Considerations for Implementing a Facility Quality Forum 1. Secure - PDF document

Considerations for Implementing a Facility Quality Forum 1. Secure the commitment of the facility administrator, director of nursing, medical director.  The administrative team ultimately makes the difference in implementing changes in policy and practice and creating a culture of communication, collaboration and opportunity  A commitment requires the endorsement of the facility and corporate support, (as warranted). It requires that the administration endorse and support those charged with planning changes.  The purpose of Quality Forums will be to influence quality of care for residents, work together with shared visions, embrace collaborative communication, and offer support for stakeholders and recipients of LTC outcomes.  Introduce the concept of a shared forum structure as part of Resident Council, Family Council, Employee meetings, and facility newsletters. 2. Create a small—and enthusiastic “Facility Quality Forum. Make this a component of the facility Risk and QAA and QAPI Program. 3. Under the direction of the Administrator, appoint multidisciplinary and transdisciplinary representatives of the staff, residents, families, and interested stakeholders.  Key Point: Secure diverse representation and feedback from varied perspectives that cross departmental lines.  Who would be good representatives? What about the president of the resident council?  Who will be champions for change?  Remember, some of the members can be added ad hoc as the team establishes goals and establishes priorities.  Create a Mission Statement: Why this is important? The elements of the statement are, “ Who we are, what we do, and why we do it.”  Create a reasonable meeting schedule, timeline, budget, (printing, education, etc.).  Provide internal support and allow for the provision of meeting space and time for the team to convene on a regular schedule.

4. Team Tasks: Schedule a meeting of representatives to discuss: “Where are our gaps in service? What are the opportunities? 5. Discuss current strengths, weaknesses, opportunities, and threats.  Identify resources and capabilities, e.g. strengths within the current staffing plan.  What would be needed to facilitate organizational depth?  Evaluate the status of current written processes and procedures.  Evaluate opportunities identified through data such as Grievance reports, resident council minutes, customer satisfaction surveys, and formal/informal feedback.  Review related regulatory requirements to determine clinical areas for focus such as: i. First impressions and transitions of care ii. Pain Management iii. End of life Care iv. Restorative Care v. Nutrition vi. ADL Management vii. Psychosocial needs and Mental Health viii. Mobility ix. Disease Management x. Behavioral Management xi. Management of High Risk populations  Solicit current opinions, comments and/or concerns regarding gaps in service, opportunities, and resident definitions of quality of life from the perspective of Physical, Mental, and Psychosocial Well Being.  Are all appropriate disciplines involved?  Identify educational resources. Key Point: The initial brainstorming session may reveal many needs and changes that will require prioritization. Begin with quick-start projects that will generate enthusiasm, rather than an arduous project like rewriting all the policies at once.  Based on the internal assessment, identify priority aspects of staffing to be improved over the next quarter.  Stay realistic while raising the bar of expectations one notch at a time.

 Appoint a leader for team discussions. Select a representative that can work with the team to provide team reports to the Risk/QAA/QAPI committees  Communicate team goals via story boards, education, newsletters, or alternate means. Assign a recorder for the forums.  Keep systems simple  Identify support documents and resource lists: Policies and procedures, educational resources and tools. 6. Include "infrastructure" changes whenever possible. Train and Educate about the Facility Quality Forum. 7. Plan. Key Point: Involving Forum representation is an ongoing initiative. “Promoting Quality through Sharing”, should be ongoing theme within your facility.  In order to sustain the gain, Identify for each targeted area, specific changes that may be needed in the institutional structure. These infrastructure changes may include such things as: a) Revising the orientation and in service programs, to include staff, residents, families. b) Ensure the Forum discussion is forwarded to the facility QAA/QAPI as necessary to mobilize changes. c) Revisions to facility P&P, education, staff/resident and family orientation, on an ongoing basis. i. Updating job descriptions/roles ii. Review and update education to match new job descriptions and role expansion. iii. Identifying tools iv. Communication strategies, etc. d) Adopt Forum reviews as part of Risk/QA meetings; e) Utilize information from other RM and Quality sources to identify new themes for Forum discussion. f) Promote knowledge through newsletters, bulletin boards, internal postings, contests, etc. g) Tracking and trending clinical indicators and matching changing acuities to staff skills and staffing patterns. 8. Take incremental steps, but make them visible.

Key Point: Though the steps may be small, they should be visible and measurable. Once actions are chosen, develop a QI monitoring tool to identify areas of success or opportunities for improvement.  Recognize success and give credit to those making a difference, however minor. As soon as one change is working, choose another. The impact of these changes will grow over time.  Example: Create s storyboard to QA/QI action steps, e.g. “Promoting Relationships at the beginning of Care Transitions” 9. Establish responsibilities and a time-line. Key Point: For each goal or action, decide who is responsible, how often and in what context they will visit the issue, and the date for expected completion or reevaluation.  Allow a reasonable amount of time to affect change. Prioritize tasks based on identification of needs. 10. Collaborate with colleagues from other facilities and regions. Key Point: Talking with others and sharing ideas, policies and educational programs will save countless hours and sustain creativity. Seek out or form regional networks for support. Who shares a vested interest innovative staffing and workforce development?  Quality Improvement is ongoing. Identify opportunities, applaud your successes, and sustain your gains. Courtesy of: Deborah Afasano, BSN, CDONA, CIC, ELNEC,C., HCRM VP of Clinical Services The Avante Group