QualityAssuranceandPerformance Improvementisthemerger oftwocomplementaryapproachestoquality,QualityAssurance(QA) andPerformanceImprovement(PI). Bothinvolveseekingandusinginformation,buttheydifferinkey ways:

  • QA isaprocess ofmeetingqualitystandardsandassuringthatcareand servicesreachanacceptablelevel. Theprocessincludes the systematicmonitoringand evaluationofthevariousaspects ofa project,service,or center/office/agency operationstoensurethatstandards ofqualityarebeingmet. Skillednursingandrehabilitationcenters(SNRC’s),hospiceandhomehealthsetquality assurancethresholdsto comply withinternallydevelopedstandardsofperformanceand;also,tocomply withallapplicable stateandFederalregulations. QAactivitiesareplannedatspecificintervalsandareongoing toalwaysassureanacceptablelevelofperformance.
  • PI(alsocalledqualityimprovement--QI)isa pro-activeandcontinuousstudyofprocesseswith theintent toprevent or decreasethelikelihoodofproblemsbyidentifyingareas ofopportunityandtestingnew approachestofix underlyingcauses ofpersistent/systemicproblems.Performanceimprovementinskillednursingandrehabilitationcenters(SNRC’s),hospiceandhomehealthaim to improveprocessesinvolvedinhealthcaredelivery,patientsafetyandquality oflife.Performanceimprovementcanmakegoodquality evenbetter.

Themerger ofthetwoapproachescreates QualityAssurancePerformanceImprovement. QAPIisa data-driven,proactiveapproachto improving thequality oflife,care,andservicesinhealthcare.TheactivitiesofQAPIinvolvemembersatalllevelsofthe organization to:identifyopportunitiesforimprovement;addressgapsinsystemsorprocesses;developandimplementanimprovementorcorrectiveplan;andcontinuouslymonitoreffectivenessofinterventions.

QAPIutilizessystemsthinking:anapproachto problemsolving,whichviews“problems” as partsofanoverallsystemrather thanreacting tospecificparts,outcomesor events.“Systems’thinkingisnotonethingbutasetofhabitsor practiceswithin aframeworkthatisbasedon thebeliefthatthe componentparts ofasystem canbestbeunderstoodin thecontextofrelationshipswitheachother andwithothersystems, rather thaninisolation.” Systems’thinkingenablesunderstandingofasystem,aswellas,thedesiredorexpectedoutcome by examiningthe linkagesandinteractionsbetween theelementsthatcomposetheentirety ofthesystem.(Wikipedia, thefree encyclopedia)

PruittHealthQAPIPurpose

ThepurposeofQAPIatPruittHealthistocontinuallytakeaproactiveapproachtoassureandimprovethewayweprovidecareandengagewithourpatients,partners,andotherstakeholderssothatwemayfullyrealizeourvision,missionandcommitmenttocaringpledge.Qualityassuranceperformanceimprovement,qualityassessmentassurance,performanceimprovementhasbeenalong-standingpracticeinourcompany,beginningin2015wewillimplementastandardizedQAPIprogramwithconsistentelementsacrossallbusinesslineswhichsupportsthePruittHealthModelofCareandcross-sectorpartnerships,includinghospitals.In the implementationofQAPIwecontinue tobeinnovatorsandpush the boundariesinthedeliveryofcareinthepost-acuteandlong-termcaresector.Indoingsowewillbechangeagentswhoarerelentlessinmakingthingshappen;throughoutour-organizationofpeople,sitesofcare,andintheutilizationofresources,includingtechnology,todeliverhealthcareservicestomeetthehealthneedsofourtargetpopulation.

Commitmentto Caring

AtPruittHealthCorporation,werecognize theinherent valueof the individual.Wearecommittedto providingthehighestqualityhealthcarewhilefosteringrelationshipsgroundedinrespect,opencommunication andprofessionalismwithourpatients,residents,clientsandcommunities.Our customers'loyalty speaksforitselfasweexceedexpectationsat thehighestlevelanddevelopenduringrelationships.

Forouremployee-partners,wecommit to cherishingperformanceexcellencethroughcontinuingprofessionaldevelopment.Werewardteamworkandempower thosethatadvocatefor andcontributetoqualitycareandservices.

Wecommit to upholding a culturethatcontinuouslyfosterscaring,fairnessandrespect.

Our Mission

Ourfamily,your family,ONEFAMILY.Committed toloving,givingandcaring.Unitedinmakinga difference.

Our Vision

Tobeinnovatorsin aseamlessandsuperiorhealthdelivery systemin thecommunities weserve.

CoreValues

Quality ofExpertise,QualityofCare,Quality ofServices,Quality ofLife

PruittHealthHistory

ALeaderin HealthCare

Forover45years,PruittHealthhasensuredthepeaceandmindofitspatients,residents,clientsandtheir familiesthroughitscommitmenttoqualityhealthcare.

PruittHealthisasoutheastregionalleaderinlong-term healthcare.Sinceitsinceptionin1969astheToccoa NursingCenter, the PruittHealthcommunity ofserviceshasgrown to encompassmorethan90post-acute,skillednursingandassistedlivinglocations,as wellasanarrayofsupplementaryresources,includinghomehealthcare,end-of-lifecare,rehabilitation,veterancareandconsultativepharmaceuticalservices.PruittHealthalsooffersavariety ofbusiness-to-businessservices.

AtPruittHealth,weunderstandourcustomers'needsmaychange over time.Tomanagethesechanges,wehavedeveloped a continuum ofservicesallowingpatientstoreceive thecaretheyneedwithin the samefamilyofproviders.Usingtheknowledgeandexperiencewe'vehonedoverfour decades,weanticipatethe needs ofpatientsand havesetinplacebestpracticestoensureourpatients receive the bestqualitycare. Our staffprovidesthe care, loveandprofessionalism thathavebeenpartofPruittHealthsinceourbeginning.

PruittHealthservescommunitiesinGeorgia,NorthCarolina,SouthCarolinaandFlorida,andourcommitment tocaringcontinuesto expandinbothcareofferingsandgeographicregions.

ThefiveelementsthatserveasthecoreofQAPI.These elementsinteractwitheachotherwithout firm linesor boundariesbetweenthem.

DesignandScope

SystematicAnalysisandSystemicAction

GovernanceandLeadership

PerformanceImprovementProjects(PIPs)

Feedback,DataSystemsandMonitoring

PruittHealthGuidingPrinciplesQAPI

  • PruittHealthmission,vision,andcore values,createsthefoundationfororganizationalQAPIperformance.
  • PruittHealthusesqualityassuranceandperformanceimprovement tomake

decisionsandguideour day-to-dayoperation. (Inestablishing thesystemweremaincognizantthatQAPIis notaprogram;rather,itisthe waywedoourwork.)

  • PruittHealthQAPIincludesallbusinesslines,partners,alldepartments andall

services.

  • QAPIis comprehensiveregardingsystemsofcare,managementpractices,andbusinesspractices.
  • PruittHealthQAPIisdata-drivenandisguidedbyour fiveperformance improvementpillars:People,Service,Quality,Finance,andGrowthand therespectivebusinessdriversineachperformanceimprovementpillar.
  • PruittHealthQAPIdecisionsarebasedondata,whichiscollectedin asystematicformatinalignmentwithourinfrastructure andaggregatedonPruittHealthConnectDashboard.
  • PruittHealthsetsannualgoalsfor performance andmeasuresprogress towardthesegoals.
  • PruittHealthsupportsQAPIthroughtheconceptofteam management,andencouragingour partnerstosupporteachother andbeaccountablefor theirprofessionalperformanceandpractice.
  • PruittHealthfocusesonsystemsandprocesses,rather than individuals. Theemphasisis onidentifyingsystemgapsandcorrectingthem rather thanon blamingindividuals.
  • PruittHealthsetshighexpectationsforethicalpracticethroughtheCodeofConduct

and arigorouscomplianceprogram.

I.LeadershipResponsibilityAccountability

It istheexpectation ofPruittHealthQAPIsystem thateachbusiness linewillestablishaQAPIprocessthatguidesanddirectsthe operationsofeachcenter,officeor agency.The executiveleadershipofeachbusinesslinesetsthe expectationand providestheresourcesforimplementation. EachbusinesslineestablishesaQAPI committee(steeringcommittee)—thesteeringcommittee hasoverallresponsibilityto developandmodifytheir respectiveQAPIplan,review information,andsetprioritiesfor performanceimprovementprojects(PIPs). AQAPI committeewillbeestablishedateachlevelofthebusinessline—center/office/agency,region,division.The executiveleadershipteam(ELT)ofPruittHealth willactas theexecutiveQAPIteam.The steeringcommitteechartersteamsto workonparticularproblemsand/or implementationofnew programs,initiative’s,projects. Essential tothesuccess ofeachQAPIsteeringcommitteeistheintegrationofinformationfrom stakeholders,atalllevelsoftheorganization.

Stakeholdersincludeemployees/partners,patients,families,physicians,andothersasappropriate.The processalsosupportsstrongbusiness-to-businessrelatedandnon-relatedcommunicationsgroundedinthePruittHealthModelofCare. QAPIinformationflowisastandardizedprocess;informationfocusesonbusinesspractice,policiesandprocedures,businessdriversandkeyperformanceindicators. Quality(QAPI)informationflowsupanddown the organizationinanorganizedformat. PruittHealthculturesupports the philosophy that,knowledgeissharedandinformationflowsfreely.Ifyouthinkanissue,statement,orconcern shouldbecommunicated totheQAPIteam/steeringcommittee,thencommunicateandaskforassistanceand/orguidance.

II.Scope

PruittHealthQAPIsystemisongoingandcomprehensive;all facets ofcareandservicesofferedbythe organizationateachleveloftheorganization(center,office,agency,region,division,andenterprise)including thefullrangeofindividualdepartmentsareincluded.QAPIaddressesallsystemsofcareandmanagementpracticesand alwaysincludesour“coreproducts”:clinicalcare,quality oflife,patientchoiceandcaretransition.ThescopeofPruittHealth QAPI isfurtherdefinedbytheFivePerformanceImprovementPillarsofExcellence(adoptedfromHARDWIRINGEXCELLENCE,authorQuintStuder).ThefivePerformanceimprovementpillarsprovide thefoundationforsettingPruittHealthgoalsfor organizationexcellence.

ServiceHHC / QualityHHC / PeopleHHC / FinanceHHC / GrowthHHC
Customer
ServicesCalls
CustomerNetPromoterScore
PatientEvents
GreenSweep
SurveyOutcomes(Readiness,Annual,Complaints)
Resident
AssessmentInstrument(RAI)
DataIntegrityAssessment
CallBell
Monitoring
NewPolicyImplementation / CareAmbassador
Program
CareTransitions
Rehospitalizations
Antipsychotics
Quality Measures
FiveStar(survey,qualitymetrics,staffing)
Checklist/systemsoverview/trends(Clinical,Environmental,ClinicalReimbursement,Operations,Pharmacy)
Abaqis/Quality ofLife
ProcessMeasure / Turnover
PartnerNetPromoterScore
Required
Training
Staffing
Trends
24/7 RN
Coverage
ConsistentAssignments / PerformanceNetIncome
NetIncome
Cash Velocity
Medicaid
Pending
DCG Accounts
RateAnalysis / Financial
Results(PNI)
Census
Trending(Total/Skilled
/Quality)
Startsof Care
RadarReview
CompetitiveAnalysis
ServiceHH / QualityHH / PeopleHH / FinanceHH / GrowthHH
Improve
CustomerNetPromoterScoreby3%
Achieve
Budgeted QualityRevenueby 3%
Maintain
ComplianceScoreof0% / ImproveHomeHealthReadmissionsby5%
IncreaseHomeHealthImprovementinAmbulation by 5%
Oasis/POCdataintegrity / ImprovePartnerNetPromoterScoreby 3%
Improve
TurnoverRateby3%
Achieve90%ofRequiredTraining
AdministratorDHS Turnover
Required
Training 90% / Achieve100%ofBudgeted NetIncome
Achieve100%ofBudgetedPerformanceNetIncome
Maintain CashVelocityof99.5% / MeetTotalBudgetedCensus of100%
MeetTotalBudgeted SOCsof 100%
ServiceHomeFirst / QualityHomeFirst / PeopleHomeFirst / FinanceHomeFirst / GrowthHomeFirst
Improve
CustomerNetPromoterScoreby3%
Achieve
Budgeted QualityRevenue0f57.51%
Maintain
RevenueatRiskof 0% / IncreaseLevelofCareAdmissionsand Re-EvaluationApprovalsby3%.
Process/ChecklistScoreabove90% / ImprovePartnerNetPromoterScoreby 3%
Improve
TurnoverRateby3%
Achieve90%ofRequiredTraining / Achieve100%ofBudgeted NetIncome
Achieve100%ofBudgetedPerformanceNetIncome
Maintain CashVelocityof99.5% / MeetTotalBudgetedCensus of100%
IncreaseLevelof CareAdmissionsandReevaluationsApprovals
ServiceHospice / QualityHospice / PeopleHospice / FinanceHospice / GrowthHospice
Improve
CustomerNetPromoterScoreby3%
Achieve
Budgeted QualityRevenueby 3%
Maintain
ComplianceScoreof0% / ImprovePainManagementby3%
IncreasePercentof CommunityPatientsServed by3%
PointofCareDataIntegrity
HospiceItemSetnoofficeabovenationalaverage
QualityChecklist90%
AVPChecklist90% / ImprovePartnerNetPromoterScoreby 3%
Improve
TurnoverRateby3%
Achieve90%ofRequiredTraining
AdministratorDHS Turnover / Achieve100%ofBudgeted NetIncome
Achieve100%ofBudgetedPerformanceNetIncome
Maintain CashVelocityof99.5% / MeetTotalBudgetedCensus of100%
ServicePharmacy / QualityPharmacy / PeoplePharmacy / FinancePharmacy / GrowthPharmacy
Off-label
AntipsychoticsST/LS Improveby3%
CustomerNetPromoterScore / OrderFulfillmentRate
SupportHCCtoachieveProcessScoreof90% / ImprovePartnerNetPromoterScoreby 3%
Improve
TurnoverRateby3%
Achieve90%ofRequiredTraining / PartARxPPDCosts
Recoupments
Achieve100%ofBudgetNetIncome
Achieve 100%PNI
Maintain TargetCash Velocity of99.50% / PercentQualityRevenue—AchieveBudgetof94.62%

Thefiveperformanceimprovementpillarmodeldefinesthestandards andtherespectivegoalsinrelationto performanceexcellenceineachbusinessline fortheorganization.Thegoalsforperformanceareresetannuallybythe cross-functionalstandards teams/committee(s)oftheorganization.

PruittHealth’sQAPIsteeringcommitteemodelincludes:afinancial,clinical/operationsandcustomer servicecross-functionalstandardscommittee.Thestandardscommitteeisoneofmostimportantcomponentsof thecontinuous improvementandcontinuouslearningenvironmentatPruittHealth. Thecommitteeacting,asa committeeof thewholeorasfurthersub-dividedintofunctionalareas,ensures thattheorganizationisawareofchangesinstandards or regulations.Thecommittee(s)mayrecommendperformancestandard changesintheformofadditions,deletions,orenhancementstopolicies,procedures,guidelines,checklist/scoringguidelines.

Recommendationsfornewormodifiedperformancestandards embody PruittHealth vision,mission,core valuesand thephilosophyofcommittedtocaring. Anyperformancestandardrecommendations madebycommittee(s)mustincludea:statementofimpactontheorganization,desired goalofthestandardand,ifappropriate,howthestandardwillbemeasured.Newor modifiedstandardsmustincludestrategiesforimplementation,trainingofpartners,andoversightprotocol.Thecommitteewillalsodeveloptoolsandrolloutstrategiestoensuretheemployee-partnersfullyunderstandandlivebythesestandards.

II.III.Feedback,Data Systems,andMonitoring

PruittHealthQAPIutilizesarobustsystemofdatacollection, thedataare collectedanddisplayedonPruittHealthConnect, the dataareupdateddaily atmidnight---datasourcesarealsoupdatedasmadeavailableon a daily,weekly,monthly,annualbasisspecifictoeachdatasource.Thedashboardismade available tokeyleaderswithin the organization,aspartoftheirroleontheQAPI committee,includingadministrators,directors ofclinicalservicesineachbusinessline.

Thedashboardservesasakeysourceofdata used forthemonthlyQAPImeeting.ThedataareanalyzedagainstPruittHealthstandardsofperformanceandannualtargetsestablishedforeachmetric.Standardsarereviewedbythe respectivestandardscommittees. Additionaldatacollectionincludesin-depthreviewofunscheduleddatasourcessuchas annualandcomplaintsurveys,committedtocaringhotlinecalls,(callsaredistributedtoallkeyleaderswhenreceivedfor promptservicerecoveryandanin-depth review/analysisiscompletedmonthlyanddistributedtoleadershipfrom theregionlevelupto the executivemanagement).IncludedasprocessmeasuresonthePruittHealthConnectDashboardare“checklist” completedquarterlybyfieldsupportstaffwhichsupport the individualbusinessunits.

  • Goalsfor systemschecklist,whichaggregatesatthebusinessunit,region,divisionandexecutivelevel,completioninclude:
  • Ensuringconsistent/predictableservicedelivery;
  • Serveasa checkonquality,whichflowsfromthebusinessunit tothe executiveteam;
  • Assureongoingcompliancewithregulatoryrequirements;
  • Supportsarobustcomplianceprogram.
  • Thechecklistareusedtocollectandsynthesizedatawhichlinksto expectedoutcomes:
  • ClinicalOutcomes
  • CustomerSatisfaction
  • CompanyStandards
  • RevenueGrowth/Stability
  • Additionalbenefitsinclude:
  • Determinecenter,region,division,corporatetrends;
  • Monitoranddocumentservicedeliverytrends;
  • Identificationofimprovementopportunities(OFI).

IV.SystematicAnalysis andSystemicAction

PruittHealthusesasystematicapproachtodeterminewhenin-depthanalysisisneededfor identifyingcontributingcausalfactorsthatunderlievariationsinperformance.Thisstructuredmethod ofanalysisisdesignedtogetto the underlyingcauseofaproblem—whichthenleadstoidentificationofeffectiveinterventionstomakeimprovements. Itisthegoal of the organization tousethemanyand varioussources ofdata(PruittHealthConnect) todoearly andongoingreview to proactivelyidentifyincrementalchangeinexpectedoutcomes.Thegoal ofearlyinterventionbalancedagainsttargetedgoalsandoutcomes,ensures consistentdelivery incareandbusinessoutcomes.

Unexpected/unanticipatedprocessfailuresoroutcomesareevaluated todeterminethe“rootcause” (RCA).

PruittHealthusesseveraldifferentmethodsfor rootcause analysis. Thefishbonediagramisusedto exploreanddisplaythepotentialrootcausesof a specific problemorcondition.When identifyingpossiblerootcauses,itishelpfulto askwhy(FiveWhys)eachoneexists. Asking“WHY”isnecessary andrecommended todiscover thetruerootcause(s).Documentingcausesonthe diagram,ishelpfulto understandthe

underlying: gapsinsystemsorprocesses;andidentifyprocesses/systemsthatneedimprovement. Using therootcause(s) willdetermineproceduresneededorsystemicchangesnecessarytoensurethatimprovementis achieved.

V.Performance ImprovementProjects (PIPs)

Prioritizingopportunitiesfor improvementsisanimportant stepinthe processofdata-drivenmanagementandoftranslatingdataintoinformationusedfor action.

PruittHealth’simplementationstrategy usesourstrategicframework,businessdriversandkeyperformanceindicatorsandincludes:

  • Identificationofproblems/opportunitiesforimprovement(OFI)and/orissuesthatareconsideredimportant(consider isthe issuehighrisk,highfrequency).
  • Considerationofwhichproblemsshouldbecomethefocus ofa performanceimprovementproject(PIP).
  • Considerationofallidentifiedproblems whichneedattentionandcorrection—butdonotneed/require aPIP.(Justdoit!OrLowHangingFruit)
  • Developmentofimprovementprojectcharterorscopeofwork.Aperforamnceimprovementprojectismorethana casualeffort—itrequiresaspecificwrittenmission to lookintotheproblemarea.ThePIteamincludespeoplein a positionto explore theproblem,includingifappropriate,directcaregivers.
  • Developingthescope ofworkandcharteringindicates that theteam hasa specific missionandthat theteam willreportbacktothe steeringcommitteeatdefined intervals.PruittHealthstatusreportingandbluesheetwillbeusedfor thisstepinthe project(bluesheetfor requireddecisionsbythe executiveleadershipteam).This step addsstrength,importance,andformalityto the PruittHealthperformance improvementprocess.The scopeofwork/charterincludes:
  • Designationofteam/projectleader andteam members;
  • A description oftheprojectand briefbackground –specifya newprogramorinresponsetonewstandard,regulations,etc.and/orperformance improvementprojectsecondaryto failure tomeetexpectedoutcomesorgoals;
  • Project/PIPtimeline.
  • Descriptionofactualtaskwhich the projectwillrequire;
  • Kickoff-Listtask
  • DesignPhase-Listtask
  • DevelopmentPhase-ListTask
  • ProjectTimelineMilestones
  • ImplementationPhase-Listtask
  • TrainingPhase-Listtask
  • ProjectHandoff/Closure-ListTask

References

CentersforMedicareandMedicaidService,StratisHealth,University ofMinnesota,QAPI TechnicalExpertPanel,(2013)QAPIAt AGlanceGuideforDeveloping a QAPIPlan.

AmericanHealthCareAssociation,QualityCabinet, (2013)ImplementingQAPI—TheTwelveActionSteps.

Pelletier,L,Beaudin,C,((2008) EssentialResourcesfor theHealthcareQualityProfessional, NationalAssociationforHealthcareQuality.

Studer,Q. (2003)HardwiringExcellence,StuderGroup.

Langley,G.,Moen,R.,Nolan,K.,Nolan,T.,Norman,C.Provost,L., (2009)TheImprovementGuide, A PracticalApproachto EnhancingOrganizationalPerformance.Jossey-Bass

Wikipedia, thefree encyclopedia,(2013)SystemsThinking,1.The ConceptofaSystem,

2.TheSystems Approach.