Fine-tune your IOP process

Agency improves communication, staff involvement

If your Improving Organizational Performance (IOP) process has seemed a little lackluster lately, it may be time to give it a new shine.

At Rockingham VNA & Hospice in Exeter, NH, the IOP committee has been meeting quarterly to review infection control, patient satisfaction, and other important quality improvement processes. But that wasn’t asking enough of the IOP process, the home care agency’s managers decided. Last year, they revamped the committee, turning it into one that meets at least monthly.

"We wanted it to be a very active committee," says Pamela Sotiriadis, RNC, BSN, manager of quality assurance, quality improvement for the agency that covers 22 towns in southeastern New Hampshire.

Managers wanted the IOP committee to review staff suggestions for quality improvement and make the whole IOP process more accessible to the staff, she adds. "If employees could see their suggestions were brought to the committee and talked about, then maybe there would be more and more staff looking at the processes within the agency, discussing patient issues, morale issues, and everything."

Employee suggestions are taken seriously

The IOP committee has 13 members, including managers and hourly staff, who each commit to serving at least one year on the committee. They meet for 90 minutes to two hours. For those not on the committee, it’s open to their opinions and concerns through a formal employee suggestion process that has employees write their suggestions on a special form.

Each suggestion made is discussed and addressed by the committee during a regular meeting. For example, an employee asked why the staff had to use a certain new documentation form. The committee discussed this and decided the agency needed to re-educate staff about the new forms.

Each employee who makes a suggestion or raises a concern receives a formal letter that acknowledges that the feedback form was read and discussed. It explains what suggestions the IOP committee made and what any follow-up action might be, Sotiriadis says.

"I have a monitor log that we will use to monitor all the staff suggestions and log in the date we received the suggestion, what the suggestion was, what actual decision was made, and who will monitor it if it needs monitoring."

Sotiriadis says the agency has not offered staff any incentives for contributing suggestions to the IOP committee, but that is a future possibility.

The agency rolled out its new IOP process with a kick-off session with the staff, at which Sotiriadis explained what the IOP committee would be doing, what the level of commitment would be, and what type of education they would get on the committee. "I asked for volunteers, and I received [some] from every department."

The new IOP committee began to meet in September 1999. The first meetings included a brief history of how a continuous quality improvement process works and a review of the IOP team’s ground rules. The committee discussed these topics, as well:

• criteria for establishing focus teams;

• developing an IOP mission statement;

• IOP vision and mission statements;

• brainstorming for a new staff suggestion form;

• discussion of team meeting skills;

• overview of Medicare’s Conditions of Participation, state laws, and requirements by the Joint Commission on Accreditation of Healthcare Organizations of Oakbrook Terrace, IL.

Also, the IOP committee soon began to form focus committees to address specific quality improvement issues.

For example, there is a team that focuses on interdisciplinary communication. "This is a very broad topic," Sotiriadis says. "We have communication via e-mail [and] voice mail; we have a lot of staff who don’t come into the office very often, so how do we get information out to them?"

The interdisciplinary communication committee tried to categorize the different types of communication, making priorities, and identifying problems and obstacles. They did this formally with a chart that outlines all of the issues that need to be addressed. (See communication chart, below.)

"Once they get all of the information together they can make recommendations," Sotiriadis says.

One area the interdisciplinary communication committee has focused on involves how telephone calls are handled. The committee was specifically interested in seeing consistency in how the calls are handled. For instance, if a physician calls the office, the call is routed to a manager. But when a patient calls, the call might be handled by any of a number of secretaries or medical records employees. "Sometimes, they’re not sure how to handle those calls," Sotiriadis explains.

"We want to make sure the calls are handled correctly and patients are not put into voice mail by mistake, or patients transferred to another department," she adds. "We want a consistent approach so if a patient calls in about this topic, then the call goes to this person and this is how it’s handled."

The end result could be that the focus committee develops written guidelines that spell out how those calls are handled, then the agency would inservice the staff on the process. n

Debbie Caresio, RN, Performance Improvement and Information Management Supervisor, Illinois Valley Community Hospital Home-Based Services, 1701 Fourth St., Peru, IL 61354. Telephone: (815) 224-1307.

Carolynn Rice, RN, BSN, MBA, Director of Quality Improvement, Advanced Home Care, P.O. Box 18049, Greensboro, NC 27419. Telephone: (336) 294-8822.

Pamela Sotiriadis, RNC, BSN, Manager of Quality Assurance, Quality Improvement, Rockingham VNA & Hospice, 137 Epping Road, Exeter, NH 03833. Telephone: (603) 772-2981.

Frank Zibrat, Associate Director, ORYX Implementation, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000. Web site:

Noelle Zuidema, RNC, Quality Management Coordinator, Colorado River Homecare, 5225 Highway 95, Suite 10, Fort Mohave, AZ 86426. Telephone: (520) 768-1303.