Empower employees to improve quality

Give staff chance to serve on FI teams

A Michigan agency has discovered that employees enjoy working on teams designed to improve quality.

Huron Valley Visiting Nurses of Ann Arbor, MI, formed five functional improvement teams last year to help the agency improve processes before a survey by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. Their efforts have paid off, especially among staff.

There has been increased employee satisfaction and "an ongoing commitment from those who participate on the teams," says Susan Johnson, acting director of quality management.

"Quality management and performance improvement are becoming integrated into people’s thinking," Johnson explains.

The functional improvement teams updated policies, improved handouts, developed new programs, and redesigned processes. Their efforts included making simple changes that pleased the staff, such as changing how paychecks are corrected.

"Sometimes mistakes were made on paychecks because people hadn’t turned the paperwork in or the staff had misread hours," Johnson says.

So the agency started a new process that would print corrected checks within a day. "That makes them very happy," she adds.

The five functional improvement teams and their purposes are as follows:

1. Quality council, also called leadership-performance improvement team.

The quality council reviews ongoing measurement activities and monitors the agency’s yearly performance improvement plan. The group also looked at customer satisfaction issues and how problems can be solved, as well as reviewing all the teams’ process improvements. The leaders of each of the other teams are members of the quality council.

2. Rights and ethics team.

Each time the ethics team meets, the members look at three areas: education, policy, and consultation, says Linda Taub, BSN, RN, director of clinical services.

"We have staff nurses or other employees who may not be up to par on ethical concepts and decision making," Taub says. "We’ve been going over principles of ethical thinking, and did a fair amount of education in that area."

The team improved the agency’s do-not-resuscitate policy and held a mandatory inservice on advance directives. During the pre-test most employees failed, but they scored 100% on the post-test.

The previous advance directives information was so complicated that most nurses "just skimmed over it, and didn’t explain to patients what advance directives were," Taub says.

"So we developed a tool that had simple language that they could go over with the patient," she adds. "And we developed a worksheet with six scenarios that nurses can give to patients to encourage them to discuss advance directives with their family members."

The consultation portion of the meetings consists of discussing ethical issues as they arise. The agency has a report for nurses to give to the director of clinical services if they have an ethical concern. This report is then given to the ethics team.

For example, Taub says she recently received a report about a patient who lives in a very dirty environment with too little caregiving. The employee who made the report thought there were ethical issues here that might require calling adult protective services.

3. Coordination and utilization team.

This team looks at the continuum of care, human resources, and information management.

"On the surface it might not look like those things are related, but we found they have a lot of commonalities," Johnson says.

"In the continuum of care, sometimes human resources are an issue if you don’t have the right blend of nurses, therapists, and social workers," she adds.

4. Care planning and provision.

This team looked at patient assessment, care, treatment, and service.

The team developed a seven-page assessment tool with an extra page for pediatric cases and a four-page care plan, says Karen Zasada, RN, MSA, director of operations.

New tool easier for data entry

"The old system was geared toward documentation, but when we went through the conversion to functional improvement we were looking for a physical assessment tool that could work with the new information system," Zasada says. The new tool is easier for data entry staff to use, and it provides a more comprehensive clinical assessment.

It took staff several months to become used to the new tool. Initially, it added an extra half-hour to their daily routine, she says.

"But now they understand the flow of the document better, so it actually probably saves them time," Zasada says.

The team also evaluated the agency’s care planning to determine if there is a systematic approach to patient care, says Karen Stetson, BSN, RN, director of clinical services.

"We focused on policies and procedures, chemotherapy administration, blood transfusion, and looking at the actual care planning process," Stetson says.

5. Environment and education team.

This team focuses on infection control, safety, prevention, equipment management, and education for patients, caregivers, and staff.

"Our infection reporting process was redesigned to concentrate on infections that patients contract while in our service," Stetson says.

The new process streamlines infection reporting and makes it easier to look for causative trends in the reported infections. The agency will use this information to develop patient or staff education that will help prevent spreading infection.

Also, the team addressed safety in the home and developed new handouts on basic home safety for patients.

"Education is fundamental to all of the improvements that this team addresses," Stetson states.

"An inservice on safe transfer of patients and back safety, which included proper use of a patient lifter, has decreased the number of injuries to staff," she adds. "As a result of this team’s work, fewer incident reports have been received during the past six months."