move to improve program process and results
DESCRIPTION
Gina Mazza RN, BSN Partner, Fazzi Associates Marian Stillwell Director of Clinical Services Heritage Health Care. Move to Improve Program Process and Results. October 2012. Objective. To identify best practice strategies for reducing avoidable hospitalizations of the home care patient. - PowerPoint PPT PresentationTRANSCRIPT
Move to Improve ProgramProcess and Results
Gina Mazza RN, BSNPartner, Fazzi Associates
Marian StillwellDirector of Clinical Services
Heritage Health Care
October 2012
To identify best practice strategies for reducing avoidable hospitalizations of the home care patient.
Objective
76 Agencies
Size of agencies by Average Daily Census:
Mean: 230
Median: 157
# agencies less than 100: 19
# between 100 and 300: 39
# agencies greater that 300: 20
Move To Improve Project Statistics
For comparative analysis, agencies were divided into three categories:
Move To Improve Project Statistics
Home Health
Compare Rate Number of Agencies
Low Hospitalization Rate
(Best)16% - 27% 23
Moderate Rate Hospitalization 28% - 32% 28
High Hospitalization Rate (Poorest) 33% or greater 25
The Program…
• Initiated collection of baseline OASIS data
• Agency practice survey
• Focus Group
• Developed Tracker and Hospitalization Management Dashboard
• Training
Revised Structure
• Audit tool revised
• Dashboard revised
• Monthly Accountability/Planning Meeting
SafeSide™ Structure
ActivityReal Time Tracking
Real Time Audits
Monthly
Targeted Trend
Improvement Effort
SafeSide Components
Hosp. Dashboard
48-Hour SafeSide
Audit
SafeSide Monthly
Accountability Meetings (MAP)
No More Than 1 New Improvement per Quarter
Lead QI/PIClinical Director/
SupervisorSafeSide Lead
Clinical Director
Input ProcessOutcomes:
Improvement Efforts
Zealous Accountability ● Data-Driven ● Goal-OrientedMeasurable Targets and Outcomes
Project Leader
Project Leader
Planning and Improvement
Meeting
Planning and Improvement
Meeting
Fazzi’s SafeSide Outcomes ModelThe Outcome Oriented Change Model
Process Improvements
Process Improvements
Practice Refinements
Practice Refinements
New StrategiesNew Strategies
Education and Competency
Education and Competency
Data Monitoring
and Tracking
Data Monitoring
and Tracking
Real-Time Audits
Real-Time Audits
Leadership of Program
Lead
CEO SeniorClinical
Dir.Mid
LevelQuality
AverageOverall Reduction
-6.0% -5.0% -2.2% 0.2% -4.2%
Frequency of Monitoring Hospitalization Rates
How often monitor scores
Often Somewhat
moreIn-
FrequentHave not
monitored
Average Overall
Reduction-6.7% -3.2% 0.8% 0.0%
Results of Agencies Performing Audits
Hospitalization Grouping at
Initiation
Change in HHC Hospitalization
Rate
% Reduction of the HHC
Rate
High Rate-11 percentage
points21.5%
Moderate Rate-5.3 percentage
points15.6%
Low Rate-2.8 percentage
points10.1%
Total-6.6 percentage
points15.7%
Overall Results
Hospitalization Grouping at
Initiation
Change in HHC Hospitalization
Rate:First 6 Months vs.
Last 6 Months
% Reductionof their HHC
Rate
High Rate -11 percentage points 19.9%
Moderate Rate -4percentage points 13.9%
Low Rate -3 percentage points 8.2%
Total Average -6 percentage points 14.8%
Recommendations
1. Audit charts of hospitalized patients
●Critical to identifying core issues related to hospitalization
●Create teachable moments
2. Set clear and measureable goals and share with team
●Set stretch goals and publicize and celebrate wins
Recommendations
3. Accountability● Have a leader that has authority, accountability and
respect of clinicians.
4. Develop a plan for change and operationalize
● Plan, Do, Check, Act
● Don’t let daily fires distract from the focus.
Recommendations
• Act with purpose
• Make decisions based on data
• Set clear goals
• Have clear outcomes
Heritage Health Care
Move to Improve Project Participant
Marian Stillwell Director of Clinical Services