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You could be collecting more data than you need
When consultant Martha George, of Healthcare Accreditation Consultants in Spring Hill, TN, sees clients and attends conferences, she is often questioned about how home care agencies can incorporate OASIS data collection into the requirements of ORYX and the performance improvement section of the Oakbrook Terrace, IL-based Joint Commission standards manual.
The questions have left George surprised. "It’s just not as simple as they make it out," she says. "There are specific requirements in the manual on topics you have to look at, as well as complying with OASIS and ORYX."
The upshot is that many agencies are beginning to collect more data than they need, says George, "or worse yet, too little. Many agencies may not know how to proceed with modifying their performance improvement (PI) programs, so they leave it the same and hope that it flies. Then they find out during inspection they have made a major error.
Since all of the standards in the PI section of the manual are now "A" standards, it is easier for agencies to get caught in the Type I trap with possible focus survey implications."
As a result, George has developed a PI makeover she recently began implementing with some of her clients. She agreed to share it with our readers. In future months, Homecare Quality Management will look at the impact the PI revamp has had at some of the agencies with which George works.
She outlines the makeover process as follows:
• Step 1: Evaluate what you have.
The first step, says George, is to take an annual look at the PI program you have in place and answer four questions:
1. Was it effective?
2. What areas were not effective?
3. What data did you collect that produced useful information?
4. What data did you collect just because you had to?
"If you monitored incident reporting and found that rather than meeting the 2% goal you set, you have hit 10%, then you know you want to get that down," she explains. "As you modify your processes and procedures, you should see a trend downwards. If you don’t, then your program isn’t effective."
Remember, she adds, PI is a concept that agencies have to learn over time. "It is not quality assurance, and it is not just stuff you collect. You have to do something with the data. Often, agencies will find that they collected more information than they needed to, and more information than they could possibly act on," says George.
• Step 2: Evaluate what you need.
This step involves not only determining what data you must collect to meet regulatory requirements, says George, but also figuring out what data to collect to help you meet your agency’s priorities, goals, and mission. You should also keep in mind what resources you have available to collect, process, and act on the data collected.
For example, if your agency’s mission statement says that you will meet the home health needs of your community in a cost-effective manner and still provide quality care, then you will want to collect data on issues as diverse as infection rates and patient satisfaction.
"If you start getting complaints in patient satisfaction that indicate areas where you are not meeting your mission, you want to look at that and what you can do to fix it." Likewise, if you set an agency priority to increase referral sources by 10%, one area you should monitor, says George, will be who refers patients to you.
As you conduct this part of the evaluation, George says, remember the reasons for collecting data, she suggests. Those are:
- to monitor a process’ stability;
- to identify opportunities for improvement;
- to identify changes that lead to improvement;
- to sustain improvement.
Some areas which she says should be considered are:
- safety in the home environment;
- employee safety;
- quality control;
- utilization review;
- staff opinions and needs;
- outcomes of processes or services;
- patient demographics and diagnoses;
- financial data;
- infection control;
- patient perception of care;
- employee competence;
- sentinel events and/or incident reports.
"You always want to monitor areas that could cause harm to a patient closely," she says, "Other areas, like staff opinions or patient satisfaction, can be looked at less intensively. Those things don’t change a lot."
Choose two areas from among these that your agency has an issue with for close scrutiny. "Most agencies know their problem areas," says George. "And remember when you are choosing your areas that ORYX is coming in. Don’t choose two areas that are not part of OASIS and your ORYX system. That’s just making work for yourself."
• Step 3: Develop your performance measure.
You need to develop a tool that provides an indication of your performance in relation to a specified outcome or process. That tool will always answer who, what, where, when, why, and how. "The tool should ask: Who is involved in the data collection process? What data will be collected? Where the data can be found?" (For a sample tool, see chart, p. 52.)
The "when" means determining if you need to look at this data quarterly, monthly, or even more often. "If the process has been performing well and is stable, you can slack off a little in the monitoring," says George.
For example, patient perception of care typically performs well in most agencies. "You can continue to monitor on an ongoing basis, but you don’t necessarily have to prepare charts or graphs and full statistical analysis on this quarterly. Maybe you should prepare a full report annually."
You also have to answer why you are collecting the data and how it will work.
"Determine components and dimensions of performance," says George. With the perception of care issue, for example, you might be looking at timeliness and continuity. The components of that process could be to evaluate the home health aide staff to determine if they arrive within five minutes of the scheduled time, whether the aides call the patient prior to the visit, and how many different aides provided care to a patient in a given month.
• Step 4: Create a calendar.
The next step is to put together a PI calendar. List all of your activities and determine when you will review your performance measures, when you collect data, when you analyze that data and when you will discuss the PI measures.
You should meet to discuss how the collection is going, adds George, and whether anyone involved in that process needs help. You should also figure out how often and how you will present the data.
These meetings should include a general discussion of the program, as well as whether a particular PI measurement is still in line with your priorities as an agency and if it is bringing you nearer to your goals. (For an example of one agency’s PI calendar, see box, above.)
• Step 5: Implementation.
Educate your staff on changes to your PI program, and include the performance measures and goals in your discussion. Then start collecting data. George advises that you include as many staff members as possible in data collection and analysis activities.
"This helps you get more perspectives, gives staff ownership, and facilitates more discussion," she says. "In the old form, a PI coordinator developed the program, collected the data, and analyzed that data. But the commission wants a lot of people involved in this process. And it works better. There is no overwhelming of the PI coordinator, and you get the point of view of people who are actually working on this."
The whole PI program can be put into a notebook. Include the plan, your agency’s mission statement, your committee members, your calendar, and any tools you create. Next, put in four quarterly separators. All graphs, data, and meeting minutes for each quarter should be filed in this folder, says George. "Surveyors love this."
Once you have implemented your program, don’t leave it to languish, but evaluate it every quarter or reporting period to see if the measures you implemented were successful. Always involve staff in any changes or modifications to the program. You might want to post data results on a board in the agency break room so that all of them can review it, she adds.
Lastly, don’t overdo it. "Pull your OASIS data into your PI program," says George. "The same with ORYX once it’s implemented. Don’t go crazy monitoring issues, though. You cannot effectively monitor everything. Choose your priorities."
• Martha George, Homecare Accreditation Consultants, 200 Cordon Parkway, No. 153, Spring Hill, TN, 37214. Telephone: (931) 486-0566.