Transcript Slide 1

Skills Competency Education
for
New PI Directors & Coordinators
Session Five
March 14, 2007
Quality Management Team Meetings
Sponsored by: The MT Rural Healthcare PI Network
Co-Sponsored by: Mountain Pacific Quality Health
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Today’s Session
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Recap Session 4: Performance reporting
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Session 5: QMT Meetings
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Purpose
Members and mechanics
Managing team conflict
Evaluating team effectiveness
Evaluating PI program effectiveness
CAH Annual Evaluation and Work Plan
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QMT Meeting Purpose
 Improve organization performance by…
 Integrating PI program components
 Data collected
 Building stakeholder collaboration
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Integrate PI Program Components
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Why Integrate Components
 Share knowledge, information, data
 Clarify complex, inter-related issues
 Example: safety, patient safety
 Reduce duplication of effort
 Minimize waste, staff frustration
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Integrate Components
All services
Mission, vision, values
Strategic initiatives
MS Committees
Annual work plans
Patient Safety, Risk M
Improve
Performance
Finance
Community Relations, PR
Human Resources
Staff, Medical Staff
Building, Environment
Regulators
Information Management
Purchasing, Materials Management
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Integrate Component Data
Dept PI reports
QIO & PIN CIS data
Strategic plan measures
Inf Control, P&T, others
Work plan measures
Incident/occurrence rpts
Improve
Performance
Financials
Staff Competencies
Satisfaction surveys
Safety, Life Safety Data
Med Records, HIT
Grievances, complaints
Regulatory surveys
PIN Benchmark data
Incident/occurrence rpts
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Build Stakeholder Collaboration
Team Membership and Roles
An Improvement Cycle
Meeting Mechanics
Managing Team Conflict
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Team Members: Stakeholders
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Stakeholders are:
 Individuals who have a vested interest in the
outcome of the meeting discussion
 Can be internal, staff members
 Can be external, community and/or Board
members
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Team Membership
Clinical Service Leaders
Quality/PI Coord, Dir
CEO
Inf Control
Board member
Pt Safety Officer/RManager
CFO
Improve
Performance
Community member
HR Director
Safety Cmtee rep, Engineer
Med Records, HIT, HIPAA
Staff member
PR Director
Purchasing, MM
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Team Membership
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Balance membership, 7-9 ideal
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System and front-line perspectives
Decision-makers and process-performers
Personalities
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Drivers
Cheerleaders
Interpersonal facilitators
Data, process junkies
Rotating membership is acceptable
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Team Member Role
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Responsible for independent assessment of
objective evidence concerning the hospital’s
overall quality management system
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Proactive, prevention-oriented, proactive
Objective evidence, fact and data-based decisions
Engage in continuous assessment and improvement
cycles
Holds other team members accountable
Makes decisions about how to move forward
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Team Member Role
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Eliminates barriers to improvement
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Educates the organization about PI
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Coordinates resource utilization and allocation for
PI activities
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Objectively evaluates the soundness of the
organization’s approach to performance
measurement, assessment, and improvement
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Team Leader Role
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Calls meetings
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Location, time, notification, agenda
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Ensures the needed information available
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Identifies current & future opportunities
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Identifies current, needed and new
resources
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Team Leader Role
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Maintains and follows up on action plan
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Documents meetings or delegates this
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Helps move team through improvement
cycle
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Plan, Do, Study, Act (PDSA)
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Plan, Do, Study, Act
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Plan
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Opportunity for improvement identified
All aspects of the opportunity clarified and
understood
Plan for improvement is developed
Do
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Test the plan for improvement
Collect data about the impact of change
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Plan, Do, Study, Act
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Study
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Aggregate and assess data from “Do”
Decide if improvement was made
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Return to Plan if not; try again until succeed
Proceed to Act if it did
Act
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Formalize the change (policies, procedures)
Monitor to ensure improvement maintained
Spread the change as appropriate
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Team Meeting Mechanics
Before the Meeting
Agendas
Minutes
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Before the Meeting
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Give a heads-up to reporting members
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Distribute the agenda and attachments
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Distribute minutes from last meeting
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Room availability and set up
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Traditional Team Agenda
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Review, approve
minutes
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“Other”
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Next Meeting
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Attachments
Review, revise agenda
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Old Business
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New Business
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Sample Traditional Agenda
1.
2.
3.
Review minutes, agenda
Follow ups
Quarter reports
a.
b.
c.
4.
PI Team reports
a.
b.
5.
6.
Acute care
Swing beds
Ambulatory care
CAP, pneumonia
Heart Failure
Other
Next meeting
Kathy
none
Kip
Carol
Kathy
5 min
Kirsten
Kim
5
5
5
1
March 10
10 min
10 min
10 min
min
min
min
pm
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Traditional Agenda
Advantages
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Template for clear
meeting record
Clear order of
discussion; flexible
Effective follow up
of pending issues
Disadvantages
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Easily run out of time
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Lots of attachments
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Easy not to be data,
objective evidence
focused
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Traditional Agenda Tricks
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List pending and critical discussion issues first
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Assign discussion time for each item
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Assign time keeper for the meeting
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Identify the “owner” of the item; accountability
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Learn to facilitate data-based discussion
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discourage team rushing to decisions; wasting time
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Consensus Agenda
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Like the traditional agenda, except…
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Reports to be given are listed
A motion is made to accept as presented
Members must request discussion on reports
they want to discuss
Discussion items are noted and addressed in
order requested
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Consensus Agenda
Disadvantages
Advantages
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Move through
standing items
quickly
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Increased time for
new discussion
items
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Members have to
request discussion
Assumes members
have reviewed reports
& data prior to meeting
Easy to bypass
important pending
items
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Work Plan Agenda
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Last meeting’s work
plan is this meeting’s
agenda
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Current, pending and
in-progress activities
listed
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Task ‘owner’ clearly
identified
Individual activity
steps identified
Target completion
dates clearly
identified
Attachments
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Work Plan Agenda
Focus
Will Do
When
What
Q4 06 Acute Jan 07
Q4 06 Swing Feb 07
Follow
up
Next
meeting
Staff PI Ed Carol
In-service
managers
March
Heart
Failure PI
Kim
- Revise DC Jan
instruct form
-MS approval Feb
March
CAH Ann
Eval
Kathy
Prep and
Dec 07
lead meeting
Fall 2007
Quarter
Reports
Who
Kip
Feb 07
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Work Plan Agenda
Advantages
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Activity focus
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Clear accountabilities
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Disadvantages
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Less documentation of
discussion
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Easy to get stuck in
operational details
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Easy to overlook data
Effective follow up of
pending issues
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Future activities identified
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Easy to track progress
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Team Meeting Minutes
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List items in same order as agenda
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Date, time of meeting; members present
Agenda items
Assessment of relevant data presented
Brief summary of discussion
Specific actions to be taken
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who, what, when
date of next report
Next meeting date, time, location
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Managing Team Conflict
Team Work
Conflict
Management
techniques
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Interpersonal Function: how
we are working with each other
Team Work¹
Team Effectiveness
Maximized when we
perform both task and
interpersonal functions
well
Team Task Function: what we are doing
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4 Stages of Team Development²
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Forming: orientation to group and task
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Safe, “best” behavior put on
Need approval; avoid controversy, conflict
Opinions about each other forming
Storming: conflict over control
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Competition and conflict emerge as attempt to
organize task functions
Leadership, structure, responsibilities, power,
authority are all at stake
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4 Stages of Team Development
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Norming: group solidifies
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Interpersonal cohesiveness develops
Acknowledge each other’s contributions
Ideas, opinions can change based on facts
Leadership shared; questions OK
Performing: maximum productivity
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Rare to reach this stage
Interdependence in personal relations and
problem solving; roles and authority adjust as
needed; group identity and loyalty high
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Team Conflict
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Conflict is inherent in the team process
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Different points of view borne out of
different perspective, personality, experience
Different personal, organization “agendas”
Has been described as “functional” or
“dysfunctional”
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Functional Conflict
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Enlarges mutual understanding through
the constructive expression of…
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Different points of view, passionate beliefs
Competing goals
Unique, creative solutions to problems
For the purpose of respectfully working
together to achieve consensus
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Win-win outcomes; “I can live with that…”
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Dysfunctional Conflict
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Undermines collaboration, trust & quality
because members…
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Compete for control of the process, outcomes
Express aggressive, manipulative behaviors
Fail to share information and listen
Prevents team achieving effectiveness
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Win-lose outcomes; “Live with it…”
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Techniques for
Managing Team Conflict
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Team roles clarified (see previous section)
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Team rules established
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Team facilitator
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Team and program effectiveness evaluations
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group members mature to manage themselves
One on one interventions
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Team Rules
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How the team will work together
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Process or system, not people
“Each process/system is perfectly designed to
produce its current outcome.”
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Mutual respect; all contribute, all listen
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Team Rules
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Differences of opinion, perspective, passion are
desirable and must be expressed freely
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Members come to share information
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What we say here stays here
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Titles are left at the door
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Data-based, objective decision-making
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Team Rules
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Primary decision-making method is consensus
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Meeting value, importance: “100 mile Rule”
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Will respect each other’s time
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complete between-meeting work
start the meeting on time
end on time
minutes and reports reviewed prior to meeting
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Team Facilitator
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Sole interest is getting to the best decisions
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No vested interest in a particular decision
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Keeps discussion focused on current topic
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Tactfully stops side conversations
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Tactfully prevents domination of discussion
by one or a few members and that all
participate
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Team Facilitator
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Stops task discussion when dysfunctional
interpersonal conflict is building
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Aggressive verbal or non-verbal behaviors
Discussion is shutdown, members withdraw
Encourages members to deal honestly,
respectfully with interpersonal conflict
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Team Effectiveness Evaluation
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At the end of the team meeting, ask…
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What did we do well; what didn’t we do well
Did we pay attention to interpersonal functions
as well as the task function
What barriers to effectiveness did we
encounter
What do we need to do differently to improve
Did we orient new members to the team
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PI Program Effectiveness Eval
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For the CMS/Regulatory perspective…
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See SOM tags C-0336 through C-0343
Session 1: Leadership and Provider roles and
responsibilities; PI Program policy and
purpose statements
Session 2: data to be collected
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PI Program Effectiveness Eval
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Ask: “In our organization culture…”
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Do our leaders demonstrate commitment to
improving performance and patient safety
Are our mission, vision, values, objectives
aligned with improving customer satisfaction
and patient safety
Do we value the uniqueness and contribution
of all members of the organization
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PI Program Effectiveness Eval
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Ask: “In our PI Program…”
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Do we use an understandable approach to
improving performance
Do we clearly define our goals in terms of
achievable, measurable objectives that stretch
us
Are there clear lines of communication
through all organization levels and services
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PI Program Effectiveness Eval
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Ask: “As a result of our PI Program…”
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Can all staff articulate our mission, values
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Can staff describe the PI process we use
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Has my own professional practice improved
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Have patient safety and customer satisfaction
increased
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One on One Interventions
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Always attempt to let people “save face”
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Minimal Risk Interventions as a Facilitator
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Outside the meeting, ask a disruptive member what
would increase his/her satisfaction with the meetings;
give constructive feedback about specific behaviors
Within the meeting, ask in very general terms about
any group process concerns identified in team
evaluations; avoid identifying individuals unless they
volunteer themselves
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One on One Interventions
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Moderate Risk Interventions as a Facilitator
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After lower risk attempts have failed, outside the
meeting, tell the disruptive member what specific
behavior improvement you are looking for
Add humor; offer to help correct a bad habit
CEO may need to do this
High Risk Interventions as a Facilitator
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As a last resort and only in a mature team, address
the undesirable behavior in the group
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CAH Annual Program Eval
C-0331
“The CAH carries out or
arranges for a periodic evaluation of its
total program. The evaluation is done at
least once a year and includes review
of…”
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CAH Annual Program Eval
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The utilization of CAH services, including
at least the number of patients served
and the volume of services (C-0332)
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Acute care, including outpatient & emergency
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Surgery, anesthesia, OB if provided
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Swing beds
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Ancillary clinical services
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CAH Annual Program Eval
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A representative sample of both active
and closed clinical records (C-0333)
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“means not less than 10% of both active
and closed patient records”
Can be conducted throughout the year
Includes records reviewed for CART/CMS,
PIN studies, other PI projects, etc
Includes records sent for external peer
review
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CAH Annual Program Eval
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The CAH’s health care policies (C-0334)
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“evidence demonstrates that the health care
policies are evaluated, reviewed and/or
revised”
Policies developed by a team of professionals
that includes one or more physicians, midlevel providers, and individuals not members
of the staff (C-0272, C-0258, C-0263)
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CAH Annual Program Eval
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“The purpose of the evaluation is to
determine…
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whether the utilization of services was
appropriate
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the established policies were followed
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any changes that are needed (C-0335)”
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Work plan generated, approved for the next 12 months
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CAH Program Annual Work Plan
Focus
Quarter
Reports
Who
Kip
Staff PI Ed Carol
Heart
Failure PI
CAH Ann
Eval
Kim
Kathy
Will Do
What
Q4 06 Acute
Q4 06 Swing
In-service
managers
- Revise DC
instruct form
-MS approval
Prep and
lead meeting
When
Follow up
Jan 07
Feb 07
Feb 07
Next
meeting
Jan
March
Feb
Dec 07
Fall 2007
March
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Questions?
Next Time
Drafting Policies and
Procedures
Wed, March 28 1 pm
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Footnotes and References
¹ Structured Experience Kit, University Associates, Inc.;
©1980 International Authors B.V.; San Diego, CA.
² Team Building: Blueprints for Productivity and
Satisfaction, W. Brendan Reddy. ©1988 NTL Institute
for Applied Behavioral Science, Alexandrian, VA and
University Associates, Inc., San Diego, CA.
The Team Handbook; Peter R. Scholtes et al; ©1988
Joiner Associates, Inc.; Madison, WI.
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Addendum: from the SOM, a
QA Program is effective if it…
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Evaluates the quality and appropriateness of
diagnosis and treatment (C-0336) including:
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Ongoing monitoring and data collection
Problem prevention, identification and data analysis
Identification of corrective actions
Implementation of corrective actions
Evaluation of corrective actions
Measures to improve quality of a continuous basis
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Addendum: from the SOM, a
QA Program is effective if…
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All patient care services and other services affecting patient health
and safety are evaluated (C-0337)
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RT, therapeutic gases and lab testing (C-0200)
Drugs and biologicals use (C-0203, C-0276, C-0227)
Blood utilization (C-0205)
Emergency Preparedness and Life Safety (C-0227 through C-0231)
Dietary, Nutrition (C-0279), Rehab (C-0281), Radiology (C-0283)
Medical records quality (C-0300 through C-0310)
Nosocomial infections and medication therapy are evaluated (C0338, C-0276 through C-0278)
Diagnosis and treatment provided by both mid-levels and physician
providers are evaluated (C-0339, C-0340, C-0259, C-0264)
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Addendum: from the SOM, a
QA Program is effective if…
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CAH considers findings and recommendations from the
QIO and takes corrective action is necessary (C-0339,
0341)
The CAH takes appropriate remedial actions to address
deficiencies found through the QA program (C-0342).
Note, this includes survey deficiencies.
Outcomes of all remedial action documented (C-0343)
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