12/01/2016home and community care1 long term care administration thursday, december 2, 2010 week 13...

23-04-21 Home and Community Care 1

Long Term Care Administration

Thursday, December 2, 2010

Week 13 - Chapters 11 & 14

Quality and Governance


The Quality Factor in LTC

W. Edwards Deming Deming is widely credited with improving production in the United States during World War II, although he is perhaps best known for his work in Japan.

There, from 1950 onward he taught top management how to improve design, service, product quality, testing and sales, markets through various methods, including statistical methods.



Deming's philosophy'a'-versus-'b' comparison:

(a) When people and organizations focus primarily on quality, quality defined by the following ratio: then quality tends to increase and costs fall over time.

(b) However, when people and organizations focus primarily on cost, then costs tend to rise and quality declines over time.



Dr. W. Edwards Deming taught that by adopting appropriate principles of management, organizations can increase quality and simultaneously reduce costs.

By reducing waste, rework, staff attrition and litigation while increasing customer loyalty.

The key is to practice continual improvement and think of manufacturing as a system, not as bits and pieces.



Three main Quality Processes:

Quality Assurance (QA)Continuous Quality Improvement (CQI)Total Quality Management (TQM)



Quality Assurance (QA)The emphasis in traditional quality

assurance is on monitoring whether the appropriate things are being done correctly.

Actions are taken to correct the problem with the focus on individual performance.

Focus on departmental level and reactive.



Continuous Quality Improvement (CQI)Improving processes with full staff

involvement, integrated organization wide.Client focused, process, performance.Working teams to identify and prioritize

areas for improvement and measure the results of improvements.

Proactive, goal to become even better.



Total Quality Management (TQM)Process for meeting and exceeding

customer requirements.Concept includes employees within the

organization as a critical customer group.Philosophy and new way of doing

business.



Risk Management (RM)Identification of risk factors.Elimination of risk.Minimization of the effects created by

incidents that do occur with the facility.Change or possibility of danger, loss, or

injury.



Risk Management (RM)Well being of staff and publicPropertyReputationEnvironmentOrganizational functioningFinancial stabilityMarket ShareOther things of value



Canadian Council on Health Services Accreditation (CCHSA) – 4 Principles

Establish culture of quality care & service.Leadership, organizational teamwork.Improve processes, achieve results.Meet needs and exceed expectations of

clients.



Defining Quality…

What is Quality?



CCHSA Definition of QualityThe degree of excellence, extent to which

the organization meets clients’ needs and exceeds their expectations.

Four Quality Dimensions.Responsiveness, effectiveness, work life

and client/community focus.



John CarverQuality never stands still.Degree client’s expectations are met or

exceeded.Inspire leaders, changing concept of

excellence.Clients of today and tomorrow.



Defining Standards

“Desired and achievable level of performance against which actual performance can be compared.”



Standards of PracticeAuthoritative statements that describes

the level of service, or performance common to all members of a profession.

Focus on the behaviour of the provider, and give direction to address the legal and professional basis of practice.



Municipal Bylaws and CodesSet fire and safety standards and building

codes.Building codes help prevent accidents.Fire codes help prevent death from fires.



Provincial StandardsBC – Adult Care RegulationsGrant Licenses to operate LTC.Compliance with minimal standards.Reviewed by inspection process.Annual onsite inpection.



Health Professional BodiesSet standards for professional practice.RNs, MDs, PT, OT, SW.Set codes of ethics.License professionals.Monitor practices.Regulate the profdession.



Performance Measures (CCHSA)

There are three types of performance measures:

accreditation requirements (standards) indicators instruments (e.g. survey tool or audit)



Quality IndicatorsPerformance measurement tool, screen,

or flag that is used as a guide to monitor, evaluate, and improve the quality of client service delivery, support services, leadership and partnerships.

Indicators relate to structure, processes and outcomes.



Benchmarking (Goldwasser)Assess current performance relative to

other organizations.Discover and understand new ideas and

methods to improve processes and practices.

Identify aggressive, yet achievable, future performance targets.



Quality of Life for ResidentsPromotion of individuality and choice.Mission, values, vision - statements.Resident-centred programs and services.Standards of Quality of Life.Clients perspective on Quality of Life.



Use of RestraintsRestraint free environment.Minimal restraint.No restraint.Better quality of life for residents.


Quality Factor in LTC

Freedom of Choice Family Decision Making

Challenging situations evolve where staff weigh the risks to the resident against the resident’s right to choose versus the family members who may contradict the resident’s requests.


Quality Factor in LTC

Cultural Aspects of Care and ServiceEducation of staff.Develop an awareness of the cultural

sensitivities in ethnic and native population groups.

Diversity programs.How do the needs of groups get met?



Elder AbuseFree from any fear of abuse from staff or

other residents.Policies and procedure must be in place

to report abuse, deal with it quickly, ensure compliance to the policies is upheld.

Responsibility of the governing body to set policies.



SexualityProvide an environment that enables

residents to express their sexuality.Staff attitudes toward sexuality.Privacy and space for this essential

human need to be expressed, especially in a long term care facility.



Environmental ConsiderationsLiterature reviews to learn what is

happening in the field.Discussing new theories of care delivery.Bring residents and families into the

discussion.Explore better opportunities.



Improving CommunicationOpen lines of communication is best.Investigate ways for residents to interact

with the community.Involve residents on committees.Rights of residents.



ChallengesQuality is a living organism.Pursuit of quality is a courtship.Ever changing face of quality.Client change, definition of satisfaction

care and service changes.Demand for quality will increase.


Governance and Advocacy

Governance EffectivenessUltimate responsibility is to ensure the

well-being of the clients the facility serves.Ability to govern.Level of operational understanding.Impact of decisions.Measure effectiveness of their actions.



Governance Effectiveness Questionnaire

The goals, expectations and concerns of individual Board members are appropriately communicated to the Chair of the Board and CEO.

Our Board has the appropriate mix of members, skills, experience and other characteristics to be effective.

All Directors attend at least 75% of Board meetings or have a valid excuse for non-attendance.

Meeting agendas include all relevant and high-priority issues and allocate time appropriately.

Directors study and understand relevant information in order to utilize their meeting time effectively and make informed decisions.



Elected Versus Appointed Board MembersRepresentative of the community.Avoid single issue or fixed ideological

position – irresponsible governance.Expertise in specific areas – law, medicineExtended orientation to fully contribute.Number one priority enhance

organization.



Governance Rules and PracticesVancouver Coastal Health is committed to being open

and accountable to the public we serve. Increasingly, in both the public and private sector, there

is a growing trend towards enhancing corporate governance practices.

We have responded by significantly reviewing these practices and improving our level of disclosure. We are committed to taking part in a continual review and updating process following the Board Resourcing and Development Office (BRDO) provincial best practice guidelines.



The governance rules and practices of VCH are set out in the Board Manual that explains how the Board of VCH conducts business.

It includes a Code of Conduct for Directors, VCH By Laws and Terms of Reference for the Board, the Chair, the CEO and Board Committees.



BC Board Resourcing and Development Office Establishes guidelines for all provincial

appointments to agencies Ensures that all provincial appointments are

made on the basis of merit following an open, transparent and consistent appointment process

Ensures that appointees receive appropriate orientation and ongoing professional development with respect to agency governance issues



Integration with Regional Authorities

What are the pros and cons for acute care, long term care and community care under one governance structure?



Roles and Responsibilities of the BoardSet strategic direction.Develops operational policies.Makes critical decisions about the type of

organization it governs.Ensures sufficient resources are in place.Accountable for its actions and decisions.



Roles and Responsibility of the Board, cont..Selection and evaluates the CEO.Achievement of goals and objectives.Advocate for the client.Ensures all interactions, services,

programs are high quality and maintain the dignity of the individual client.

Role as evaluator and critic.



Roles and Responsibility of the Board, cont..Decision on model of governance.Decision on philosophy of care.



Mission as the Central FocusSingle most influential document.Primary source that guides a governing

board, management and staff.Complements and gives direction to the

organization’s strategic plan and sets the framework for its annual goals and objectives.


Sample Mission Statement

To provide quality of life and quality of care to residents who come to us for long-term residential or short-term rehabilitative care.

We assist residents to achieve their highest possible level of physical, psychosocial and spiritual potential, always working to protect and enhance their dignity.

We seek to continually improve the services we provide.


Sample Mission Statement

To be a thriving healthcare community in which the individual needs and desires of the residents direct and shape daily life.



Carver Model - Policy Governance Board is the stewards of the organization. Focus on making high level policy.

Four key policy areas:

1. Restriction or limitations of the CEO.

2. Development of outcomes.

3. Process of governance, board effectiveness.

4. Accountability of staff.



Philosophy of CareClient-centredness critically evaluates the

organization’s processes so that resources are assigned based on client needs.

Individual needs of the resident take precedence over the needs of the delivers of the service.



Governance and AccountabilityTrusteeship - honour trust placed on them

by the public.Leadership – make difficult decisions in a

time of uncertainty and change.Accountability – clear policy direction.Responsibility – efficiently and effectively.



Governance and Quality of LifeEnsure quality of life for its clients is the

best that it can be, and evaluated.How do you quantify feelings?How do you measure depression, pain or

quality of life?What significant improvements to quality

of life have occurred in the past year?



Governance and Quality of Life, cont…Choice in the daily life of residents.Dining routine, dietary choices, control

over their room location.Are staff aware of the resident’s right to

choose?Regular dialogue for residents and staff.



Governance and Quality of Life, cont…Baycrest Geriatric Health Care System has hired

an ombudsperson first long-term care facilities in Ontario to establish this role.

Mary Ward joined Baycrest in November. Reporting directly to the president and CEO, Ward will investigate complaints from clients and family members in an impartial fashion and facilitate resolution.



Effective Residents’ CouncilImprove communication within their homes. Help identify problems early when it is easier to

correct them. Serve as a sounding board for new ideas. Help individuals speak out about concerns and

help overcome fear of retaliation. Improve the atmosphere of the nursing home.Promote friendship.



Family Councils Forum for friends and families of

residents in long-term care to share experiences, learn and exchange information.

Family councils provide a valuable mechanism for dialogue, support, education and processing concerns.



Future Directions for Governance

Role is to improve the health and well-being in the community served by the eldercare organization.

12/01/2016home and community care1 long term care administration thursday, december 2, 2010 week 13...

Documents

community care

quality factor

product quality

quality declines

traditional quality

ltcrisk management rmwell

continual improvement

staff involvement