Just as quickly as it came, summer has passed, schools are back in session, and the leaves are starting to turn! Fall in New England has arrived and the crisp autumn weather has set in. Orchards are full of apple trees, pumpkins are starting to appear, and Halloween and Thanksgiving will be here before we know it. While the season is short, the foliage makes fall a beautiful time of year.
NEAHQ has been hard at work preparing for some exciting educational programs this fall. Each year, NEAHQ celebrates Healthcare Quality Week (October 17-23) to honor our fellow healthcare quality professionals who are dedicated to improving the quality of care and patient outcomes across the region. We want to thank for your passion and dedication to quality improvement and we recognize the important contributions that healthcare quality professionals make. To celebrate his year, NEAHQ is holding a virtual mini conference, complete with a keynote speaker, level-specific workshops, and a panel. Be sure to review the program update in this issue of the newsletter for additional information. As always, we hope to continue to serve as the resource of choice for healthcare quality professionals across the continuum for networking, education, and information.
Lastly, as we enter this year’s flu season alongside the current wave of COVID-19, we want to remind and encourage all to get vaccinated against both COVID-19 and the flu. We wish you and your loved ones the best of health.
Haley Friedler, MPH
haleyfriedler@gmail.com
Apply for the Professional Enhancement Grant!
The mission of the New England Association for Healthcare Quality (NEAHQ) is to empower healthcare professionals throughout New England by providing education, networking, certification preparation and professional practice resources. To support this mission and further promote the professional development of our members, the NEAHQ Board of Directors is pleased to announce a call for applications for the 2021 Professional Enhancement Grant.
The grant provides $1200 financial assistance to NEAHQ members to obtain the Certified Professional in Healthcare Quality (CPHQ) credential or for a current CPHQ to attend an educational conference.
NEAHQ members in good standing are eligible to apply. The grant will be awarded based on the applicant’s compliance with eligibility criteria as well as the quality and comprehensiveness of responses on the application, which can be found at www.neahq.org.
NEAHQ will be accepting applications through December 1, 2021 and the grant will be awarded in early January.
We look forward to your applications!
Implementing Enhancements to Multidisciplinary Transition of Care Rounds in a Health Plan Setting
Samantha Adams RN, BSN, CCM, Lauren Hartwell MPH, Elizabeth Rekowski RN MSN, Maureen Drossos RN, BSN, CCM
Purpose and Objectives:
The purpose of this Process Improvement Project (PIP) was to develop, implement, and evaluate a structured multidisciplinary rounds platform for case management and utilization management teams to address complex transition of care barriers in a health plan setting. This PIP was undertaken as part of an enterprise Population Health Management effort to improve transition of care programs by incorporating evidence-based, best practice standards. Additionally, this project was intended to break down silos and ensure that all team members are getting the same information at the same time to problem solve transition barriers more efficiently and effectively.
It is well documented that effective multidisciplinary communication, collaboration, and coordination from admission through post-discharge can be the difference between a successful transition and a costly readmission [1-4]. However, these findings apply to hospital-based case management. This project expands on the evidence by implementing structured multidisciplinary transition of care rounds for a health insurance plan. This PIP was designed to achieve the following: (1) develop a clear structure for multidisciplinary transition of care rounds using a standard operating procedure (SOP) that includes roles, responsibilities, and case identification guidelines; (2) educate staff on how to participate in rounds per the SOP and utilize a standard case presentation format; (3) establish a documentation method to facilitate closed loop communication; and (4) ensure pertinent multidisciplinary team members attend rounds to discuss transitional barriers and recommend solutions.
Primary Practice Setting:
The setting was a regional health insurance plan in New England. The project scope was limited to the Commercial membership within the Inpatient Services and Population Heath Care Management teams. The Inpatient Services team consists of 18 Registered Nurses (RNs) and six Behavioral Health Clinicians who provide admission and continued stay authorization management. The integrated Care Management team consists of 14 RNs and three licensed social work case managers, who provide telephonic clinical guidance to members in managing care across the continuum, from preventive care to chronic and complex conditions. For this PIP, the team consulted with Medical Director leadership to ensure buy-in and participation and established a process to engage Physical and Occupational Therapy resources as needed.
Findings and Conclusions:
A mixed method evaluation survey was administered to participants in multidisciplinary transition of care rounds pre- and post-implementation of the standard operating procedure to assess improvement in efficiency and effectiveness. Participants responded to six statements about multidisciplinary transition of care rounds, indicating their level of agreement or disagreement on a seven-point Likert scale ranging from “Strongly Agree” to “Strongly Disagree” with a neutral midpoint. In June 2020, the pre-implementation survey was administered and completed by 41 staff representing the disciplines of Utilization Management (18, 45%), Care Management (18, 45%), Behavioral Health (2, 5%), and Other (2, 5%). There were 12 staff who indicated they had never participated in rounds; their responses were removed from the analysis. In November 2020, the post-implementation survey was administered and completed by 35 staff members representing the disciplines of Utilization Management (14, 40%), Care Management (20, 57%), and Behavioral Health (1, 3%). There were 9 staff who indicated they had never participated in rounds; their responses were removed from the analysis. Quantitative survey results are shown in Table 1.
There was a 120% increase in the proportion of staff who strongly agreed that they “have a clear understanding of other’s roles and responsibilities during rounds,” which suggests that the SOP and staff education was successful in clearly defining roles and responsibilities for rounds participants. There was also a notable 200% increase in the proportion of staff who strongly agreed that “case presentation during rounds is efficient and structured.” This outcome speaks to the effectiveness of using a standard case presentation format – for this project, the teams used the SBAR (Situation-Background-Assessment-Recommendation) technique as a framework for communication during rounds (Figure 1). Additionally, there was a 200% increase in the proportion of staff who strongly agreed that multidisciplinary transition of care rounds “provides insight I need to do my job well” and a 400% increase in the proportion of staff who strongly agreed that “the right people are consistently present during rounds.”
To date, the teams have presented 15 cases at multidisciplinary transition of care rounds. When staff were asked to provide qualitative feedback regarding the new standard operating procedure, they indicated an increase in collaboration and teamwork and highlighted efficiency gains from using a consistent case presentation format. Staff also indicated that multidisciplinary transition of care rounds allowed them to receive input from and ask questions of other disciplines, as well as increase access to new information about the member or family. Further study is suggested to evaluate improvement in member utilization outcomes and cost.
Table 1. Evaluation survey results for multidisciplinary transition of care rounds.
|
Survey Item |
|
Strongly Agree |
Agree |
Somewhat Agree |
Neutral |
Somewhat Disagree |
Disagree |
Strongly Disagree |
|
I have a clear understanding of my role and responsibilities during rounds. |
Pre (n=28) |
25.0% |
50.0% |
17.9% |
3.6% |
3.6% |
0.0% |
0.0% |
|
Post (n=26) |
42.3% |
42.3% |
11.5% |
3.8% |
0.0% |
0.0% |
0.0% |
|
|
I have a clear understanding of other’s roles and responsibilities during rounds. |
Pre (n=27) |
18.5% |
37.0% |
29.6% |
3.7% |
7.4% |
0.0% |
3.7% |
|
Post (n=26) |
42.3% |
46.2% |
11.5% |
0.0% |
0.0% |
0.0% |
0.0% |
|
|
Cases selected for rounds are relevant to me/my job. |
Pre (n=27) |
14.8% |
40.7% |
18.5% |
3.7% |
11.1% |
3.7% |
7.4% |
|
Post (n=26) |
26.9% |
50.0% |
19.2% |
3.8% |
0.0% |
0.0% |
0.0% |
|
|
Case presentation during rounds is efficient and structured. |
Pre (n=27) |
11.1% |
44.4% |
22.2% |
7.4% |
0.0% |
11.1% |
3.7% |
|
Post (n=25) |
36.0% |
44.0% |
16.0% |
4.0% |
0.0% |
0.0% |
0.0% |
|
|
Case discussion during rounds provides insight I need to do my job well. |
Pre (n=27) |
7.4% |
33.3% |
18.5% |
14.8% |
7.4% |
14.8% |
3.7% |
|
Post (n=26) |
23.1% |
46.2% |
19.2% |
11.5% |
0.0% |
0.0% |
0.0% |
|
|
The right people are consistently present during rounds. |
Pre (n=29) |
3.4% |
34.5% |
10.3% |
10.3% |
17.2% |
13.8% |
10.3% |
|
Post (n=26) |
19.2% |
57.7% |
15.4% |
3.8% |
3.8% |
0.0% |
0.0% |
Figure 1. SBAR (Situation-Background-Assessment-Recommendation) case presentation tool.
Greetings NEAHQ members! We hope you have made the most of the beautiful months of summer and have begun engaging in New England Fall activities. The Program Committee had a busy summer and hosted two webinars between April- June and have also been in the process of planning a Virtual Conference for Healthcare Quality Week.
- Past Events: Interactive webinars were led by Antonia Blinn, CPHQ and Sarah Lederberg Stone, MPH, PhD from the Massachusetts Department of Public Health (DPH) on a ‘Racial Equity Data Road Map’ tool and a webinar on “Better Handoff for Safer Care” was led by Dr. Chris Landrigan from Boston Children’s Hospital & Bill Floyd Co-Founder & CEO from the I-PASS Institute. We had a wonderful turnout for both these webinars and received fantastic feedback by attendees.
- Upcoming events: A virtual Conference for Healthcare Quality Week will be held on October 19, 2021 from 3pm to 6pm and features a keynote speech by the ‘Penn Medicine Nudge Unit’ and several ‘Applied Learning’ workshops with beginner, intermediate and advanced level breakouts, and a structured panel session on leading QI work in a virtual environment. Registration now open! Click here.
Thank you to all participants, panelists and speakers for making these programs a success! We hope you found it to be a value-add. We look forward to having you participate in our Healthcare Quality Week conference and applied learning sessions!
Best,
Lauren Hartwell & Aliysa Rajwani
NEAHQ Program Committee Co-Chairs
NEAHQ currently has $48,623.46 in total assets. Total revenue generated in Q2 2021 was $1,170.00. Revenue was generated from program fees and membership dues. Total expenditures for Q2 2021 were $666.26. Total expenditures were made up of administrative and operating expenses. Net revenue for Q2 2021 came out to $503.74.
As always, please feel free to reach out to treasurer@neahq.org with any questions.
Would you please share a brief overview of your career?
My career started out and has remained in physical rehabilitation. I began as a Certified Therapeutic Recreation Specialist. I worked between Spaulding Burbank Hospital and Emerson Hospital. When a fulltime position opened, I transitioned to Fairlawn Rehabilitation Hospital in Worcester. In 1997 a new hospital called Whittier Rehabilitation Hospital was opening in Westborough, so I applied and interviewed and was offered a position to be part of the start-up crew. Well, it’s now history because almost 24 years later, I am still there. In 2002 I started to get involved with Quality and Outcomes at the hospital and split my time as TR Clinical Specialist and Quality and Outcomes Coordinator. During this period, I also started working on my Master in Health Education degree at night. I was enjoying the new part of my role, so when an opportunity opened for Quality Assurance and Outcomes Manager in 2003, I decided to apply. I transitioned into the QA role full time and only worked as a CTRS as needed for special cases. In 2004, I earned my Master in Health Education and passed the certification exam for Certified Health Education Specialist (CHES). In 2007, there was an opening for Director of Performance Improvement to which I applied, and I have been in this role ever since.
Which aspect of your current position is especially rewarding?
The most rewarding part of my current position is when we have a successful PI project and we sustain the change. Since a lot of work and energy goes into making the changes, it is rewarding when it succeeds and a process is made safer for our patient care and/or more efficient for our staff. The end result is that everyone benefits! That makes the work that was put into the process improvement all worth it. An added benefit to my role is getting to work with staff in all departments.
Has any one individual greatly influenced to your career?
The biggest influence on my career in quality came from a woman from our corporate level who was a big advocate for QA and patient safety. My interest in quality processes began when she visited our hospital to provide an in-service about Toyota and Lean. Later she filled in as our DON while we were looking to hire a new one. She encouraged me to get involved in the quality role and taught me a lot about the whole PDCA process, analyzing data, and regulations.
What led to your involvement with NEAHQ?
I have been a member of NEAHQ since about 2003 or 2004 (MAHQ). Working in a small hospital, I don’t have a department staff in quality, so I started to attend NEAHQ/MAHQ events for education and networking with other quality professionals. They always mentioned vacant positions, and every time I attended events I saw all the wonderful volunteers who make these events happen. I inquired about volunteer opportunities years ago, but then never followed up because my kids were still too young and I didn’t have the time. I reached out again a couple years ago and Lynn Myers was so wonderful to educate me about what each committee and role entailed and the required time commitment. She then reached out to me again and encouraged me to get involved with the Board of Directors. So, thanks to Lynn, I have met many wonderful professional in the quality field that want to make NEAHQ the best it can.
What are your goals as a NEAHQ Board Member?
As a board member, I hope to contribute my time and energy to help our organization to continue to grow, as well as, continue to educate professionals on topics that are current in the quality field. I will do whatever is needed of me on the board to help NEAHQ succeed.
How do you see the role of quality in healthcare organizations changing?
I see our role as quality professionals in healthcare organizations becoming more and more important due to all the regulatory and reimbursement changes that continue to come down the pike. Quality is a critical part of healthcare and is vital when striving to be a high reliability organization with patient- centered care.
How do you balance your demanding professional life with your personal life?
Balancing my personal and professional life is a challenge. I work for a family- owned hospital where we all wear many hats. Work is demanding and sometimes it seems like there are not enough hours in the day since there are no other quality staff. The key is working closely with all departments, getting them involved in our PI processes, and working together as a team. My personal life involves two wonderful children who participate in many sports and a husband who also has a busy job. We spend a lot of time running between work and sporting or school events for the kids. I wouldn’t want it any other way.
The New England Association for Healthcare Quality (NEAHQ) is the regional association for healthcare quality professionals. Since 1975, NEAHQ has provided a forum where healthcare quality professionals across the healthcare continuum can join together to advance this specialty. Our vision is to empower healthcare quality professionals across New England to improve health. We aim to serve as the resource of choice for healthcare quality professionals across the continuum for networking, education, and information, as a collaborative, member-oriented, inclusive, and continuously improving organization.
Benefits of a membership to NEAHQ include:
- Membership Rates: Pay discounted rates to all NEAHQ events, including webinars and the annual conference.
- Healthcare Quality Job Board: Browse healthcare quality job opportunities to further your career or post an opportunity at your organization for other members to see.
- Member Forums: Use these virtual platforms to exchange information with other NEAHQ members about healthcare quality trends and issues. Member forums allow you to ask a question of your professional peers or share a best practice from your work to move healthcare quality forward.
- Archived Events: Did you miss an in-person event or webinar? As a NEAHQ member you can access archived events so you will never miss an opportunity to stay up to date with the healthcare quality knowledge.
- Member-to-Member Networking: Interested in connecting with your fellow healthcare quality professionals? Attend one of NEAHQ’s in-person networking events or create a profile on the website and connect with other members through the NEAHQ Website Membership Directory.
Membership annual dues are $75. To join, go to the NEAHQ website at https://www.neahq.org/join and complete the form online or download it and mail it in with your payment.
6S is a method used to create and maintain a clean, orderly, and safe work environment. It consists of:
- Sort (Get rid of it): Separate what is needed in the work area from what is not; eliminate the latter.
- Set in order (Organize): Organize what remains in the work area.
- Shine (Clean and solve): Clean and inspect the work area.
- Standardize (Make consistent): Standardize cleaning, inspection, and safety practices.
- Sustain (Keep it up): Make 6S a way of life.
- Safety (Respect workplace and employee): Create a safe place to work.
Prevalence of Unmet Health-Related Social Needs among Massachusetts Residents
CHIA expanded the scope of reporting from its Massachusetts Health Insurance Survey (MHIS) last month to include a new area of study – Social Determinants of Health – with the research brief Over Half of Massachusetts Residents Report Unmet Health-Related Social Needs in Their Families. The MHIS is a Massachusetts household survey fielded every other year. The Unmet Health-Related Social Needs (HRSN) research brief documents the prevalence of unmet HRSNs in Massachusetts. Residents who reported food insecurity, housing instability, financial strain, or employment instability in their families were considered to have an unmet HRSN. The research brief found that the majority (52%) of all Massachusetts residents reported at least one unmet HRSN in their families in 2019, and over one-third (34%) reported multiple unmet HRSNs. Unmet HRSNs were experienced by residents and their families at all income levels, across race/ethnicity groups, and across all family types. However, residents with very low or low income, residents of color, and residents in single-parent families experienced unmet HRSNs at significantly higher rates than their counterparts. The full brief contains more details on the findings. It is CHIA’s first step to document the burden of unmet HRSNs in Massachusetts and better understand how they are experienced by residents and their families across the state.