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hello and welcome to today’s webinar
presented by the lake superior quality innovation network on developing an action plan I’m Kathleen Lavich, a quality
improvement coordinator for the lake or Lake superior QIN. The lake
superior QIN is comprised of three organizations: MPRO in Michigan, Metastar in Wisconsin and Stratis Health in Minnesota and we
support the Centers for Medicare and Medicaid services priorities for health care quality improvement in each organization’s respective state. Our
objectives today are to recognize the importance of
developing a structured action plan identify strong, intermediate and weak actions and to develop an action
plan Developing an action plan falls under strategy five of the change package Be a continuous learning organization Action item 5c6 states: take advantage of existing performance improvement templates and tools that are easy to use and guide system’s thinking to define the problem test interventions and measure the impact on the problem and the larger system Tools are available to support your performance improvement projects including tools to develop an action plan including measurement National Nursing Home Quality Care Collaborative nursing home participants are committed
to appointing a multidisciplinary team
within their facility Learn from the collaborative process and conduct small scale tests of change and help successful changes become
standard practices if your actions inspire others to
dream more learn more do more and become more, you are a leader the role nursing home leadership is to guide, support and encourage teams to develop new ideas and change systems for better outcomes To be engaged and listen to their staff to help eliminate barriers that prevent them from doing their best work and to work with their teams to assure changes are sustained Involvement of organizational leadership ensures that quality improvement initiatives Are consistent with the mission values and goals of the facility And also is reflective back to change package strategy 1, lead with purpose be the leader you want to follow and focus on systems for change A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to spread innovations and new ideas that are based on evidence based practice. The change
package for example provides you with best practices from
high performing nursing homes And the steps to accomplish are the same as those used in any type of performance improvement
project. Four tips when making change: Have a clear vision Be authentic. Communicate. And follow through until the change is ingrained in the organization Change is inevitable and when you’re conducting quality improvement change is necessary for improvement Ways to reduce resistance to change: setting goals and measuring outcomes Coaching people who are resisting to change ensure that those affected by the change
have the right tools training and understanding to perform.
Clearly communicate the reasons for the change. be flexible and adapt as needed be proactive versus reactive. again change package strategy five be a continuous learning organization talks about focusing on the human side change
recognize how hard it is for people to change. understand that staff need to know why a
change is needed which is the value of it what specifically they need to do
differently, provide the support, resources and tools they need and check in with your staff frequently to see how the changes are going remove barriers that they face to make the changes The action plan outlines the steps to carry out the proposed change explain the steps and show how the team
will measure to ensure improvement occurs. Your team will identify actions to get the improvement or outcome that you want Think about testing or piloting changes in one area of your facility before launching throughout because some changes have unintended consequences When designing action plans, clearly state what is to be done, by whom and when. Action plans will be monitored, so it is important to have clearly defined measures When developing your action plans consider such questions as what safe guards are needed to prevent the root cause from happening again. What contributing factors might trigger this root cause to reoccur? How can we prevent this from happening? How can we change the way we do things to make sure this root cause never happens? If an event like this happened again, how could we stop the accident trajectory? or in other words, quickly catch and correct the problem before the resident is harmed. if a resident was harmed by the root cause, how could we minimize the effect of the failure on the resident? The team defines the actions, responsibilities, measures and deadlines for implementing
the change The team needs to follow up with any ongoing action items that are identified. and be ready to redefine any steps that aren’t working as the team anticipated Quality improvement depends upon staff are trained and empowered to work as a team in real time Problem solve and use critical thinking skills to improve resident outcomes Note that at this point in your performance improvement project, you may want to re-evaluate the composition of your team to make sure you are including people who are a part of the process being changed. It is a good idea throughout your project to make sure you have the right people on the team and to adjust membership as needed. The Department of Veterans Affairs National Center for Patient Safety developed a hierarchy of action that classifies corrective actions as weaker, intermediate or stronger. Action strengths are based on the principles of human factors were the most effective actions accommodate for human behavior. Weaker actions depend on staff to remember their training or what is writter in the policy. Intermediate actions are somewhat dependent on staff remembering to do the right thing, but they also provide tools to help staff remember or to promote clear communication. Stronger actions do not depend on staff to remember to do the right thing. Weaker actions support or clarify the process but they rely solely on the human. these actions not necessarily prevent
the event or cause from occurring questions to ask in evaluating if the
election is weaker would include is this action focused on
informing the person? is this action establishing rules that do not already exist? does this action prompt, warn or alert a person? Might capture their
attention. does this action examine if the process
could be improved to be better? is the outcome of the action left up to
personal interpretation. Example of a weaker action statement would be “All computer users must maintain a strong on unique
password for their system accounts” Intermediate actions modify existing
processes and they reduce the reliance on humans to
get it right but they do not fully control for human error. Questions to ask in evaluating if the action is intermediate in preventing the event or cause. Does the action help the person to remember the process? does it improve upon the information
needed to do the process? does it serve as a guide tool used
during the process? Does this action reduce variation on the
outcome? Will most people do it successfully? And does this action account for human
limitations of time, workload and task? An example of an intermediate action statement, would be like a checklist. A checklist located next to computer shows the steps the requirements necessary to log into the system including password
requirements Stronger actions change or redesign the
process corrective actions to change the system
and do not allow the errors to occur are the strongest. It is helpful to
involve supervisory and management staff in the
action planning discussions. Designing intermediate and strong actions
often requires an understanding of various residents care systems and the facility’s resource allocations staff members on the team may not possess this knowledge because the feasibility and costs
associated with corrective actions must also be considered as helpful to
include the management in the corrective action discussions if
they’re not already members on the team. If a particular action cannot be
accomplished due to current constraints for example a
lack the resources the team should look for other ways to change the process to prevent a similar event from
occurring in the future doing nothing should not be an option. Stronger actions and the best at removing the dependence on the human to get it
right they are physical and permanent rather than procedural and temporary. Questions to ask in the
evaluating if the actions stronger in preventing the event or cause, does the action force a person to get it right? Does it eliminate the chance choose the
wrong option? is it designed for the environment or system
to operate without additional issues or concerns for the person taking the
action? can this be replicated successfully
under any circumstances or by a different
person? does it require minimal supervision or measurement of compliance? Does it involve standardized forcing
functions to remove human error? and variation through technology or design? An example of a stronger action statement: for example a forcing function all passwords must be at least eight
characters long and contain combination upper and lower case letters numbers and
symbols The log in system will not
accept passwords without these features examples a stronger actions would be
changing the physical surroundings Adding engineering controls into the system forcing functions are constraints the
design and gas lines so that only oxygen can be connected to the
oxygen lines electronic medical records cannot
continue charting unless all fields are filled in. Additional examples of strong reactions
include simplifying the process removing unnecessary stops like unit
dose testing usability of devices before
purchasing them intangible involvment in action by leadership in support of residence safety for example leaders are seen and heard supporting the change. Suppose staff
members cannot locate the equipment to use when
lifting larger residence because especially equipment is not kept
in the same location the strongest action to prevent another accident would be to keep all equipment
designed for special-needs residents in just one storage area so in other
words you’re gonna change the physical surroundings staff members will no longer need to
differentiate regular equipment from specialized
equipment if this action is not feasible
consider placing a sign on the lift equipment do not use for residents over
250 pounds this is an example of a warning or a
label sometimes called a visual cue. It is
a weak action because staff members might
overlook warning but if no other stronger action
is available a weak action is better than none at all. Developing an action plan aim for actions with a stronger
intermediate rating. actions that change the system and do not allow errors to occur on the strongest. the goal is to implement the strongest
action to change the system And eliminate the root cause. Common solutions such as providing training or education or asking clinicians to be more careful don’t change the process or the system. because those solutions are based onto assumptions. One, that the lack of knowledge contributed to the event. and 2, if a person is educated or trained, the mistake won’t happen again. Choosing actions that are tightly linked to the root causes and that lead to a system or process change have the highest likelihood of being effective. Actions that simply support the current process are considered weaker and should not be selected as the sole intervention. The goal is to make changes that result in lasting improvement. To be effective, interventions or
corrective actions should target the elimination of root causes, offer long-term solutions to the problem may have a greater positive than
negative impact on other processes. In addition the outcomes of the actions or
interventions must be achievable, objective and measurable. Action plans are
generally require creating a new process Action plans will generally require creating a new process or making a change to a current process. The key is to choose actions that address the outcomes the team is trying to accomplish. some action plans will be short-term
interventions which can be accomplished quickly and will be short term solutions Usually to fix a contributing factor, for example, purchasing an additional hoyer lift rated for use. for resident weighing over 250 pounds but short term solutions rarely fix root causes. Some action plans require
a long-term implementation steps for example recommending their formal
evaluation our future specialized equipment needs for residents be regularly incorporated
into the console the strategic planning and budgeting processes. We’re gonna look at a couple different templates that you can use to develop
your action plan This template you can use this worksheet
identifying the action plan and enter the root cause at the top
of the charts In column 1, designate the goal. the next column enter the specific actions that you’re gonna take to reach
your goal in the third column ensure the
individual or the group responsible for completing the action in the next column enter the time frame
for completion in the last column enter a measure that
would be used to show that the actions led to improvement here’s an example of this particular template completed you know
if they put their root cause at the top the lack of consistent communication regarding therapy appointment times for
residents and they completed it with a goal which
includes a measure their target is ten percent or less each month they’ve indicated two separate actions and corresponding people will be
responsible for those actions and that fourth column that you
would enter actual date and you see they have their measure indicated in there. In the last column, the percentage of
missed therapy appointments per month in that Transitional Care neighborhood this template is from the CMS QAPI website and can also be used for your action
plans here’s one more example many action plan
template you can using as a little more detail in it and includes the root causes this slide
shows an example of how to complete the template Along with the implementing the action
plans developed ways to gather data that will be used to measure the success successful quality improvement processes
create feedback loops using data to inform
the practice and measure results. Facts based decisions are likely to be the correct decisions
all of the following criteria: should be met to conclude that an action plan
is part of your performance improvement project has been successful measures a success were monitored over time the goal was attained, process changes were made and sustained and no recurrent events and you are
confident that the change is permanent what you measure should
provide the answers just three questions did the recommended Action actually get
done? did the warning signs get put on the
hoyer lift? did a formal equipment evaluation step
get added to the annual budgeting process? number two, are people implementing the
recommended changes how often is the wrong type of hoyer lift
used for residents weighing over pre-determined weight. Is staff provided an opportunity to participate in an equipment needs assessment during the budgeting process Number 3, have the changes made a difference? That concludes our webinar on developing an action plan. As part of this learning session, we are asking you to complete an activity together with your team. use one of the action plan templates that were presented today or one of your own choosing, as part of your current or next performance improvement project. For further information on the National Nursing Home Quality Care Collaborative, Please contact your state lead in the Lake Superior Quality Innovation Network. You have now completed webinar 4 of 4 for learning session number 2 we’ll be emailing you an evaluation To receive your nursing CEUs or certificate of participation, please complete the evaluation. Thank you for watching and thank you for all you do to improve the quality of care and quality of life for our nursing home residents.

Reynold King

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