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Telligen

Making BIG Changes Attainable with Affinity Group Outreach

June 3, 2016

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Telligen QIN-QIO

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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

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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?

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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

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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?

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• 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

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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%

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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

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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

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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

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Contact Information

Sheryl Marshall, RN, CDC – QI Manager at Telligen

– Sheryl.marshall@area-d.hcqis.org

– 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