Improving
Quality Outcomes
An Organizational Approach
Mark Coggins, Pharm.D, CGP, FASCP
VP Pharmacy Services and Medication Management
Equation for
Sustainable Improved
Quality Outcomes
PDSA = Plan Do Act Study
IDT = Interdisciplinary Team
OC = Organizational Culture
Plan Do Study Act
IQO = PDSA + IDT + OC
Transdisciplinary Ownership
IQO = PDSA + IDT + OC
• When every team member
is held accountable for the
actions of other team
members (including
different disciplines)
represented on the
Interdisciplinary Team.
• Required to solve complex
issues
• Resist defining leadership
by title, position, or
education alone
Organizational Culture
IQO = PDSA + IDT +
We make
positive,
lifelong
impressions
Core
Service
Standards
We
continously
strive to
improve
personal &
company
performance
We create an
unrivaled
customer
experience...
in a safe,
courteous, &
timely
manner
We
exemplify
teamwork &
respectful
relationships
We make
everyone
feel
important
We reflect a
professional
impression
through
appearance
& behavior
PatientCentered
We are
responsible
and treat
customer
possessions
with care and
respect
We foster
positive
communicatio
n with our
customers
We are
warm
knowledgea
ble and
competent
We inspire
loyaty by
making
interactions
with us
effortless and
swift
OC
Redefine Success
“Strive not to be a
success, but rather to
be of value” Einstein
• An organization’s mission statement should guide the IDT.
“Improve Every Life We Touch, Providing Exceptional Healthcare.
While Exceeding Expectations”
• The goal of QAPI is not to achieve success alone, but rather to
create value.
• The value should be defined in terms of how what we are
working to do improves the quality of care for
patients/residents.
Success versus Value
• Success = we achieved reductions of inappropriate
antipsychotic use by 30%.
• Value = Improved Outcomes
• For example …
By ensuring all antipsychotic use is appropriate for all
patients/residents we will demonstrate value by:
• Reducing the number of persons undertreated for pain,
• Reducing the number of persons with signs and symptoms of undertreated
depression,
• Reducing the number of patients with preventable UTIs,
• Improve the number of persons with improved ADLs or therapy
• SUSTAINABLE SUCCESS starts with success that produced
value.
Normandy,
San Antonio, Texas
Pilot
Diversicar
e
Texas
Region
March 2015
Full
Implementation
Nov 2014 - Feb 2015
Nov 2014 - ongoing
throughout Pilot &
with Full Roll-out
“Quality in
Dementia Care
Program”
3rd Quarter 2014
National Monthly
QAPI Meeting
“Issue Discussed Antipsychotic Use”
PLAN
“Planning continues
throughout Pilot”
DO
“Study/Check your
outcomes and
implement changes as
needed”
STUDY
March 2015 Today
Power of
Momentum
“Study & change
practices based
on new lessons
learned”
“Use what you
learned and ACT”
ACT
Multiple
PDSA
Momentum = Mass x Velocity
Success
Improving Appropriate Antipsychotic Use
16.3%
16.4%
16.0%
15.4%
15.3%
13.6%
13.3% 13.3%
12.4%
12.3% 12.3%
12.2%
11.9%
11.6%
11.5% 11.5%
11.2%
11.1%
% Improvement in Long Stay Quality Measures
3 Month MDS Lookback
Feb 2015 versus Feb 2016
VALUE
0%
-5%
-10%
-15%
-20%
-25%
-30%
-35%
-40%
-45%
Education
QUALITY IN DEMENTIA CARE
Q uestion who, what, when, where, and why a behavior occurred;
U nderstand behavioral expressions can be a communication of potential needs;
A nticipate needs by seeing through the person’s eyes;
L isten with our hearts;
I mplement meaningful patient-specific interventions before medications;
T reat the person with respect and dignity; and answer,
Y es we can help the person have a meaningful and improved quality of life;
I nclude the person’s family in care planning;
N ever forget the person’s life story nor define the person by a diagnosis of
Dementia, because this is not who the person has become.
C heck for physical, psychological, environmental, and medical causes of behavioral expressions;
A ccess and manage pain;
R educe antipsychotic medications and reduce them as soon as possible; and
E valuate and modify our approaches as the person’s needs change.
Mark D. Coggins, Pharm.D, CGP, FASCP 2015 Diversicare Leadership Conference and Quality in Dementia Care
Toolkit
Antipsychotic Reduction Toolkit
Provide Readily Available Educational Tools (Examples)
•
•
•
•
•
•
•
20 Questions to Ask About the Person
Approaches to Identifying Causes of Behaviors
Nonpharmacological Interventions
Antipsychotic List with Risks (Educate team and family) Alternatives to Utilizing Antipsychotics in Dementia
What families need to know about antipsychotic reductions
Antipsychotic Reduction Guide
Best Practices for Quality in Dementia Care Meetings
Monitoring Tools
Daily Reporting - All new patients with antipsychotics ordered
Operational and Clinical Ownership
•
Each RVP reports to COO AnP use on weekly calls
•
Each Director of Clinical Operations monitors and reports their center action plans to VP Clinical Services
Weekly Reporting
•
Automated drill down reports emailed to all appropriate leaders on their current antipsychotic use and
trends every Friday.
National and Center QAPI focus
•
Transdisciplinary Accountability
Preparing the
IDT for Success
Experience
“Information is not knowledge. The
only source of knowledge is
experience” Einstein
• Identify experts and champions
o Internal (within your organization)
o External (peers, QIOs, Health Care Associations, etc.)
• Accelerates positive outcomes
• Minimizes mistakes
Encourage Curiosity and
Demand Humility
“I have no special
talent. I am only
passionately curious.”
Albert Einstein
Leave Your Ego at
the Door
Respect the value
each team
member brings
regardless of title
or credentials
PatientCentered
Encourage
Curiosity
Long-term success
is achieved when
each discipline
gains insight and
knowledge from
experts on the team
Perseverance
It's not that I'm so smart; it's just
that I stay with problems longer.
Einstein
• Patient-centered care requires a team approach and
persistence.
• Avoid the tendency to set your goals around regulatory
requirements or meeting state or national averages.
o When your goal is to be average you likely will fail
o Results in lost momentum
Focus on Solutions
“Insanity is doing the
same thing over and over
again and expecting
different results”
“A person who never
made a mistake never
tried anything new
things”
Einstein
• Learn from efforts which may not have gone as planned
o Team approaches help to minimize mistakes based on poor decisions
o Don’t let the fear of a failed dosage reduction keep you from trying.
• Focus most of time and energy on developing new
solutions
o What worked today may not work tomorrow
The Power of Imagination
Imagination is everything. It is
the preview of life’s coming
attractions. Imagination is more
important than knowledge.
Einstein
• What is the person’s life story?
• Likes and dislikes?
Music, TV, teaching, cooking, singing, mother
• Imagination improves individualized approaches to help
enhance quality of life
Live in the moment
“I never think of the future it comes
soon enough.” Einstein
• High risk medications lead to negative medication related
outcomes
• Work toward being more proactive to prevent issues
• Patients/Residents deserve to have high risk medications
addressed ASAP
• Encourage positive pushback and disruption of the status quo
• Avoid the temptation of basing your next attempt for a gradual
dose reduction or discontinuation on minimum regulatory
requirements
Focus on the Present
“Any man who can drive safely while
kissing a pretty girl is simply not giving
the kiss the attention it deserves.”
Einstein
• FOCUS on what is going on with the patient.
• Who, what, when, why, were, how?
• Behaviors are likely and expression of an unmet
need
• What is the patient trying to communicate to us?
Pain Management
IDT Focus
Family
Admission
Meeting
Care
Huddles
Morning
Care
Clinical
Planning
Meeting Physical
Psychological
QAPI
Environmental
IllnessMeeting
PAIN ?
PAIN ?
PAIN ?
Cornerstone of Care
• Consistent assignments whenever possible
• Work to have the same caregivers and nurses caring for the
same group of patients whenever possible
• Paramount to being able to pick up on subtle changes
• Does not overcome the need for on-going education
• Consistent assignments plus education
5 Star Nursing Home
Average Quality Rating
14.9%
Improvement
15.8%
Improvement
4.77
9.6%
Improvement
3.3
4.33
3.6%
Improvement
4.15
3.74
3.37
3.49
3.01
Texas
United States
Apr-15
Diversicare (All)
May-16
Diversicare (Texas)
Thank you