Bridging from Bronze to Silver Continuing the Journey

Transcription

1 Bridging frm Brnze t Silver Cntinuing the Jurney Dawn Murr-Davidsn, Directr f Quality Initiatives and Clinical Affairs, PHCA and Quality Award Examiner

2 Objectives Describe the prcess fr preparing t cmplete Silver Level Quality Award Applicatin Outline fr Skilled Nursing Centers hw the Baldrige Principles align with the cmpnents f the required facility assessment and QAPI plan t meet the Phase 2 Requirements f Participatin. Discuss cmmn pitfalls and share tips fr cmpletin f the Silver Level Quality Award Applicatin. Identify steps t identify readiness and create an actin plan t cmplete a Silver Level Award Applicatin.

3 Understanding the Natinal Quality Award Levels Brnze Award Recipients are able t describe: Missin and Visin Outline plans t imprve prcesses within their rganizatin Identify key challenges Recgnize the ability t achieve perfrmance imprvement measures Silver Award Recipients prvide an extensive assessment f their systematic appraches, perfrmance measures and prcesses and results linked t key custmer requirements, success factrs and challenges Gld Award Recipients demnstrate high levels f perfrmance thrugh their apprach, deplyment and cnsistency f results. **Prvider Octber 2016

4 Quality Award Recertificatin Plicy Active BRONZE Status Brnze recipients have 3 years t apply fr Silver frm the year they receive the award. Brnze recipients wh apply fr Silver within 3 years and d nt receive the Silver award, but pass the minimum requirements, will be cnsidered an active Brnze recipient fr the next 3 years. The three-year clck is re-set every time an applicatin is submitted and meets these standards. If by the third year an applicatin meeting these standards has nt been submitted, the applicant is cnsidered a past Brnze recipient. Past Recipient Status The center is listed as a past Brnze recipient n the Quality Award website. The center must reapply at the Brnze level if it decides t participate again and is required t fllw the same standards as Brnze applicants (see active Brnze status).

5 Quality Award Recertificatin Plicy Active SILVER Status Recipients have 3 years t apply fr Gld frm the year they receive the award. Recipients wh apply fr Gld within 3 years and d nt receive the Gld award, but are determined t have maintained the standards f a Silver recipient, will be cnsidered an active Silver recipient fr the next 3 years. The three-year clck is re-set every time an applicatin is submitted and meets these standards. Recipient can als maintain active Silver status if they receive an award at the basic and verall criteria level frm a prgram that is a member f the Alliance fr Perfrmance Excellence. If by the third year an applicatin meeting these standards has nt been submitted, the applicant is cnsidered a past Silver recipient. Past Recipient Status The center is listed as a past Silver recipient n the Quality Award website. The center must reapply at the Brnze level if it decides t participate again and is required t fllw the same standards as Brnze applicants (see active Brnze status).

6 Value f the Quality Award Prcess Language Tl: Prmtes a cnsistent language t perfrmance excellence Accuntability Tl Organizatinal Prfile What is imprtant t the rganizatin? Prcess categries Based n what is imprtant, what d we d and hw d we d it? Results Categry Nw that we ve dne it, were we successful? Sustainability Tl: Management dcument which describes hw the rganizatin perates Imprvement Tl: Prvides the rganizatin t self-assess, but als t btain feedback in the frm f pprtunities fr imprvement Alignment Tl: Assists rganizatin t tear dwn sils and prmtes a systems view f success Recruitment and Retentin Tl

7 And the Results Shw

8 30 Day Hspital Readmissins 30 Day Hspital Readmissins AHCA Members 17.3 Natin 17.2 Quality Award Recipients HOSPITAL READMISSION RATES

9 17.5 Off-Label Use f Antipsychtics Off-Label Antipsychtic Use Quality Award Recipients Natin AHCA Members

10 Occupancy Rate Occupancy Rate Quality Award Recipients Natin AHCA Members

11 GROSS MARGIN Grss Margin Quality Award Recipients Natin AHCA Members

12 Silver Applicatin Overview

13 Applicatin Overview and Timeline Review Applicatin Plicies and Eligibility Nursing Centers can utilize the AHCA Tp Line Reprts Elements f the Applicatin Organizatin Prfile: Brnze Applicatin Six Baldridge Interrelated Prcess Categries Seventh Baldrige Categry Results, Results, Results Review Applicatin Deadlines and Submissin Prcess: Dn t wait until the last minute

14 2018 Applicatin Timeline 2018 Applicatins and Deadlines Published August 1, 2017 Intent t Apply Opens September 2017 Intent t Apply Clses Nvember Applicatins are Accepted Online December Final Applicatin Deadline January/February 2018 Specific Dates will be Released in the Future, but Begin Yur Prject Plan Nw

15 A Few Highlights Based n 2017 Applicatin Criteria Brnze Applicatin Silver Applicatin Types f Applicatins NF and AL/PC Applicatin Applicatin is the same with guidance fr AL/PC Cmmunities. Length f Applicatin 5 25 Categry 7 Results Sectin 2017 Required Categries: 30-Day Rehspitalizatin Antipsychtic Rate 5-Star Quality Measure Rating Overall Custmer Satisfactin Custmer Willingness t Recmmend t Others Staff Turnver/Retentin 5 Star Staffing Measure Rating 5 Star Overall Rating 5 Star Survey Measure Rating Financial and/r Market Results cnnected t a center s rganizatinal prfile

16 Step One: Build n the Baldrige Fundatin Increase yur understanding f the Baldrige Framewrk and Utilize a Cmmn Language

17 Baldrige Framewrk Prmtes: Managing all cmpnents f yur rganizatin as a unified whle t achieve nging success (systems perspective) Purpse: Analyze rganizatinal perfrmance Quantify perfrmance thrugh results Identify areas fr imprvement r change

18 Baldrige Fcus Areas Cre Values and Cncepts: Organizatinal beliefs and behavirs which serve as the fundatin fr integrating key perfrmance and peratinal requirements with a results-riented framewrk that creates a basis fr actin, feedback and nging success. Prcesses: Methds yur rganizatin uses t accmplish wrk. Results: Three prnged apprach t examining results Internal View External View (Cmparative data utside yur rganizatin/cmpany) Future View Linkages: An essential element fr understanding the cnnectin between the Health Care Criteria categries.

19 Baldrige Cre Values and Cncepts Systems perspective Visinary leadership Resident-fcused excellence Valuing peple Organizatinal learning and agility Fcus n success Managing fr innvatin Management by fact Scietal respnsibility and cmmunity health Ethics and transparency Delivering value and results Nte: These cre values and cncepts are questins thrughut the Silver Applicatin

20 Seven Critical Aspects f Baldrige Each aspect is interrelated and prmtes rganizatin alignment driving high perfrmance and Results, the Seventh Aspect f Baldrige Nte: These critical aspects are knwn as the Cre Elements n the Silver Applicatin

21 Categry 1: Leadership Visin and Values Prmting Legal and Ethical Behavir Cmmunicatin Fcus n Actin Gvernance Scietal Respnsibility

22 Translating the Questins int Respnses Basic Item Requirement: HOW d yur SENIOR LEADERS lead the rganizatin? (70 pints) Categry 1: Leadership Overall Item Requirement: 1.1a HOW d SENIOR LEADERS persnal actins build an rganizatin that is successful nw and in the future? 1.1b HOW d SENIOR LEADERS cmmunicate with and engage the entire WORKFORCE and KEY CUSTOMERS? 1.1c HOW d SENIOR LEADERS create a fcus n actin t achieve the rganizatin s MISSION? Read each questin carefully fr key wrds r phrases Remember the examiner des nt knw yur rganizatin and may nt be a subject matter expert in healthcare

23 Categry 1: Leadership Basic Item Requirement: HOW d yur SENIOR LEADERS lead the rganizatin? (70 pints) Overall Item Requirement: 1.1a HOW d SENIOR LEADERS persnal actins build an rganizatin that is successful nw and in the future? 1.1b HOW d SENIOR LEADERS cmmunicate with and engage the entire WORKFORCE and KEY CUSTOMERS? 1.1c HOW d SENIOR LEADERS create a fcus n actin t achieve the rganizatin s MISSION?

24 Categry 2: Strategy Categry examines HOW yur rganizatin develps STRATEGIC OBJECTIVES and ACTION PLANS, implements them and MEASURES prgress. Basic Item: Hw d yu develp strategy? Overall Item Requirement: D yu presently have written strategic bjectives, related t gals and a timetable fr achieving them? D these Strategic bjectives specifically ling t r address the strategic challenges f yur rganizatin? Can yu shw evidence f evaluatin f the strategy develpment prcess itself?

25 Categry 2: Strategy Cnsideratins Deals with the verall rganizatinal strategy Strategic Plan Prcess Might include changes in HEALTH CARE SERVICE fferings, PROCESSES fr patients and/r ther CUSTOMER ENGAGEMENT Describe the methds used t evaluate and imprve the effectiveness f the strategy develpment prcess Strategy develpment refers t yur rganizatin s APPROACH t preparing fr the future. STRATEGIC OBJECTIVES define in measurable terms what the rganizatin needs t achieve t be successful and shuld fcus n specific challenges, advantages and pprtunities mst imprtant t the rganizatin.

26 Strategic Planning Strategic planning is the prcess f defining a strategy and making decisins abut hw it will allcate resurces. The purpse f strategic planning is t help an rganizatin establish pririties t better meet its missin/visin.

27 Categry 3: Custmers Address custmer types Example: If my custmers are residents, families and referrals surces--each shuld be addressed Multiple part questins Example: HOW d yu listen t, interact with, and bserve CUSTOMERS t btain actinable infrmatin? Cmparative Data (mre than just cmparing against self and/r sister rganizatins) Addresses bth custmer satisfactin and custmer engagement

28 Categry 3: Custmers Basic Item Requirement: HOW d yu btain infrmatin frm yur CUSTOMERS (PATIENTS and ther CUSTOMERS fr lng-term marketplace success)? Nte Wrkfrce is t be cvered Categry 5 Overall Item Requirement (Custmer Satisfactin) 3.1a HOW d yu listen t, interact with, and bserve CUSTOMERS t btain actinable infrmatin? 3.1b HOW d yu determine CUSTOMER satisfactin, dissatisfactin, and engagement? 3.1c HOW d yu btain infrmatin n CUSTOMERS satisfactin with yur rganizatin relative t ther rganizatins including direct cmpetitrs, if available?

29 Engagement It s Nt Just fr Marriage And is Different frm Custmer r Wrkfrce Satisfactin Tw Sectin in the Silver Level Applicatin that lks at Engagement in an Organizatin Custmer Engagement Categry 3 Custmers Wrkfrce Engagement Categry 5 Wrkfrce

30 Categry 3: Custmers Custmer Satisfactin versus Custmer Engagement-- Understanding the difference: Custmer satisfactin is the number f custmers r percentage f ttal custmers, whse reprted experience with a business, its prducts, r its services exceeds specified satisfactin gals. Custmer engagement is a mre cmplex statistic; it is the participatin f custmers with ne anther r with a business/brand. Either the business r the custmer can initiate it, and it can be thrugh any medium.

31 Categry 3: Custmers The Prf is in the Numbers Clients will reward yu fr making them feel special: A fully engaged client recmmends a brand nearly 4 times mre ften than des a client wh feels neutral. 13% f fully engaged clients pst t a blg r website abut their psitive experiences. An upset client is 4 times mre likely than a neutral client t pst nline abut their pr custmer experience. A fully engaged client visits that cmpany s website n average 8 times in a six mnth perid. They will als make an average f three purchases! Surce: Satisfactin vs. Engagement: Which Retains Custmers Better?

32 Categry 3: Custmers Custmer Engagement: HOW d yu ENGAGE custmers by serving their needs and building relatinships? (Brand Lyalty) Other Questins in the Custmer Categry: HOW d yu determine yur HEALTH CARE SERVICE fferings? HOW d yu build and manage CUSTOMER relatinships? HOW d yu manage CUSTOMER cmplaints?

33 Categry 4: Measurement, Analysis and Imprvement Examines HOW yur rganizatin analyzes, manages, and imprves its DATA, infrmatin, and KNOWLEDGE ASSETS HOW it manages its infrmatin technlgy. HOW yur rganizatin uses findings t imprve its PERFORMANCE. Overall Item Requirement Hw d yu use DATA (and infrmatin) t track daily peratins and analyze verall rganizatinal PERFORMANCE? Hw d yu use COMAPARATIVE DATA? Hw d yu review and imprve yur rganizatin s PERFORMANCE? What are yur KEY PERFORMANCE MEASURES? **Nte: Results are included in Categry 7 (nt in Categry 4)

34 Categry 5: Wrkfrce Basic Item Requirement 5.1 Wrkfrce Envirnment: HOW d yu build an EFFECTIVE and supprtive WORKFORCE envirnment? (40 pints) Overall Item Requirement 5.1a. HOW d yu manage yur WORKFORCE CAPABILITY and CAPACITY needs? 5.1b. HOW d yu recruit, manage, and retain yur WORKFORCE? 5.1c. HOW d yu prvide supprtive benefits and ensure wrkplace health and security fr yur WORKFORCE?

35 Engagement It s Nt Just fr Marriage And is Different frm Custmer r Wrkfrce Satisfactin Tw Sectin in the Silver Level Applicatin that lks at Engagement in an Organizatin Custmer Engagement Categry 3 Custmers Wrkfrce Engagement Categry 5 Wrkfrce

36 Cultural Attributes t Engagement Clear Sense f Purpse: Emplyees have a clear line f sight t what matters mst in the rganizatin Peple-Fcused Managers: Emplyees that knw their manager genuinely cares abut them as a persn Meaningful Cnnectedness: Emplyees feel a sense f belnging and cnnectin t their rganizatin Active Vice f Emplyee: Emplyees have the pprtunity t share ideas, express cncern sand prvide input Visible Integrity: Emplyees see rganizatinal values reflected in day-t day behavir

37 Engagement is Emtinal An engaging culture is ne in which an emplyee feels an emtinal cnnectin Five emtinal factrs: Significance Safety Cntrl Cnnectin Fairness

38 Categry 5: Wrkfrce Wrkfrce Engagement: HOW d yu engage yur WORKFORCE t achieve a HIGH- PERFORMANCE wrk envirnment? (45 pints) Basic Item Requirement 1. Overall Item Requirement 5.2a. HOW d yu fster an rganizatinal culture that is characterized by pen cmmunicatin, HIGH PERFORMANCE, and an engaged WORKFORCE? 5.2b. HOW d yu assess WORKFORCE ENGAGEMENT? 5.2c. HOW des yur perfrmance management system supprt HIGH PERFORMANCE and WORKFORCE ENGAGEMENT? 5.2d. HOW des yur LEARNING and develpment system supprt the rganizatin s needs and the persnal develpment f yur WORKFORCE members, managers, and leaders?

39 Categry 6: Operatins HOW yur rganizatin designs, manages, and imprves its: HEALTH CARE SERVICES WORK PROCESSES: Generally, prcesses invlve cmbinatins f peple, machines, tls, techniques, materials, and imprvements in a defined series f steps r actins. HOW yur rganizatin imprves peratinal EFFECTIVENESS t deliver VALUE t PATIENTS and ther CUSTOMERS and t achieve nging rganizatinal success.

40 Categry 6: Operatins Overall Item Requirement 6.1a What are yur KEY WORK PROCESSES and their requirements? 6.1b HOW d yu design yur KEY HEALTHCARE services and KEY WORK PROCESSES t meet requirements? 6.1c HOW d yu manage yur KEY WORK PROCESSES t ensure that they meet KEY PROCESS requirements? 6.1d HOW d yu imprve yur KEY HEALTHCARE services and KEY WORK PROCESSES?

41 Categry 6: Operatins Wrk systems: Hw the wrk f yur rganizatin is accmplished. Wrk systems invlve yur wrkfrce, yur key suppliers and partners, yur cntractrs, yur cllabratrs, and ther cmpnents f the supply chain needed t prduce and deliver yur prducts and services and yur business and supprt prcesses. Yur wrk systems cmprise the internal wrk prcesses and the external resurces necessary fr yu t develp, prduce, and deliver yur prducts and services t yur custmers and t succeed in yur marketplace. Wrk Prcesses: Might include prduct and service design and delivery, custmer supprt, supply chain management, business, and supprt prcesses. They are the prcesses that invlve the majrity f yur rganizatin's wrkfrce.

42 Categry 7: Results Key Takeaway: The amunt and quality f results reprted have a significant impact Results include all areas imprtant t yur rganizatin n the scre.

43 Results Categries 7.1 Health Care and Prcess Results 7.2 Custmer-Fcused Results 7.3 Wrkfrce-Fcused Results 7.4 Leadership, Gvernance, and/r Survey Results 7.5 Financial and/r Market Results

44 New: 2017 Criteria Silver applicants are required t reprt n 10 specific measures in the Results Sectin 30-Day Rehspitalizatin Antipsychtic Rate 5-Star Quality Measure Rating Overall Custmer Satisfactin Custmer Willingness t Recmmend t Others Staff Turnver/Retentin 5 Star Staffing Measure Rating 5 Star Overall Rating 5 Star Survey Measure Rating Financial and/r market Results cnnected t a center s rganizatinal prfile

45 Fur Dimensins f Results Levels: Current perfrmance n a meaningful measurement scale Trends: The directin and rate f change f yur results Cmparisns: Perfrmance relative t that f ther, apprpriate rganizatins such as cmpetitrs r rganizatins similar t yurs and t benchmarks r health care industry leaders Integratin: Results being tracked are meaningful fr the rganizatin and supprt rganizatinal gals with cnsideratin t revisins in plan if required

46 Cncepts Utilized t Evaluate Results Imprtance: D the results reprted address imprtant requirements identified in the Organizatinal Prfile and Prcess Items? Levels: Is current perfrmance n a meaningful measurement scale? Trends: What is the directin and rate f change in results? Cmparisn: Is the perfrmance relative t that f ther apprpriate rganizatins and t benchmarks r industry leaders?

47 Step 2: Avid Cmmn Pitfalls--Frm an Examiner s Perspective

48 The Fur Dimensins f Prcess Apprach: Hw des yur rganizatin g abut designing and selecting effective prcesses methds and measures? Deplyment: Hw des yur rganizatin g abut implementing yur apprach cnsistently acrss the rganizatin? Learning: (One f the biggest blckers t successfully achieving Silver Awards) Hw des yur rganizatin assess prgress and capture new knwledge, including lking fr pprtunities fr imprvement and innvatin? Des yur rganizatin review its prcesses? Integratin: Hw des yur apprach align with the needs f the rganizatin ensuring that measures, infrmatin and imprvement systems cmplement each ther acrss the prcesses and wrk units t achieve rganizatinal gals? Nte: These are the scring criteria fr each cre element in the Silver Applicatin

49 Avid Cmmn Pitfalls Fllw the Technical Requirements Utilize the Online Applicatin Frm Checklist Pages in the Applicatin Bklet Refer t the Guidelines, Key Terms and Glssary Review the Guidelines fr Respnding t Prcess items Page Review the Guidelines fr Respnding t Result Items Page Explain Results Include Cmparative Data Assume the examiner des nt understand yur rganizatin r healthcare Answer the Questin

50 Linkages Linking the criteria categries are an essential element f the systems perspective Examples: D prcesses cnnect t results? Is the need fr data in the strategic planning prcess identified fr imprving peratins? Is there a cnnectin between the strategic plan and the wrkfrce plan? Is there a link between market knwledge and the strategic plan? Des the resident and ther key stakehlder data establish actin plans?

51 Step 3: Frmulate a Plan The Jurney f Tw Bridges

52 Planning a Successful Jurney Knw yur AHCA Web Site Access User Name and Passwrd Sign-up fr the PHCA Daily Updates Begin t develp a prject plan Review the 2017 Silver Applicatin Questins t Cnduct a Self- Assessment Integrate Facility Assessment Strategy and Silver Award Applicatin (Nursing Centers) Prir Silver Applicant Review and Understand Feedback Feedback Reprt August 18, 2017 Create a Perfrmance Imprvement Plan Watch fr Detailed 2018 timeline Take advantage f the Intent t Apply Discunt Mid-September 2017 Finalize Prject Plan Remember Hliday Annual Surveys

53 Plan t attend a PHCA Silver Award Wrkshp Octber 30, 2017 Questins Cntact Infrmatin: Dawn Murr-Davidsn, Directr f Quality Initiatives PHCA dmurrdavidsn@phca.rg