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1WelcomeHCH Quality Leaders:Key Practices and Improvement StrategiesThursday, August 30, 2012We will begin promptly at 1 p.m. Eastern.Event Host:Sarah Knopf, MAResearch AssistantNational Health Care for theHomeless Council, Inc.This publication was supported by Grant/Cooperative Agreement Number U30CS09746-04-00 from the HealthResources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely theHealthrepresentCare andareofHumanRightsresponsibility of the authors and do not necessarilythe Housingofficial viewsHRSA/BPHC.
HCH Quality Leaders:Key Practices andImprovement StrategiesAugust 30, 2012Health Care and Housing are Human Rights
3PresentersSarah Knopf, MACarol Blank, BSN, RNMarie Wisely, CPHQResearch AssistantManagerNational Health Carefor the Homeless CouncilCommunity Health CenterClinic and Health Carefor the Homeless ProgramDirector of Qualityand Clinical ServicesNashville, Tenn.RiverStone HealthCommunity Health Care, Inc.Davenport, IowaBillings, Mont.Health Care and Housing are Human Rights
4Webinar OverviewQuality LeadersCase StudyOverview Background MethodsCase Study #1Case Study #2RiverStoneHealthCommunityHealth Care,Inc.Billings, MTQ &ASessionDavenport, IAHealth Care and Housing are Human Rights
5Case Study Backgroundn Qualityvs.Productivityn No HRSA annualproductivity requirementsn Allows increased focuson qualityn Whatkey practices and QI strategies work wellin the HCH setting?Health Care and Housing are Human Rights
6Case Study Objectives(1) IdentifyHCH QualityLeaders(2) Identify keypractices drivingqualityoutcomes(3) Identify toolsused to evaluateperformanceand improvequality(4) Share keylessons withHCH granteesHealth Care and Housing are Human Rights
7Methodsn Identifiedn top 10 HCH Quality LeadersBased on 2010 UDS data for hypertension and diabetescontrol measures (HRSA’s clinical performance measures)n Keyexpert interviews with 4 Quality Leaders1.Community Health Care, Inc. (Davenport, IA)2.RiverStone Health (Billings, MT)3.Harbor Homes, Inc. (Nashua, NH)4.Care for the Homeless (New York, NY)Health Care and Housing are Human Rights
Case Study #1RiverStone HealthCarol Blank, BSN, RNManager of Community Health Center Clinic and Health Care forthe Homeless ProgramBillings, MTHealth Care and Housing are Human Rights
RiverStone Health HCHn Largeumbrella organizationn Numerous, valuablen n n n n n resourcesPublic HealthCommunity Health Center ClinicsDentalMontana Family Medical ResidencyMaternal Child Health & WICHome Health & HospiceHealth Care and Housing are Human Rights9
Our HCH Programn Program started in 1993n Staffingn n n n n n n NurseAdministrative AssistantOutreach workerCase ManagerLicensed Addictions CounselorMental Health TherapistClinic Locationsn n n n Women & Family ShelterMen’s Rescue MissionThe HUBMain ClinicHealth Care and Housing are Human Rights10
n n Services offeredn Family practice care for all ages including Lab & X-rayn Dental caren Medication financial assistancen Case managementAccessn Shelter & HUB Clinics – walk in for caren Main clinic – scheduled out, day of scheduling & walk in caren n Decreased no show rate for HCH patients from 17% to 13% when advanced access wasinitiated in the main clinic.Team Based Care centered around the patient and their needsn Increased continuity with one providern n Increased continuity with nurse, support staff & Behavioral Health staffn n Increased trust & confidenceIncreased trust & confidenceTeam huddlesn Improved care managementHealth Care and Housing are Human Rights11
Quality Improvement Example #1n Toincrease outreach to our community’shomeless populationPostersn Brochuresn Resource Mapsn Participation in area homeless eventsn Partner with community resourcesn Health Care and Housing are Human Rights12
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Quality Improvement Example #2n Toimprove quality of care – patient dashboardsMonthly report per disease processn By providern Lists of all provider’s patients with diabetes including thefollowing:n n n n n n n Last appointmentA1CMicoalbuminLDLBPVaccinesHealth Care and Housing are Human Rights15
Dashboard continuedn Nurse reviews list and assesses needs of patientsn n Transportation?clarification of care planNurse & support staff contact patients to encourage followup with provider and offer assistance as needed.n HCH staff available to assist with all HCH patientsn n n Outreach workerCase ManagerCoordination of care & services available from RiverStonen Health programs and/or community partners.n Health Care and Housing are Human Rights16
Reviewn Accessn Teambased caren Focuson the patient and their needsn CareManagementn Ongoingquality improvementHealth Care and Housing are Human Rights17
Case Study #2Community Health Care, Inc.Marie Wisely, CPHQDirector of Quality and Clinical ServicesDavenport, IAHealth Care and Housing are Human Rights
Clinic Statistics Nine locations (Iowa and Illinois) Range of primary care services Specialty care (Infectious Disease,chiropractic, mental health, healtheducation, nutrition) 40,000 patients 280 employees19
QualityDepartment20
PurposeWhat is the purpose of the qualitydepartment? Continuously monitor and improve thequality and safety of services provided toour patients Minimize or reduce adverse outcomes Improve efficiency Minimize or eliminate duplication of effort Meet external requirements foraccreditation and other state and federalregulation21
StructureStructure Director of Quality and Clinical Services Quality Coordinator Clinical Specialist Clinical Trainer Nurse Manager Patient Care Coordinator EHR Coordinator Compliance Coordinator22
Major ResponsibilitiesQuality Improvement Responsible for the development, implementation and maintenanceof the quality plan Act as internal consultants- guide staff in the selection ofimprovement opportunities, assembling teams, collecting baselinedata, performing tests, measuring results and communicating results Data ManagementStandardize data management proceduresDevelop systems for monitoring outcomesDesigning data collection plansOversee the timely collection of dataTo ensure improvement efforts are effective perform periodicreviews (chart audits or system tracers or patient tracers)23
Major ResponsibilitiesLeadership and Development of Nursing Staff Provide support, leadership and direction to nursing staffleaders Assists in program development including staff training andcompetency assessment Act as a liaison between nursing and provider staffClinical Outcome Measures Assists the Medical and Dental Directors with selection oforganization wide clinical priorities Oversee the peer review program Selection of clinical practice guidelinesGrant Expectations Facilitate the selection of grant measures and goals which arebased on organization priorities and best practice24
Major Responsibilities (cont.)Infection Control Develop and implement the organization wide infectioncontrol and prevention program Assess internal procedures and practices which have thepotential to cause infection Manage the disease reporting program Development the Pandemic preparedness plan Develop and implement bloodborne pathogens program Facilitate employee flu campaignPatient Satisfaction Creation of the patient satisfaction tool Oversee survey distribution Summarize results25
Major Responsibilities (cont.)Policy and Procedure Development – Develop policy and procedures which allows CHC to operate withconsistency, manage risks and comply with law and regulation Evaluate current and new policy and procedures for compliancewith regulation and joint commission requirementsEducation and Training Provide educational support to staff with regards to qualityimprovement, data interpretation and analysis, infection control andregulatory standardsJoint Commission Accreditation Monitor clinical and operational processes for compliance to thestandards in an effort to maintain a constant state of surveyreadiness Develop implementation strategies Facilitate on site review26
Major Responsibilities (cont.)Unusual Occurrence Reports and PatientComplaints Review unusual occurrence reports and patientcomplaints for appropriate follow-up and plansfor improvementAnalyze data for trends27
Performance /QualityImprovementProgram28
Performance Improvement ProgramA standard organization wide approach toimproving patient care and operationswhich is focused on the process notindividuals29
Culture of Quality: Recruiting andOrientationDuring the interview process all potentialcandidates are informed of our qualityprogram and their individualresponsibilities Annually each employee is ranked basedon their participation. Monetary incentive for participating oninternal committees. A portion of provider incentive is tied topatient outcomes 30
Culture of Quality: Communication Director of Quality and Clinical Services attendsall provider meetingsOn a monthly basis Quality Coordinator meetsindividually with each provider regarding clinicaloutcomesCEO and Medical Director review progresstoward goals annually with each providerAll clinical improvement priorities are availableelectronically. Data is available on a monthly basisData includes level of compliance Individual Peer Organization wide31
Culture of Quality: Communication(Cont.)Organization wide data is reported to theinternal Performance Improvement/Quality Improvement Committee. Areasfor improvement must be accompanied byan action or improvement plan PI projects in progress are reported to alldepartments via a Quality Newsletter andin person presentations. 32
Improvement MethodologyAdopting a structured approach formeasuring and improving allows for: An objective way to solve problems Base decisions on data rather than hunches Use our resources efficiently33
Improvement Model DMAIC DesignMeasureAnalyzeImproveControl34
Improvement RequirementsEach department is required toparticipate in at least one PI project peryear. Annually organization wide PI projects areselected and approved by leadership andthe Board of Directors. 35
Project Selection Improvement opportunities are evaluatedbased on the following criteria: Connection to our mission and strategic goalsLikelihood of positive patient outcomesIncrease access to careIncrease patient and/or staff satisfactionImproves a key processFacilitates standardization or continuum of careFinancial impactProject feasibility36
Project Oversight Project progress is monitored by: Improvement teams Internal performance improvement/qualityimprovement committee Leadership Board Quality Improvement Committee(Organization goals)37
Data Management38
PlanCHC’s data management plan covers amultitude of variables including clinical,financial, operational, as well as patient andstaff satisfaction. There is a systematic, organization widecommunication plan for the continuousreview of prioritized data. COO & Managers review operational data on amonthly basis. (Dashboards) The PIQI & QI committee reviews allorganization wide data collection on a regularbasis39
Measure Selection Organizations that measure everythingimprove nothing. Data collection is prioritized based on thefollowing criteria: Patient Health Outcomes & Satisfaction Alignment with CHC’s strategic goals, mission,vision & values Regulatory requirements such as JointCommission & BPHC Financial Impact40
InternalPerformanceImprovementCommittee41
Performance Improvement/QualityImprovement Purpose of the committee- Implement andcommunicate a single, organization-wide, customerdriven approach to performance improvementAction Steps Evaluate the effectiveness of the organization wideimprovement plan Measure and assess current performance throughdata analysis Make recommendations to leadership teamregarding improvement focus and annual goals Evaluate compliance with accreditationrequirements42
Board QualityImprovementCommittee43
Committee ResponsibilitiesKeep organization focused on establishedgoals Review data presented by staff, makerecommendations related to compliancewith established improvement goals,regulation and accreditation requirements Approve the organization wideimprovement plan 44
Committee ResponsibilitiesApprove annual review and goal selectionof internal committees Ensure healthcare providers have theproper credentials and privileges topractice Recommend to the Board of Directorsnew or established providers become orremain employed 45
ChallengesTurnover Technology Competing priorities Resources 46
47Q &ASarah Knopf, MACarol Blank, BSN, RNMarie Wisely, CPHQResearch AssistantManagerDirector of Qualityand Clinical ServicesNational Health Carefor the Homeless CouncilCommunity Health Center Clinicand Health Carefor the Homeless ProgramNashville, Tenn.RiverStone Healthsknopf@nhchc.orgBillings, Mont.Carol.Bla@riverstonehealth.orgCommunity Health Care, Inc.Davenport, Iowamwisely@davchc.comHealth Care and Housing are Human Rights
Resourcesn Coming Soon: completeQuality Leaders CaseStudy at www.nhchc.orgn Look out for forthcomingQuality Leaders QuickGuide:n Practical tools andresources to track andimprove your healthcenter’s quality of care.n Also at www.nhchc.orgHealth Care and Housing are Human Rights48
Davenport, Iowa . Health Care and Housing are Human Rights Webinar Overview Quality Leaders Case Study Overview Background Methods Case Study #1 RiverStone . Maternal Child Health & WIC ! Home Health & Hospice RiverStone Health HCH 9 . Health Care and Housing are Human Rights ! Program started in 1993 ! Staffing !
City of Orlando - FPR Department – Orange County Public Schools 21st CCLC RFP 2015-16: Citrus Square, Rosemont, Engelwood 3 Orlando live in poverty. In 2013, Orlando ranked 1st among all mid-size cities in the country for its number of chronically homeless residents (NHCHC Orlando Fact Sheet, 2013).
impairments seen in homeless patients are often associated with traumatic brain injury, mental ill-ness, chronic substance abuse, infection, strokes, tumors, poisoning or developmental disabilities. Cognitively impaired homeless person
Jan 01, 2021 · root cause analysis kristen bigelow-talbert, community health quality manager, mshm,
A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost Innovation Series 2012 Authors: Matthew Stiefel, MPH: Senior Director, Center for Population Health, Kaiser Permanente Care Management Institute; Fellow, IHI
RDNs are effective nutrition counselors . They have both the scientific knowledge and the counseling skills necessary to provide helpful food and nutrition advice, and tailor nutrition recommendations to each individual's unique needs and circ umstances. RDNs also help identify available resources to meet daily nutritional needs for patients.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U30CS09746, a National Training and Technical Assistance Cooperative Agreement for 1,625,741, with 0% match from nongovernmental sources.
This issue of Healing Hands will examine innovative shelter-based health care programs that provide low-barrier health care to people living in shelter settings, showing that . Center in Bridgeport, Connecticut. The Southwest Community Health Center is a federally-qualified health center (FQHC) with sites all over Bridgeport, including
Article 505. Class I, Zone 0, 1, and 2 Locations Figure 500–2. Mike Holt Enterprises, Inc. www.MikeHolt.com 888.NEC.CODE (632.2633) 25 Hazardous (Classified) Locations 500.4 500.4 General (A) Classification Documentation. All hazardous (classified) locations must be properly documented. The documentation must be available to those who are authorized to design, install, inspect .
