• ** Scrum: The Art of Doing Twice the Work in Half the Time – By Jeff Sutherland and JJ Sutherland
25
Contact Information
Sheryl Marshall, RN, CDC – QI Manager at Telligen
– 515-273-8844
This material was prepared by Telligen, the Medicare Quality Improvement
Organization for Colorado, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human
Services. The contents presented do not necessarily reflect CMS policy. 11SOW-
IA-Cteam-05/2016-11647